1     
DENTAL HYGIENIST AMENDMENTS

2     
2019 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: Christine F. Watkins

5     
Senate Sponsor: ____________

6     

7     LONG TITLE
8     General Description:
9          This bill enacts provisions related to Medicaid reimbursement for dental hygienists.
10     Highlighted Provisions:
11          This bill:
12          ▸     defines terms;
13          ▸     requires the Department of Health to reimburse a dental hygienist directly for
14     certain services provided through the Medicaid program;
15          ▸     creates a deadline for the department to begin reimbursing dental hygienists
16     directly;
17          ▸     creates a reporting requirement; and
18          ▸     provides a sunset date for the provisions of this bill.
19     Money Appropriated in this Bill:
20          None
21     Other Special Clauses:
22          None
23     Utah Code Sections Affected:
24     AMENDS:
25          26-18-2.6, as last amended by Laws of Utah 2017, Chapter 22
26          63I-2-226, as last amended by Laws of Utah 2018, Chapters 38 and 281
27     

28     Be it enacted by the Legislature of the state of Utah:
29          Section 1. Section 26-18-2.6 is amended to read:
30          26-18-2.6. Dental benefits -- Direct reimbursement for dental hygienists.
31          (1) (a) Except as provided in Subsection (8), the division shall establish a competitive
32     bid process to bid out Medicaid dental benefits under this chapter.
33          (b) The division may bid out the Medicaid dental benefits separately from other
34     program benefits.
35          (2) The division shall use the following criteria to evaluate dental bids:
36          (a) ability to manage dental expenses;
37          (b) proven ability to handle dental insurance;
38          (c) efficiency of claim paying procedures;
39          (d) provider contracting, discounts, and adequacy of network; and
40          (e) other criteria established by the department.
41          (3) The division shall request bids for the program's benefits:
42          (a) in 2011; and
43          (b) at least once every five years thereafter.
44          (4) The division's contract with dental plans for the program's benefits shall include
45     risk sharing provisions in which the dental plan must accept 100% of the risk for any difference
46     between the division's premium payments per client and actual dental expenditures.
47          (5) The division may not award contracts to:
48          (a) more than three responsive bidders under this section; or
49          (b) an insurer that does not have a current license in the state.
50          (6) (a) The division may cancel the request for proposals if:
51          (i) there are no responsive bidders; or
52          (ii) the division determines that accepting the bids would increase the program's costs.
53          (b) If the division cancels the request for proposals under Subsection (6)(a), the
54     division shall report to the Health and Human Services Interim Committee regarding the
55     reasons for the decision.
56          (7) Title 63G, Chapter 6a, Utah Procurement Code, shall apply to this section.
57          (8) (a) The division may:
58          (i) establish a dental health care delivery system and payment reform pilot program for
59     Medicaid dental benefits to increase access to cost effective and quality dental health care by
60     increasing the number of dentists available for Medicaid dental services; and
61          (ii) target specific Medicaid populations or geographic areas in the state.
62          (b) The pilot program shall establish compensation models for dentists and dental
63     hygienists that:
64          (i) increase access to quality, cost effective dental care; and
65          (ii) use funds from the Division of Family Health and Preparedness that are available to
66     reimburse dentists for educational loans in exchange for the dentist agreeing to serve Medicaid
67     and under-served populations.
68          (c) The division may amend the state plan and apply to the Secretary of Health and
69     Human Services for waivers or pilot programs if necessary to establish the new dental care
70     delivery and payment reform model. The division shall evaluate the pilot program's effect on
71     the cost of dental care and access to dental care for the targeted Medicaid populations.
72          (9) (a) As used in this Subsection (9), "dental hygienist" means an individual who is
73     licensed as a dental hygienist under Section 58-69-301.
74          (b) The department shall reimburse a dental hygienist in accordance with Subsection
75     (9)(c) beginning on the earlier of:
76          (i) January 1, 2022; or
77          (ii) 30 days after the date on which the replacement of the department's Medicaid
78     Management Information System software is complete.
79          (c) The department shall reimburse a dental hygienist directly for a service provided
80     through the Medicaid program if:
81          (i) the dental hygienist requests to be reimbursed directly; and
82          (ii) the dental hygienist provides the service within the scope of practice described in
83     Section 58-69-801.
84          (d) Before November 30 of each year in which the department reimburses dental
85     hygienists in accordance with Subsection (9)(c), the department shall report to the Health and
86     Human Services Interim Committee, for the previous fiscal year:
87          (i) the number and geographic distribution of dental hygienists who requested to be
88     reimbursed directly;
89          (ii) the total number of Medicaid enrollees who were served by a dental hygienist who
90     was reimbursed under this Subsection (9); and
91          (iii) the total amount reimbursed directly to dental hygienists under this Subsection (9).
92          Section 2. Section 63I-2-226 is amended to read:
93          63I-2-226. Repeal dates -- Title 26.
94          (1) Subsection 26-7-8(3) is repealed January 1, 2027.
95          [(2) Subsection 26-7-9(5) is repealed January 1, 2019.]
96          [(3)] (2) Section 26-8a-107 is repealed July 1, 2019.
97          [(4)] (3) Subsection 26-8a-203(3)(a)(i) is repealed January 1, 2023.
98          [(5)] (4) Subsection 26-18-2.3(5) is repealed January 1, 2020.
99          [(6)] (5) Subsection 26-18-2.4(3)(e) is repealed January 1, 2023.
100          (6) Subsection 26-18-2.6(9), which addresses reimbursement for dental hygienists, is
101     repealed July 1, 2027.
102          [(7) Subsection 26-18-408(6) is repealed January 2, 2019.]
103          [(8)] (7) Subsection 26-18-410(5) is repealed January 1, 2026.
104          [(9)] (8) Subsection 26-18-411(5) is repealed January 1, 2023.
105          [(10)] (9) Subsection 26-18-604(2) is repealed January 1, 2020.
106          [(11)] (10) Subsection 26-21-28(2)(b) is repealed January 1, 2021.
107          [(12)] (11) Subsection 26-33a-106.1(2)(a) is repealed January 1, 2023.
108          [(13)] (12) Subsection 26-33a-106.5(6)(c)(iii) is repealed January 1, 2020.
109          [(14)] (13) Title 26, Chapter 46, Utah Health Care Workforce Financial Assistance
110     Program, is repealed July 1, 2027.
111          [(15)] (14) Subsection 26-50-202(7)(b) is repealed January 1, 2020.
112          [(16)] (15) Subsections 26-54-103(6)(d)(ii) and (iii) are repealed January 1, 2020.
113          [(17)] (16) Subsection 26-55-107(8) is repealed January 1, 2021.
114          [(18)] (17) Subsection 26-56-103(9)(d) is repealed January 1, 2020.
115          [(19)] (18) Title 26, Chapter 59, Telehealth Pilot Program, is repealed January 1, 2020.
116          [(20)] (19) Subsection 26-61-202(4)(b) is repealed January 1, 2022.
117          [(21)] (20) Subsection 26-61-202(5) is repealed January 1, 2022.