This document includes Senate 3rd Reading Floor Amendments incorporated into the bill on Fri, Feb 1, 2019 at 12:47 PM by lpoole.
This document includes House Floor Amendments incorporated into the bill on Thu, Feb 14, 2019 at 11:51 AM by pflowers.
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7 LONG TITLE
8 General Description:
9 This bill makes changes to the Medicaid adult dental services waiver program.
10 Highlighted Provisions:
11 This bill:
12 ▸ directs the Department of Health to apply for a waiver from the federal government
13 to:
14 • expand Medicaid dental coverage to elderly Medicaid patients; and
15 • provide coverage for porcelain and porcelain-to-metal crowns to certain
16 Medicaid patients; and
17 ▸ adds the University of Utah School of Dentistry's associated statewide network to
18 the list of providers for adult dental services in the Medicaid program.
19 Money Appropriated in this Bill:
20 None
21 Other Special Clauses:
22 None
23 Utah Code Sections Affected:
24 AMENDS:
25 26-18-413, as last amended by Laws of Utah 2018, Chapter 78
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27 Be it enacted by the Legislature of the state of Utah:
28 Section 1. Section 26-18-413 is amended to read:
29 26-18-413. Medicaid waiver for delivery of adult dental services.
30 (1) (a) Before June 30, 2016, the department shall ask the United States Secretary of
31 Health and Human Services to grant waivers from federal statutory and regulatory law
32 necessary for the Medicaid program to provide dental services in the manner described in
33 Subsection (2)(a).
34 (b) Before June 30, 2018, the department shall submit to the Centers for Medicare and
35 Medicaid Services a request for waivers, or an amendment of existing waivers, from federal
36 law necessary for the state to provide dental services, in accordance with Subsections (2)(b)(i)
37 and (d) through (g), to an individual described in Subsection (2)(b)(i).
38 (c) Before June 30, 2019, the department shall submit to the Centers for Medicare and
39 Medicaid Services a request for waivers, or an amendment to existing waivers, from federal
40 law necessary for the state to:
41 (i) provide dental services, in accordance with Subsections (2)(b)(ii) and (d) through
42 (g) to an individual described in Subsection (2)(b)(ii); and
43 (ii) provide the services described in Subsection (2)(h).
44 (2) (a) To the extent funded, the department shall provide services to only blind or
45 disabled individuals, as defined in 42 U.S.C. Sec. 1382c(a)(1), who are 18 years old or older
46 and eligible for the program.
47 (b) Notwithstanding Subsection (2)(a)[
48 (i) if a waiver is approved under Subsection (1)(b), the department shall provide dental
49 services to an individual who:
50 [
51 26-18-411; and
52 [
53 Section 62A-2-101, licensed under Title 62A, Chapter 2, Licensure of Programs and
54 Facilities[
55 (ii) if a waiver is approved under Subsection (1)(c)(i), the department shall provide
56 dental services to an individual who is an aged individual as defined in 42 U.S.C. Sec.
57 1382c(a)(1).
58 (c) To the extent possible, services to individuals described in Subsection (2)(a)
59 [
60 and the University of Utah School of Dentistry's associated statewide network.
61 (d) The department shall provide the services to individuals described in Subsection
62 (2)(b):
63 (i) by contracting with an entity that:
64 (A) has demonstrated experience working with individuals who are being treated for
65 both a substance use disorder and a major oral health disease;
66 (B) operates a program, targeted at the individuals described in Subsection (2)(b), that
67 has demonstrated, through a peer-reviewed evaluation, the effectiveness of providing dental
68 treatment to those individuals described in Subsection (2)(b);
69 (C) is willing to pay for an amount equal to the program's non-federal share of the cost
70 of providing dental services to the population described in Subsection (2)(b); and
71 (D) is willing to pay all state costs associated with applying for the waiver described in
72 Subsection (1)(b) and administering the program described in Subsection (2)(b); and
73 (ii) through a fee-for-service payment model.
74 (e) The entity that receives the contract under Subsection (2)(d)(i) shall cover all state
75 costs of the program described in Subsection (2)(b).
76 (f) Each fiscal year, the University of Utah School of Dentistry shall transfer money to
77 the program in an amount equal to the program's non-federal share of the cost of providing
78 services under this section through the school during the fiscal year.
79 (g) During each general session of the Legislature, the department shall report to the
80 Social Services Appropriations Subcommittee whether the University of Utah School of
81 Dentistry will have sufficient funds to make the transfer required by Subsection (2)(f) for the
82 current fiscal year.
83 (h) If a waiver is approved under Subsection (1)(c)(ii), the department shall provide
84 coverage for porcelain and porcelain-to-metal crowns if the services are provided:
85 (i) to an individual who qualifies for dental services under Ĥ→ [
85a (2)(b) ←Ĥ ; and
86 (ii) by an entity that covers all state costs of Ŝ→ :
86a (A) providing ←Ŝ the coverage described in this Subsection
87 (2)(h) Ŝ→ [
87a (B) applying for the waiver described in Subsection (1)(c)(ii). ←Ŝ
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89 Subsection (2)(a) that are not provided by the University of Utah School of Dentistry or the
90 University of Utah School of Dentistry's associated network are provided:
91 (i) through fee for service reimbursement until July 1, 2018; and
92 (ii) after July 1, 2018, through the method of reimbursement used by the division for
93 Medicaid dental benefits.
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95 department, the scope, amount, duration, and frequency of services may be limited.
96 (3) The reporting requirements of Section 26-18-3 apply to the waivers requested under
97 Subsection (1).
98 (4) (a) If the waivers requested under Subsection (1)(a) are granted, the Medicaid
99 program shall begin providing dental services in the manner described in Subsection (2) no
100 later than July 1, 2017.
101 (b) If the waivers requested under Subsection (1)(b) are granted, the Medicaid program
102 shall begin providing dental services to the population described in Subsection (2)(b) within 90
103 days from the day on which the waivers are granted.
104 (c) If the waivers requested under Subsection (1)(c)(i) are granted, the Medicaid
105 program shall begin providing dental services to the population described in Subsection
106 (2)(b)(ii) within 90 days after the day on which the waivers are granted.
107 (5) If the federal share of the cost of providing dental services under this section will be
108 less than 65% during any portion of the next fiscal year, the Medicaid program shall cease
109 providing dental services under this section no later than the end of the current fiscal year.