1     
MEDICAID DENTAL COVERAGE AMENDMENTS

2     
2019 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: Allen M. Christensen

5     
House Sponsor: Steve Eliason

6     

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
26     

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          [(i)] (A) qualifies for the health coverage improvement program described in Section
51     26-18-411; and
52          [(ii)] (B) is receiving treatment in a substance abuse treatment program, as defined in
53     Section 62A-2-101, licensed under Title 62A, Chapter 2, Licensure of Programs and
54     Facilities[.]; and
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     [within Salt Lake County] shall be provided through the University of Utah School of Dentistry
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 Subsection (2)(b); and
86          (ii) by an entity that covers all state costs of:
87          (A) providing the coverage described in this Subsection (2)(h); and
88          (B) applying for the waiver described in Subsection (1)(c)(ii).
89          [(h)] (i) Where possible, the department shall ensure that services described in
90     Subsection (2)(a) that are not provided by the University of Utah School of Dentistry or the
91     University of Utah School of Dentistry's associated network are provided:
92          (i) through fee for service reimbursement until July 1, 2018; and
93          (ii) after July 1, 2018, through the method of reimbursement used by the division for
94     Medicaid dental benefits.
95          [(i)] (j) Subject to appropriations by the Legislature, and as determined by the
96     department, the scope, amount, duration, and frequency of services may be limited.
97          (3) The reporting requirements of Section 26-18-3 apply to the waivers requested under
98     Subsection (1).
99          (4) (a) If the waivers requested under Subsection (1)(a) are granted, the Medicaid
100     program shall begin providing dental services in the manner described in Subsection (2) no
101     later than July 1, 2017.
102          (b) If the waivers requested under Subsection (1)(b) are granted, the Medicaid program
103     shall begin providing dental services to the population described in Subsection (2)(b) within 90
104     days from the day on which the waivers are granted.
105          (c) If the waivers requested under Subsection (1)(c)(i) are granted, the Medicaid
106     program shall begin providing dental services to the population described in Subsection
107     (2)(b)(ii) within 90 days after the day on which the waivers are granted.
108          (5) If the federal share of the cost of providing dental services under this section will be
109     less than 65% during any portion of the next fiscal year, the Medicaid program shall cease
110     providing dental services under this section no later than the end of the current fiscal year.