This document includes Senate Committee Amendments incorporated into the bill on Fri, Jan 29, 2021 at 11:54 AM by lpoole.
1     
DENTAL HYGIENIST AMENDMENTS

2     
2021 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: Todd D. Weiler

5     
House Sponsor: V. Lowry Snow

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 2020, Chapter 225
26          63I-1-226, as last amended by Laws of Utah 2020, Chapters 19, 154, 172, 181, 221,
27     232, 303, 347, and 429

28     

29     Be it enacted by the Legislature of the state of Utah:
30          Section 1. Section 26-18-2.6 is amended to read:
31          26-18-2.6. Dental benefits.
32          (1) (a) Except as provided in Subsection (8), the division may establish a competitive
33     bid process to bid out Medicaid dental benefits under this chapter.
34          (b) The division may bid out the Medicaid dental benefits separately from other
35     program benefits.
36          (2) The division shall use the following criteria to evaluate dental bids:
37          (a) ability to manage dental expenses;
38          (b) proven ability to handle dental insurance;
39          (c) efficiency of claim paying procedures;
40          (d) provider contracting, discounts, and adequacy of network; and
41          (e) other criteria established by the department.
42          (3) The division shall request bids for the program's benefits at least once every five
43     years.
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 a request for proposal or a contract that results from a request
54     for proposal described in Subsection (6)(a), the division shall report to the Health and Human
55     Services Interim Committee regarding the 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.
71          (d) The division shall evaluate the pilot program's effect on the cost of dental care and
72     access to dental care for the targeted Medicaid populations.
73          (9) (a) As used in this Subsection (9), "dental hygienist" means an individual who is
74     licensed as a dental hygienist under Section 58-69-301.
75          (b) The department shall reimburse a dental hygienist Ŝ→ for dental services performed in
75a     a public health setting and ←Ŝ in accordance with Subsection
76     (9)(c) beginning on the earlier of:
77          (i) January 1, 2023; or
78          (ii) 30 days after the date on which the replacement of the department's Medicaid
79     Management Information System software is complete.
80          (c) The department shall reimburse a dental hygienist directly for a service provided
81     through the Medicaid program if:
82          (i) the dental hygienist requests to be reimbursed directly; and
83          (ii) the dental hygienist provides the service within the scope of practice described in
84     Section 58-69-801.
85          (d) Before November 30 of each year in which the department reimburses dental
86     hygienists in accordance with Subsection (9)(c), the department shall report to the Health and
87     Human Services Interim Committee, for the previous fiscal year:
88          (i) the number and geographic distribution of dental hygienists who requested to be
89     reimbursed directly;

90          (ii) the total number of Medicaid enrollees who were served by a dental hygienist who
91     were reimbursed under this Subsection (9); Ŝ→ [
and] ←Ŝ
92          (iii) the total amount reimbursed directly to dental hygienists under this Subsection (9) Ŝ→
92a     [
.] ;
92b      (iv) the specific services and billing codes that are reimbursed under this Subsection (9); and
92c      (v) the aggregate amount reimbursed for each service and billing code described in Subsection
92d     (9)(d)(iv).
92e      (e) (i) Except as provided in this Subsection (9), nothing in this Subsection (9) shall be
92f     interpreted as expanding or otherwise altering the limitations and scope of practice for a
92g     dental hygienist.
92h      (ii) A dental hygienist may only directly bill and receive compensation for billing codes that
92i     fall within the scope of practice of a dental hygienist. ←Ŝ
93          Section 2. Section 63I-1-226 is amended to read:
94          63I-1-226. Repeal dates, Title 26.
95          (1) Subsection 26-1-7(1)(f), related to the Residential Child Care Licensing Advisory
96     Committee, is repealed July 1, 2024.
97          (2) Subsection 26-1-7(1)(h), related to the Primary Care Grant Committee, is repealed
98     July 1, 2025.
99          (3) Section 26-1-7.5, which creates the Utah Health Advisory Council, is repealed July
100     1, 2025.
101          (4) Section 26-1-40 is repealed July 1, 2022.
102          (5) Section 26-1-41 is repealed July 1, 2026.
103          (6) Section 26-7-10 is repealed July 1, 2025.
104          (7) Subsection 26-7-11(5), regarding reports to the Legislature, is repealed July 1,
105     2028.
106          (8) Section 26-7-14 is repealed December 31, 2027.
107          (9) Title 26, Chapter 9f, Utah Digital Health Service Commission Act, is repealed July
108     1, 2025.
109          (10) Subsection 26-10-6(5), which creates the Newborn Hearing Screening Committee,
110     is repealed July 1, 2026.
111          (11) Section 26-10-11 is repealed July 1, 2025.
112          (12) Section 26-10b-106, which creates the Primary Care Grant Committee, is repealed
113     July 1, 2025.
114          (13) Subsection 26-18-2.6(9), which addresses reimbursement for dental hygienists, is
115     repealed July 1, 2028.
116          [(13)] (14) Title 26, Chapter 18, Part 2, Drug Utilization Review Board, is repealed
117     July 1, 2027.
118          [(14) Subsection 26-18-417(3) relating to a report to the Health and Human services
119     Interim Committee is repealed July 1, 2020.]
120          (15) Subsection 26-18-418(2), the language that states "and the Behavioral Health

121     Crisis Response Commission created in Section 63C-18-202" is repealed July 1, 2023.
122          (16) Title 26, Chapter 18a, Kurt Oscarson Children's Organ Transplant Coordinating
123     Committee, is repealed July 1, 2021.
124          (17) Section 26-33a-117 is repealed on December 31, 2023.
125          (18) Title 26, Chapter 33a, Utah Health Data Authority Act, is repealed July 1, 2024.
126          (19) Title 26, Chapter 36b, Inpatient Hospital Assessment Act, is repealed July 1,
127     2024.
128          (20) Title 26, Chapter 36c, Medicaid Expansion Hospital Assessment Act, is repealed
129     July 1, 2024.
130          (21) Title 26, Chapter 36d, Hospital Provider Assessment Act, is repealed July 1, 2024.
131          (22) Section 26-39-201, which creates the Residential Child Care Licensing Advisory
132     Committee, is repealed July 1, 2024.
133          (23) Section 26-40-104, which creates the Utah Children's Health Insurance Program
134     Advisory Council, is repealed July 1, 2025.
135          (24) Section 26-50-202, which creates the Traumatic Brain Injury Advisory
136     Committee, is repealed July 1, 2025.
137          (25) Title 26, Chapter 54, Spinal Cord and Brain Injury Rehabilitation Fund and
138     Pediatric Neuro-Rehabilitation Fund, is repealed January 1, 2025.
139          (26) Title 26, Chapter 63, Nurse Home Visiting Pay-for-Success Program, is repealed
140     July 1, 2026.
141          (27) Title 26, Chapter 66, Early Childhood Utah Advisory Council, is repealed July 1,
142     2026.