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7 LONG TITLE
8 General Description:
9 This bill amends the Medical Assistance Act.
10 Highlighted Provisions:
11 This bill:
12 ▸ requires the Department of Health and Human Services to request authorization to
13 provide dental services to Medicaid-eligible adults not already eligible for dental
14 services; and
15 ▸ makes technical amendments.
16 Money Appropriated in this Bill:
17 None
18 Other Special Clauses:
19 None
20 Utah Code Sections Affected:
21 AMENDS:
22 26-18-413, as last amended by Laws of Utah 2020, Chapter 225
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24 Be it enacted by the Legislature of the state of Utah:
25 Section 1. Section 26-18-413 is amended to read:
26 26-18-413. Medicaid waiver for delivery of adult dental services.
27 (1) (a) Before June 30, 2016, the department shall ask CMS to grant waivers from
28 federal statutory and regulatory law necessary for the Medicaid program to provide dental
29 services in the manner described in Subsection (2)(a).
30 (b) Before June 30, 2018, the department shall submit to CMS a request for waivers, or
31 an amendment of existing waivers, from federal law necessary for the state to provide dental
32 services, in accordance with Subsections (2)(b)(i) and (d) through [
33 described in Subsection (2)(b)(i).
34 (c) Before June 30, 2019, the department shall submit to [
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36 federal law necessary for the state to:
37 (i) provide dental services, in accordance with Subsections (2)(b)(ii) and (d) through
38 [
39 (ii) provide the services described in Subsection [
40 (d) On or before January 1, 2024, the department shall submit to CMS a request for
41 waivers, or an amendment of existing waivers, from federal law necessary for the state to
42 provide dental services, in accordance with Subsections (2)(b)(iii) and (d) through (f), to an
43 individual described in Subsection (2)(b)(iii).
44 (2) (a) To the extent funded, the department shall provide dental services to only blind
45 or 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 (A) qualifies for the health coverage improvement program described in Section
51 26-18-411; and
52 (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 Facilities;
54 [
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 (iii) if a waiver is approved under Subsection (1)(d), the department shall provide
59 dental services to an individual who is:
60 (A) not described in Subsection (2)(a);
61 (B) not described in Subsection (2)(b)(i);
62 (C) not described in Subsection (2)(b)(ii);
63 (D) not pregnant;
64 (E) 21 years old or older; and
65 (F) eligible for full services through the Medicaid program.
66 (c) To the extent possible, services to individuals described in Subsection (2)(a) shall
67 be provided through the University of Utah School of Dentistry and the University of Utah
68 School of Dentistry's associated statewide network.
69 (d) The department shall provide the services to individuals described in Subsection
70 (2)(b):
71 (i) by contracting with an entity that:
72 (A) has demonstrated experience working with individuals who are being treated for
73 both a substance use disorder and a major oral health disease;
74 (B) operates a program, targeted at the individuals described in Subsection (2)(b), that
75 has demonstrated, through a peer-reviewed evaluation, the effectiveness of providing dental
76 treatment to those individuals described in Subsection (2)(b);
77 (C) is willing to pay for an amount equal to the program's non-federal share of the cost
78 of providing dental services to the population described in Subsection (2)(b); and
79 (D) is willing to pay all state costs associated with applying for the waiver described in
80 Subsection (1)(b) and administering the program described in Subsection (2)(b); and
81 (ii) through a fee-for-service payment model.
82 (e) The entity that receives the contract under Subsection (2)(d)(i) shall cover all state
83 costs of the program described in Subsection (2)(b).
84 (f) Each fiscal year, the University of Utah School of Dentistry shall, in compliance
85 with state and federal regulations regarding intergovernmental transfers, transfer funds to the
86 program in an amount equal to the program's non-federal share of the cost of providing services
87 under this section through the school during the fiscal year.
88 (g) If a waiver is approved under Subsection (1)(c)(ii), the department shall provide
89 coverage for porcelain and porcelain-to-metal crowns if the services are provided:
90 (i) to an individual who qualifies for dental services under Subsection (2)(b); and
91 (ii) by an entity that covers all state costs of:
92 (A) providing the coverage described in this Subsection [
93 (B) applying for the waiver described in Subsection (1)(c).
94 (h) Where possible, the department shall ensure that dental services described in
95 Subsection (2)(a) that are not provided by the University of Utah School of Dentistry or the
96 University of Utah School of Dentistry's associated network are provided:
97 (i) through [
98 (ii) after July 1, 2018, through the method of reimbursement used by the division for
99 Medicaid dental benefits.
100 (i) Subject to appropriations by the Legislature, and as determined by the department,
101 the scope, amount, duration, and frequency of services provided under this section may be
102 limited.
103 (3) (a) If the waivers requested under Subsection (1)(a) are granted, the Medicaid
104 program shall begin providing dental services in the manner described in Subsection (2) no
105 later than July 1, 2017.
106 (b) If the waivers requested under Subsection (1)(b) are granted, the Medicaid program
107 shall begin providing dental services to the population described in Subsection (2)(b) within 90
108 days from the day on which the waivers are granted.
109 (c) If the waivers requested under Subsection (1)(c)(i) are granted, the Medicaid
110 program shall begin providing dental services to the population described in Subsection
111 (2)(b)(ii) within 90 days after the day on which the waivers are granted.
112 (d) If the waivers requested under Subsection (1)(d) are granted, the Medicaid program
113 shall begin providing dental services to the population described in Subsection (2)(b)(iii)
114 within 90 days after the day on which the waivers are granted.
115 (4) If the federal share of the cost of providing dental services under this section will be
116 less than [
117 providing dental services under this section no later than the end of the current fiscal year.