1     
MEDICAID DENTAL WAIVER AMENDMENTS

2     
2023 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: Evan J. Vickers

5     
House Sponsor: Steve Eliason

6     

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
23     

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 [(g)] (f), to an individual
33     described in Subsection (2)(b)(i).
34          (c) Before June 30, 2019, the department shall submit to [the Centers for Medicare and
35     Medicaid Services] CMS a request for waivers, or an amendment to existing waivers, from
36     federal law necessary for the state to:
37          (i) provide dental services, in accordance with Subsections (2)(b)(ii) and (d) through
38     [(g)] (f), to an individual described in Subsection (2)(b)(ii); and
39          (ii) provide the services described in Subsection [(2)(h)] (2)(g).
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     [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)[.]; and

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 [(2)(h)] (2)(g); and
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 [fee for service] fee-for-service reimbursement until July 1, 2018; and
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 [65] 55% during any portion of the next fiscal year, the Medicaid program shall cease
117     providing dental services under this section no later than the end of the current fiscal year.