2
3
4
5
6
7 LONG TITLE
8 Committee Note:
9 The Health and Human Services Interim Committee recommended this bill.
10 Legislative Vote: 13 voting for 0 voting against 5 absent
11 General Description:
12 This bill amends the Medical Assistance Act.
13 Highlighted Provisions:
14 This bill:
15 ▸ requires the Department of Health and Human Services to request authorization to
16 provide dental services to Medicaid-eligible adults not already eligible for dental
17 services; and
18 ▸ makes technical amendments.
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 2020, Chapter 225
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 CMS to grant waivers from
31 federal statutory and regulatory law necessary for the Medicaid program to provide dental
32 services in the manner described in Subsection (2)(a).
33 (b) Before June 30, 2018, the department shall submit to CMS a request for waivers, or
34 an amendment of existing waivers, from federal law necessary for the state to provide dental
35 services, in accordance with Subsections (2)(b)(i) and (d) through [
36 described in Subsection (2)(b)(i).
37 (c) Before June 30, 2019, the department shall submit to [
38
39 federal law necessary for the state to:
40 (i) provide dental services, in accordance with Subsections (2)(b)(ii) and (d) through
41 [
42 (ii) provide the services described in Subsection [
43 (d) On or before June 30, 2023, the department shall submit to CMS a request for
44 waivers, or an amendment of existing waivers, from federal law necessary for the state to
45 provide dental services, in accordance with Subsections (2)(b)(iii) and (d) through (f), to an
46 individual described in Subsection (2)(b)(iii).
47 (2) (a) To the extent funded, the department shall provide dental services to only blind
48 or disabled individuals, as defined in 42 U.S.C. Sec. 1382c(a)(1), who are 18 years old or older
49 and eligible for the program.
50 (b) Notwithstanding Subsection (2)(a):
51 (i) if a waiver is approved under Subsection (1)(b), the department shall provide dental
52 services to an individual who:
53 (A) qualifies for the health coverage improvement program described in Section
54 26-18-411; and
55 (B) is receiving treatment in a substance abuse treatment program, as defined in
56 Section 62A-2-101, licensed under Title 62A, Chapter 2, Licensure of Programs and Facilities;
57 [
58 (ii) if a waiver is approved under Subsection (1)(c)(i), the department shall provide
59 dental services to an individual who is an aged individual as defined in 42 U.S.C. Sec.
60 1382c(a)(1)[
61 (iii) if a waiver is approved under Subsection (1)(d), the department shall provide
62 dental services to an individual who is:
63 (A) not described in Subsection (2)(a);
64 (B) not described in Subsection (2)(b)(i);
65 (C) not described in Subsection (2)(b)(ii);
66 (D) 18 years old or older; and
67 (E) eligible for the program.
68 (c) To the extent possible, services to individuals described in Subsection (2)(a) shall
69 be provided through the University of Utah School of Dentistry and the University of Utah
70 School of Dentistry's associated statewide network.
71 (d) The department shall provide the services to individuals described in Subsection
72 (2)(b):
73 (i) by contracting with an entity that:
74 (A) has demonstrated experience working with individuals who are being treated for
75 both a substance use disorder and a major oral health disease;
76 (B) operates a program, targeted at the individuals described in Subsection (2)(b), that
77 has demonstrated, through a peer-reviewed evaluation, the effectiveness of providing dental
78 treatment to those individuals described in Subsection (2)(b);
79 (C) is willing to pay for an amount equal to the program's non-federal share of the cost
80 of providing dental services to the population described in Subsection (2)(b); and
81 (D) is willing to pay all state costs associated with applying for the waiver described in
82 Subsection (1)(b) and administering the program described in Subsection (2)(b); and
83 (ii) through a fee-for-service payment model.
84 (e) The entity that receives the contract under Subsection (2)(d)(i) shall cover all state
85 costs of the program described in Subsection (2)(b).
86 (f) Each fiscal year, the University of Utah School of Dentistry shall, in compliance
87 with state and federal regulations regarding intergovernmental transfers, transfer funds to the
88 program in an amount equal to the program's non-federal share of the cost of providing services
89 under this section through the school during the fiscal year.
90 (g) If a waiver is approved under Subsection (1)(c)(ii), the department shall provide
91 coverage for porcelain and porcelain-to-metal crowns if the services are provided:
92 (i) to an individual who qualifies for dental services under Subsection (2)(b); and
93 (ii) by an entity that covers all state costs of:
94 (A) providing the coverage described in this Subsection [
95 (B) applying for the waiver described in Subsection (1)(c).
96 (h) Where possible, the department shall ensure that dental services described in
97 Subsection (2)(a) that are not provided by the University of Utah School of Dentistry or the
98 University of Utah School of Dentistry's associated network are provided:
99 (i) through [
100 (ii) after July 1, 2018, through the method of reimbursement used by the division for
101 Medicaid dental benefits.
102 (i) Subject to appropriations by the Legislature, and as determined by the department,
103 the scope, amount, duration, and frequency of services provided under this section may be
104 limited.
105 (3) (a) If the waivers requested under Subsection (1)(a) are granted, the Medicaid
106 program shall begin providing dental services in the manner described in Subsection (2) no
107 later than July 1, 2017.
108 (b) If the waivers requested under Subsection (1)(b) are granted, the Medicaid program
109 shall begin providing dental services to the population described in Subsection (2)(b) within 90
110 days from the day on which the waivers are granted.
111 (c) If the waivers requested under Subsection (1)(c)(i) are granted, the Medicaid
112 program shall begin providing dental services to the population described in Subsection
113 (2)(b)(ii) within 90 days after the day on which the waivers are granted.
114 (d) If the waivers requested under Subsection (1)(d) are granted, the Medicaid program
115 shall begin providing dental services to the population described in Subsection (2)(b)(iii)
116 within 90 days after the day on which the waivers are granted.
117 (4) If the federal share of the cost of providing dental services under this section will be
118 less than [
119 providing dental services under this section no later than the end of the current fiscal year.