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     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 [(g)] (f), to an individual
36     described in Subsection (2)(b)(i).
37          (c) Before June 30, 2019, the department shall submit to [the Centers for Medicare and
38     Medicaid Services] CMS a request for waivers, or an amendment to existing waivers, from
39     federal law necessary for the state to:
40          (i) provide dental services, in accordance with Subsections (2)(b)(ii) and (d) through
41     [(g)] (f), to an individual described in Subsection (2)(b)(ii); and
42          (ii) provide the services described in Subsection [(2)(h)] (2)(g).
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     [and]
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)[.]; and
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 [(2)(h)] (2)(g); and
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 [fee for service] fee-for-service reimbursement until July 1, 2018; and
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 [65] 55% during any portion of the next fiscal year, the Medicaid program shall cease
119     providing dental services under this section no later than the end of the current fiscal year.