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HB 819 — Sunset Review of Medicaid Dental Services

by Rep. J. Diaz and others (SB 994 by Senators Negron, Sobel, and Flores)

This summary is provided for information only and does not represent the opinion of any Senator, Senate Officer, or Senate Office.

Prepared by: Health Policy Committee (HP)

The bill removes dental services as a required benefit from the Medicaid Managed Assistance program component of the Statewide Medicaid Managed Care (SMMC) program effective March 1, 2019. The bill requires the Office of Program Policy Analysis and Government Accountability to provide the Governor, President of the Senate, and Speaker of the House of Representatives by December 1, 2016, a comprehensive report that examines the effectiveness of Medicaid managed care plans in improving access, satisfaction, delivery, and value of dental services. The report must also examine, by plan and in the aggregate, the historical trends of costs, access, utilization, and improvement of dental care statewide and in the experience of other states.

The Legislature may use this report to determine the scope of dental benefits in the Medicaid managed care programs for future procurements, and whether to provide the benefit separate from medical benefits. If the Legislature takes no action before July 1, 2017, the Agency for Health Care Administration is directed to implement a statewide competitive procurement for a separate dental program for children and adults with a choice of at least two vendors. The contract must be for 5 years, be non-renewable, and include a medical loss ratio provision consistent with the requirement for health plans in the SMMC program.

If approved by the Governor, these provisions take effect July 1, 2016.

Vote: Senate 35-2; House 100-15