Florida Senate - 2014 CS for SB 340
By the Committee on Community Affairs; and Senators Flores,
Hays, and Ring
578-02846-14 2014340c1
1 A bill to be entitled
2 An act relating to the statewide prepaid dental
3 program; creating s. 409.91205, F.S.; providing
4 legislative findings and intent; creating the Medicaid
5 statewide prepaid dental program; directing the Agency
6 for Health Care Administration to contract with
7 prepaid dental health plans meeting specified
8 criteria; directing the agency to apply for and
9 implement state plan amendments or waivers of
10 applicable federal laws and regulations necessary to
11 implement the statewide prepaid dental program;
12 directing the agency to issue a competitive
13 procurement to licensed prepaid dental health plans to
14 implement the program; requiring that the agency
15 include all counties in the procurement; providing
16 that all existing contracts become null and void upon
17 procurement of new contracts; providing that
18 enrollment in the statewide prepaid dental program
19 shall not begin until the necessary state plan
20 amendments or waivers of applicable federal laws and
21 regulations are obtained and implemented; providing
22 that a child who is eligible to receive Medicaid
23 benefits during a specified period shall receive
24 dental services through the Medicaid managed medical
25 assistance program; directing the agency to provide
26 any required notice to recipients regarding the
27 transition from the Medicaid managed medical
28 assistance program to the statewide prepaid dental
29 program; providing that the agency may assess the
30 costs incurred in providing the notice to plans
31 participating in the statewide prepaid dental program;
32 requiring prepaid dental plans participating in the
33 statewide prepaid dental program to submit encounter
34 data; providing that the agency shall require a
35 medical loss ratio for prepaid dental plans
36 participating in the statewide prepaid dental program;
37 requiring the agency to submit an annual report to the
38 Governor and Legislature; specifying the contents of
39 the report; amending s. 409.973, F.S.; removing the
40 requirement that managed care plans participating in
41 the Medicaid managed assistance program provide
42 pediatric dental services; providing an effective
43 date.
44
45 Be It Enacted by the Legislature of the State of Florida:
46
47 Section 1. Section 409.91205, Florida Statutes, is created
48 to read:
49 409.91205 Statewide prepaid dental program.—
50 (1) The Legislature finds and declares that the design and
51 delivery of children’s Medicaid dental services should be
52 directed by the principle that the health of children is an
53 overriding concern. The Legislature also finds that the delivery
54 of dental services as compared to other health care services is
55 considerably different and, considering the historical
56 shortcomings of access to dental care in Florida, special
57 attention must be given to children’s accessibility to dental
58 care and provider network sustainability. Therefore, it is the
59 intent of the Legislature that a Medicaid prepaid dental program
60 be established, on a statewide basis in all counties, separate
61 and apart from the Medicaid managed medical assistance program
62 described in ss. 409.961-409.985. Further, the Legislature finds
63 that it is of paramount interest to the Medicaid program that
64 continuous and high-quality dental care be provided to Medicaid
65 recipients, and thus the agency shall ensure a seamless
66 transition of the responsibility for the provision of dental
67 services to children from the managed medical assistance program
68 to the statewide prepaid dental program.
69 (2) Notwithstanding ss. 409.961–409.985, the agency shall
70 implement the statewide prepaid dental program by contracting on
71 a prepaid or fixed-sum basis with at least two appropriately
72 licensed prepaid dental health plans to provide dental services
73 to children statewide that demonstrate extensive experience in
74 administering dental benefits for children enrolled in Medicaid
75 and that have experience in constructing and maintaining
76 statewide dental and specialty dental provider networks for
77 Medicaid programs.
78 (a) The agency shall apply for and implement state plan
79 amendments or waivers of applicable federal laws and regulations
80 necessary to implement the statewide prepaid dental program.
81 (b) Upon receiving the necessary federal approval for the
82 statewide prepaid dental program and in order to ensure that
83 high-quality dental care is provided to Medicaid recipients, the
84 agency shall issue a competitive procurement to licensed prepaid
85 dental health plans to implement the dental health program. The
86 agency shall include all counties in the competitive
87 procurement. All existing contracts entered into with licensed
88 prepaid dental health plans become null and void upon
89 procurement of new contracts.
90 (c) Enrollment in the statewide prepaid dental program
91 shall not begin until the necessary state plan amendments or
92 waivers of applicable federal laws and regulations are obtained
93 and implemented; however, enrollment shall begin no later than
94 September 1, 2015.
95 (d) A child who is eligible to receive Medicaid benefits
96 between the date that this act takes effect and the
97 implementation of the statewide prepaid dental plans shall
98 receive dental services as provided in ss. 409.961–409.985 until
99 the child is eligible to enroll in the statewide prepaid dental
100 program.
101 (e) Before enrollment in the statewide prepaid dental
102 program, the agency shall provide any required notice to
103 recipients regarding the transition. The agency may assess the
104 costs incurred in providing the notice to the plans
105 participating in the statewide prepaid dental program.
106 (f) The prepaid dental plans participating in the statewide
107 prepaid dental program shall be required by contract to submit
108 encounter data as described in s. 409.967(2)(d).
109 (g) The agency shall require a medical loss ratio of 85
110 percent for prepaid dental plans participating in the statewide
111 prepaid dental program. The calculation shall use uniform
112 financial data collected from all plans and shall be computed
113 for each plan on a statewide basis. The method for calculating
114 the medical loss ratio shall require that expenditures be
115 classified in a manner consistent with 45 C.F.R. part 158.
116 (3) The agency shall submit a report by January 15 of each
117 year on operation of the statewide prepaid dental program to the
118 Governor, the President of the Senate, and the Speaker of the
119 House of Representatives which compares the combined annual
120 benefits utilization and encounter data reported by all
121 participating prepaid dental plans, along with the agency’s
122 findings with respect to projected and budgeted annual program
123 costs, the extent to which each plan is complying with all
124 contract terms and conditions, the effect that each plan’s
125 operation is having on access to care for Medicaid recipients in
126 the plan’s service area, and the statistical trends associated
127 with indicators of good oral health among all recipients served
128 in comparison with the state’s population as a whole.
129 Section 2. Paragraph (e) of subsection (1) of section
130 409.973, Florida Statutes, is amended to read:
131 409.973 Benefits.—
132 (1) MINIMUM BENEFITS.—Managed care plans shall cover, at a
133 minimum, the following services:
134 (e) Adult dental services as described in s. 409.906(1).
135 Section 3. This act shall take effect upon becoming a law.