Revision: Feb. 11, 2010, midnight
HB 1537 – AS AMENDED BY THE HOUSE
10Feb2010… 0232h
2010 SESSION
05/10
HOUSE BILL 1537
AN ACT allowing primary care providers to provide preventive oral health services to children between 0 and 3 years of age under the state Medicaid program.
SPONSORS: Rep. DiPentima, Rock 16; Rep. Pilliod, Belk 5; Rep. Millham, Belk 5
COMMITTEE: Health, Human Services and Elderly Affairs
This bill directs the department of health and human services to seek funding for a children’s oral health initiative that would enable primary care providers to deliver preventive oral health services to children between 0 and 3 years of age under Medicaid. The program is contingent upon future funding and approval of a state Medicaid plan amendment.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
10Feb2010… 0232h
10-2718
05/10
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Ten
AN ACT allowing primary care providers to provide preventive oral health services to children between 0 and 3 years of age under the state Medicaid program.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Section; Department of Health and Human Services; Children’s Oral Health Initiative. Amend RSA 126-A by inserting after section 4-f the following new section:
126-A:4-g Children’s Oral Health Initiative.
I. The department shall seek funding for a Medicaid children’s oral health initiative program as part of the department’s budget for the biennium ending June 30, 2013, and each biennium thereafter. The program shall provide reimbursement to primary care providers who deliver preventative oral health services, such as dental screenings and fluoride varnish treatments, to children between 0 and 3 years of age enrolled in the state Medicaid program. Primary care providers who choose to participate in the program shall complete training approved by the department and submit evidence of program completion to the department, which shall maintain a list of trained providers. Program implementation, including adoption of rules required by paragraph II, and submission of a Medicaid state plan amendment as required by paragraph III, shall be contingent upon sufficient funding.
II. The commissioner shall adopt rules under RSA 541-A relative to administration of the children’s oral health initiative, including eligibility criteria, the type and frequency of services covered, reimbursement rates, and provider training requirements. The department also shall develop a list of approved training programs, which shall include, but may not be limited to, those offered by the American Academy of Pediatrics and the Southern New Hampshire Area Health Education Center. Upon implementation of the program, the department shall provide, upon request, a list of dentists participating in the state Medicaid program to primary care providers in the oral health initiative.
III. The department shall submit a Title XIX Medicaid state plan amendment to the Centers for Medicare and Medicaid Services for the purpose of establishing the children’s oral health initiative.
2 Effective Date. This act shall take effect 60 days after its passage.
LBAO
10-2718
02/01/10
HB 1537 FISCAL NOTE
AN ACT allowing primary care providers to provide preventive oral health services to children under the state Medicaid program.
FISCAL IMPACT:
The Department of Health and Human Services states this bill will have no fiscal impact in FY 2011. This bill may increase state expenditures by an indeterminable amount in FY 2012 and each year thereafter. This bill will have no fiscal impact on state, county, and local revenue or county and local expenditures.
METHODOLOGY:
The Department of Health and Human Services (DHHS) states this bill directs the Department to submit a Title XIX Medicaid state plan amendment (SPA) to the Centers for Medicare and Medicaid Services (CMS), on or before January 1, 2011, authorizing primary care providers to deliver preventative oral health services, such as dental screenings and fluoride varnish treatments, to children under the state Medicaid program. Primary care providers (PCP’s) who choose to participate in the program would be required to complete training approved by the Department and submit evidence of program completion to the New Hampshire Medical Society, which shall maintain, and make available to the department, a list of certified providers. The bill also requires the Department to seek funding for the program as part of the Department’s budget for the biennium ending June 30, 2013, and each biennium thereafter. Program implementation would be contingent upon sufficient funding and approval of the state plan amendment by CMS. The Department states they will need to make modifications to the Claims Payment System to add this benefit to the menu of reimbursable claims, as well as complete State plan amendment and rules. The Department states since DHHS would have to prepare a budget, irrespective of the passage of this bill, the bill itself would have no fiscal impact.
In the event that the proposed program is implemented, the Department has provided a high-level and upper-end cost estimate of the program. The Department states there are approximately 20,000 children, age 0-3 on Medicaid at any given time receiving well child checks. For the purposes of this fiscal note, DHHS assumes all such children will receive the service making this estimate a maximum exposure projection. The Department states at least two annual applications of fluoride varnish are necessary to ensure efficacy. Each service would consist of oral health risk assessment, application of fluoride varnish, provision of anticipatory guidance to caregiver and referral with follow-up to a participating dentist. These services would be reimbursed at $38.00 per encounter, resulting in a cost of approximately $1,520,000 (20,000 children X $38 per encounter X 2 annual applications).
The Department states that only 75% of children receiving the primary care oral health intervention will ultimately engage with a dentist either because the child already has a dental home or because the family simply does not follow up. Children who are seen by a dentist following the referral by the PCP will receive at a minimum a comprehensive oral evaluation. Evaluations would be reimbursed at $54.50 per visit, resulting in a cost of approximately $817,500 annually (15,000 children X $54.50).
In total, the proposed bill could have a maximum impact of approximately $2,337,500 ($1,520,000 + $817,500), of which 50% or $1,168,750 would be state general funds. The Department states they would anticipate that application of the federally mandated Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Program, to the preventative oral health services identified in this bill would have an indeterminable downstream savings. The exact fiscal impact cannot be determined at this time.
The Office of Legislative Budget Assistant states this bill was a request of the Commission to Study Preventing Dental Disease among New Hampshire’s Children which was established pursuant to Chapter 130:2. Laws of 2009. The final report of the Commission issued November 1, 2009 includes the following information –
• The New Hampshire Medicaid Program paid $641,915 in claims in CY 2007 and $738,196 for CY 2008 for outpatient operating room services associated with preventable dental conditions in young children. This represented 436 and 574 patients, respectively;
• The NH Medicaid Program reports that in CY 2008, 312 children (0-18 years) enrolled in NH Medicaid were seen in the emergency department of various hospitals for dental conditions. Of these 110, had at least one dental office visit in 2007;
• Under the EPSDT benefit for children in the Medicaid program, dental services must be provided at regular intervals that meet the reasonable standards set by each state. EPSDT covers any and all services that are determined to be medically necessary.
The Office of Legislative Budget Assistant has prepared this fiscal note in accordance with RSA 14:46, V.