Revision: April 23, 2010, midnight
HB 1537 – VERSION ADOPTED BY BOTH BODIES
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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.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
Amended 02/17/10
HB 1537 FISCAL NOTE
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.
FISCAL IMPACT:
The Department of Health and Human Services states this bill, as amended by the House (Amendment #2010-0232h), will have no fiscal impact in FY 2011. This bill may have an indeterminable impact on state expenditures 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 include a Medicaid benefit expansion for preventative oral health services in its agency budget request for the biennium ending June 30, 2013, and each biennium thereafter. The Department would be required to adopt rules and submit a Title XIX Medicaid state plan amendment (SPA) to the Centers for Medicare and Medicaid Services (CMS) if sufficient funding is provided to the Department in the State’s FY 2012-2013 operating budget. Implementation of the program would be contingent on sufficient funding and approval of the state plan amendment by CMS. The Department states the proposed bill would have no fiscal impact as it would only require the Department to seek funding for the program and require implementation if sufficient funding is granted.
For informational purposes, the Department states –
• There are approximately 20,000 children, age 0-3 on Medicaid at any given time receiving well child checks.
• 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.
• 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 primary care physician will receive at a minimum a comprehensive oral evaluation. Evaluations would be reimbursed at $54.50 per visit.
• Claims Payment System modification will be necessary to add this benefit to the menu of reimbursable claims.
• It is anticipated that the application of fluoride varnish and the linkage to a dental home where a children would receive dental services will decrease expenditures for emergency department and operating rooms to treat advanced caries (cavities or tooth decay).
The Department states the maximum exposure of the proposed benefit is approximately $2,337,500 [(20,000 children X $38 per encounter X 2 annual applications = $1,520,000) + (15,000 children X $54.50 = $817,500)], of which 50% or $1,168,750 would be state general funds, assuming all eligible children participate. However, the Department anticipates a slow uptake of this service and thus the high-end cost may not be realized for 3 to 4 years. Thus initial costs of the program will be less and are dependent on the number of providers who avail themselves of the required training and the number of children seen by those providers. In addition, the Department states this maximum exposure estimate is not intended to represent cost avoidances by preventing or arresting dental caries in young children. The Department states in FY 2009 DHHS expended approximately $313,245 in emergency department and operating room (including hospitals and ambulatory surgical centers) for children aged 0-3, 97% of whom were treated due to caries. This figure does not include ancillary charges such as anesthesia, and professional services. For calendar years 2007 and 2008, DHHS expended $740,558 and $904,415 respectively on children aged 0-4, for operating room encounters to treat caries, these figures are inclusive of ancillary costs such as anesthesia, recovery room, pharmacy, and like costs. The Department is unable to determine when such cost avoidances will be realized or how substantial the savings might be. The Department states they would anticipate that application of the federally mandated Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Program which requires States, among other things, to ensure dental access to Medicaid enrolled children. In order for a dental encounter to count for EPSDT compliance, the encounter must be with a dentist. Accordingly, better linkage of young children with dentists will have an indeterminable benefit for DHHS in relation to its EPSDT mandates as well as potentially improving quality of life for Medicaid enrolled children.
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 Hawkins Consent Decree (a court-ordered settlement agreement approved in the US District Court in the case of Hawkins v. Commissioner of the Department of Health and Human Services) states that, “Prior to age three oral health screening shall occur in the context of a well-child visit.” It further requires that the NH DHHS “shall use its best efforts to provide primary care providers with education and training they need-and to encourage them to take the actions necessary-for the delivery of appropriate oral health screenings to Class Members under the age of three including but not limited to information about prevention of transmission of caries-causing bacteria from parent to child, prevention of early childhood caries, fluoride supplementation, oral hygiene practices tailored to young children, diet and nutrition and when and how to refer Class Members under age three for a dental screening.”
• According to the Commission, at the time of the report Northeast Delta Dental had verbally agreed to reimburse trained primary care providers who treat children enrolled in NH Healthy Kids for providing oral risk assessments, anticipatory guidance to the caregiver, fluoride application followed by a referral to a dental home.
• Training programs are available both locally and nationally for primary-care medical providers interested in performing oral health screenings and preventive dental services on high to moderate risk young children. This includes a program by Southern New Hampshire Area Health Education Center and the American Academy of Pediatrics web-based training program.
The Office of Legislative Budget Assistant has prepared this fiscal note in accordance with RSA 14:46, V.