HB103 (2021) Detail

Establishing a dental benefit under the state Medicaid program.


HB 103  - AS INTRODUCED

 

 

2021 SESSION

21-0069

10/08

 

HOUSE BILL 103

 

AN ACT establishing a dental benefit under the state Medicaid program.

 

SPONSORS: Rep. Schapiro, Ches. 16; Rep. Stavis, Graf. 13; Rep. McWilliams, Merr. 27; Rep. Wazir, Merr. 17; Sen. Rosenwald, Dist 13

 

COMMITTEE: Health, Human Services and Elderly Affairs

 

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ANALYSIS

 

This bill requires the commissioner of the department of health and human services to solicit information and to contract with dental managed care organizations to provide dental care to persons under the Medicaid managed care program.

 

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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

21-0069

10/08

 

STATE OF NEW HAMPSHIRE

 

In the Year of Our Lord Two Thousand Twenty One

 

AN ACT establishing a dental benefit under the state Medicaid program.

 

Be it Enacted by the Senate and House of Representatives in General Court convened:

 

1  Statement of Purpose.  

I.  The general court recognizes that untreated oral health conditions negatively affect a person’s overall health and that good oral health improves a person’s ability to obtain and keep employment.  The general court further recognizes that regular dental care and access to preventive and restorative treatments for oral health conditions are less expensive than emergency care and prevent oral conditions from developing into more complex health conditions that would require medical care.

II.  Therefore, to improve overall health, promote savings in the state’s Medicaid managed care program, and prevent future health conditions caused by oral health problems, and based on the recommendation of the working group convened pursuant to 2019, 346:225, the general court hereby determines that it is in the best interest of the state of New Hampshire to extend dental benefits under the Medicaid managed care program to individuals 21 years of age and over.

2  New Paragraph; Medicaid Managed Care Program; Dental Benefits.  Amend RSA 126-A:5 by inserting after paragraph XIX the following new paragraph:

XIX-a.(a)(1)  The commissioner shall pursue contracting options to administer the state’s Medicaid dental program with the goals of improving access to dental care for Medicaid populations, improving health outcomes for Medicaid enrollees, expanding the provider network, increasing provider capacity, and retaining innovative programs that improve access and care through a value-based care model.  

(2)  The commissioner shall issue a request for information to assist in selecting the administrative model for the state’s Medicaid dental program.  Such model shall be either a model administered by a dental managed care organization or a model administered by the state’s current medical managed care organizations.  The commissioner shall obtain the requested information from both the current medical managed care organizations and any interested dental managed care organization.  The administrative model selected shall demonstrate the greatest ability to satisfy the state's need for value, quality, efficiency, innovation, and savings.  The request for information shall be released no later than August 1, 2021.  The request for information shall address improving health outcomes, expanding the provider network, increasing capacity of providers, integrating a value-based care model, and exploring innovative programs for children and adults.

(3)  If the model administered by a dental managed care organization is selected, the commissioner shall issue a 3-year request for proposals, with 2 optional one-year extensions, to enter into contracts with the vendor that demonstrates the greatest ability to satisfy the state's need for value, quality, efficiency, innovation, and savings.  The state plan amendment shall be submitted to the Centers for Medicare and Medicaid Services (CMS) no later than November 1, 2021.  Implementation of a procured contract shall begin April 1, 2022.  The commissioner shall establish a capitated rate for the appropriate model for the contract that is full risk to the vendor.  In contracting for a dental managed care model and the various rate cells, the department shall ensure no reduction in the quality of care of services provided to enrollees in the managed care model and shall exercise all due diligence to maintain or increase the quality of care provided.  Following approval by the joint health care reform oversight committee, pursuant to RSA 420-N:3, the department shall seek, with the review of the fiscal committee of the general court, all necessary and appropriate state plan amendments and waivers to implement the provisions of this paragraph.  The program shall not commence operation until such state plan amendments or waivers have been approved by CMS.  All necessary state plan amendments and waivers shall be submitted by November 1, 2021.

(4)  The commissioner shall adopt rules, pursuant to RSA 541-A, if necessary, to implement the provisions of this paragraph and shall first obtain approval of proposed rules by the joint health care reform oversight committee, pursuant to RSA 420-N:3.

(b)  Any vendor awarded a contract pursuant to this paragraph shall provide the required dental services to children and the following dental services to individuals 21 years of age and over, reimbursed under the United States Social Security Act, Title XIX, or successors to it:

(1)  Preventive dental services including an annual comprehensive oral examination, necessary x-rays or other imaging, prophylaxis, topical fluoride, oral hygiene instruction, behavior management and smoking cessation counseling, and other services as determined by the commissioner.

(2)  Comprehensive restorative treatment necessary to prevent or treat oral health conditions, to reduce or eliminate the need for future acute oral health care, and to avoid more costly medical or dental care.

(3)  Treatment necessary to relieve pain, eliminate infection or prevent imminent tooth loss.

(4)  Prosthodontic coverage subject to medical necessity.  

(c)  In this paragraph, “dental managed care organization” means any dental care organization, dental service organization, health insurer, or other entity licensed under Title XXXVII, that provides, directly or by contract, dental care services covered under this paragraph rendered by licensed providers and that meets the requirements of Title XIX or Title XI of the federal Social Security Act.  

3  Effective Date.  This act shall take effect upon its passage.

 

LBA

21-0069

Revised 3/3/21

 

HB 103-FN- FISCAL NOTE

AS INTRODUCED

 

AN ACT establishing a dental benefit under the state Medicaid program.

 

FISCAL IMPACT:      [ X ] State              [    ] County               [    ] Local              [    ] None

 

 

 

Estimated Increase / (Decrease)

STATE:

FY 2021

FY 2022

FY 2023

FY 2024

   Appropriation

$0

$0

$0

$0

   Revenue

$0

$0

$0

$0

   Expenditures

$0

Indeterminable

Indeterminable

Indeterminable

Funding Source:

  [ X ] General            [    ] Education            [    ] Highway           [ X ] Other - Federal matching Medicaid funds.

 

 

 

 

 

METHODOLOGY:

This bill requires the Department of Health and Human Services to solicit information and contract with dental managed care organizations to extend dental benefits under the Medicaid managed care program to individuals 21 years of age and over.  Specifically, the bill amends RSA 126-A:5 by inserting a new paragraph XIX-a, which requires the Department to:

  • Release a request for information no later than August 1, 2021;
  • Submit a state plan amendment to the Centers for Medicare and Medicaid Services (CMS) within the quarter of the program effective date; and
  • Implement a contract beginning on April 1, 2022

 

As shown in the table below, the Department has provided the following estimates of the cost of adding a dental benefit to the Medicaid program: "medium," "high," and "August 2020 plan," the last of which the Department expects will provide the basis for the plan that is ultimately implemented as a result of this bill.  It should be noted, however, that the FY 2020/21 budget trailer bill (codified in law as Chapter 346:225, III, Laws of 2019), required the Department to implement an adult dental benefit by April 1, 2021, so the cost of a generic dental benefit is attributable to that existing law rather than to the current bill.  While this bill does not repeal or amend that chapter law, it does differ from it, in that it establishes a new implementation date of September 1, 2022.  For that reason, for the purposes of this fiscal note, it is assumed that there will be no cost until FY 2022.

DHHS-Projected Dental Benefit Costs, Per Full Year of Implementation

 

 

Medium

High

August 2020 Plan

Gross Per-Member, Per Month (PMPM) Cost

 $            20.50

 $            36.79

 $            24.38

     Additional Transportation Services

 $              2.60

 $              2.60

 $              2.60

     Medical Cost Offsets (e.g., reduced emergency costs)

 $            (0.76)

 $            (0.76)

 $           (0.76)

          Net Projected PMPM Cost:

$            22.34

$            38.63

 $            26.22

 

 

 

 

Federal Share of Costs

 

 

 

     Traditional Medicaid Population (50% of cost)

 $    5,130,000

 $     8,860,000

 $    5,840,000

     Expanded Medicaid Population (90% of cost)

$  11,450,000

 $   19,810,000

 $  14,490,000

          Projected Federal Share of Costs:

 $  16,580,000

 $   28,670,000

 $  20,330,000

 

 

 

 

State Share of Costs

 

 

 

     Traditional Medicaid Population (50% of cost)

 $     5,130,000

 $     8,860,000

 $    5,840,000

     Expanded Medicaid Population (10% of cost)

 $     1,270,000

 $     2,200,000

 $    1,610,000

          Projected State Share of Costs:

 $    6,400,000

 $  11,060,000

 $   7,450,000

 

As the benefit is expected to be implemented on April 1, 2022, FY 2022 costs will be 25% of the annual costs reflected above. The Department notes that the "medium," "high," and "August 2020" plans reflect the following assumptions:

  • Medium
    • Includes: diagnostic, preventive, restorative, oral surgery
    • Excludes: fixed and removable prosthodontics, endodontics, orthodontics
  • High
    • Includes: diagnostic, preventive, restorative, oral surgery, removable prosthodontics, endodontics
    • Excludes: orthodontics, fixed prosthodontics
  • August 2020:
    • Includes: diagnostic, preventive, restorative, oral surgery, removable prosthodontics
    • Excludes: endodontics, periodontics except for preventive/maintenance, fixed prosthodontics and crowns, and orthodontics

 

AGENCIES CONTACTED:

Department of Health and Human Services

 

Links

HB103 at GenCourtMobile
HB103 Discussion

Action Dates

Date Body Type
Feb. 1, 2021 House Hearing
March 8, 2021 House Hearing

Bill Text Revisions

HB103 Revision: 31394 Date: March 3, 2021, 12:13 p.m.

Docket


Sept. 2, 2021: Subcommittee Work Session: 09/02/2021 10:00 am LOB 205


: Retained in Committee


March 8, 2021: ==CONTINUED== Public Hearing: 03/08/2021 01:00 pm Members of the public may attend using the following link: To join the webinar: https://www.zoom.us/j/99826124489 / Executive session on pending legislation may be held throughout the day (time permitting) from the time the committee is initially convened.


Feb. 1, 2021: ==RECESSED== Public Hearing: 02/01/2021 01:00 pm Members of the public may attend using the following link: To join the webinar: https://www.zoom.us/j/96551569054 / Executive session on pending legislation may be held throughout the day (time permitting) from the time the committee is initially convened.


Jan. 6, 2021: Introduced (in recess of) 01/06/2021 and referred to Health, Human Services and Elderly Affairs HJ 2 P. 35


Jan. 6, 2020: To Be Introduced 01/06/2020 and referred to Health, Human Services and Elderly Affairs