No. SB 152
Filed under Healthcare.
Medicaid Provider Networks; Requiring Medicaid managed care plans and providers to negotiate mutually acceptable rates, methods, and terms of payment for purposes of Medicaid reimbursements; requiring plans to pay dentists at certain rates; specifying additional requirements for the provider network contracts under the statewide managed care program, etc.
Plain English Summary
AI-GENERATEDMedicaid managed care plans and providers must now negotiate mutually acceptable rates, methods, and terms of payment, and plans must pay dentists at least the payment rate the state's Medicaid agency itself sets.
A dentist only counts as an 'active' provider on a plan's network listing if they average 20 hours a week of direct patient care at that location; below 4 hours a week, they cannot be listed at all.
Specialists like endodontists, oral surgeons, and periodontists must be listed separately from general dentists, by specialty, with the age ranges of patients they actually treat.
Plans must also report, provider by provider, which specific services -- sedation type, in-office anesthesia, emergency-care access, and care for patients with intellectual or developmental disabilities -- each dentist actually offers.
AICreates a general duty for Medicaid managed care plans and their contracted providers to negotiate mutually acceptable rates, payment methods, and payment terms, rather than the plan simply setting them.
AIPlans must pay dentists at least as much as the Medicaid agency's own dental payment rates, establishing a statutory floor beneath what any managed care plan can pay for dental services.
AIA dentist can only be shown as an active Medicaid provider on a plan's network database if they average at least 20 hours a week of direct patient care at that specific location.
AIA dental provider offering less than 4 hours a week of direct patient care to Medicaid beneficiaries at a location cannot be listed on the network provider database at all.
AIEndodontists, oral surgeons, periodontists, and other specialty dental providers must appear separately from general dentists on the network database, sorted under the specialty they actually provide.
AIA group practice or university employing multiple dental providers who each fall under the hours thresholds must appear on the network database as one combined entity rather than as separate individual providers.
AIDental plans must break down and report, for each provider, exactly which services are offered, including sedation and anesthesia type and access to emergent care, instead of a general adequacy statement.