No. SB 1640
Filed under Healthcare.
Medicaid Dental Pilot Program for Persons with Disabilities; Defining the term “persons with disabilities”; requiring the Agency for Health Care Administration to establish and operate a Medicaid dental pilot program in a specified region to provide enhanced dental services to persons with disabilities; specifying dental services covered by the pilot program; requiring the agency to reimburse dental providers under the pilot program at a specified rate; requiring the agency to collect certain data on the pilot program, etc.
Plain English Summary
AI-GENERATEDA new three-year Medicaid dental pilot program launches in Region E for Medicaid enrollees who receive SSI for disability, are enrolled in a home and community-based services waiver, or meet a specific federal disability standard.
Covered dental care spans routine cleanings and exams through major services like root canals, crowns, and dentures, plus emergency care, but these benefits supplement rather than replace what Medicaid dental coverage already provides.
Participating dentists get reimbursed at 80 percent of the 50th percentile of 2024 industry fee data, and the program must run through at least two licensed dental managed care organizations experienced with disabled patients.
The agency must track access, utilization, spending, and oral health outcomes, and report to state leaders by January 1, 2029 on whether to expand statewide -- but the pilot itself expires on June 30, 2029 regardless.
AIThe Agency for Health Care Administration must create and run a three-year Medicaid dental pilot program in Region E of the Statewide Medicaid Managed Care program, offering enhanced dental services to Medicaid enrollees with disabilities.
AIOnly Medicaid enrollees who receive SSI on the basis of disability, are enrolled in a home and community-based services waiver, or meet a named federal disability standard as determined by the Social Security Administration or the state Medicaid program qualify.
AICovered services must include routine, basic, major, and emergency dental care, but these benefits add to rather than substitute for the dental coverage Medicaid enrollees already receive under separate statutes.
AIDental providers in the pilot program must be paid at a set rate tied to a national fee index, with the agency able to use a comparable benchmark instead of the named industry source if it chooses.
AIThe pilot cannot be run by a single managed care organization; at least two, each meeting agency standards and having demonstrated experience serving people with disabilities, must deliver the program.
AIThe agency must evaluate the pilot's effectiveness and formally recommend to the Governor and legislative leaders whether the program should be expanded statewide, based on the data it is required to collect.
AIThe pilot program's authorizing section is set to expire on its own, regardless of the evaluation report's findings, meaning the program ends unless separate legislation extends or replaces it.