Florida Senate - 2014                              CS for SB 340
       
       
        
       By the Committee on Community Affairs; and Senators Flores,
       Hays, and Ring
       
       
       
       
       578-02846-14                                           2014340c1
    1                        A bill to be entitled                      
    2         An act relating to the statewide prepaid dental
    3         program; creating s. 409.91205, F.S.; providing
    4         legislative findings and intent; creating the Medicaid
    5         statewide prepaid dental program; directing the Agency
    6         for Health Care Administration to contract with
    7         prepaid dental health plans meeting specified
    8         criteria; directing the agency to apply for and
    9         implement state plan amendments or waivers of
   10         applicable federal laws and regulations necessary to
   11         implement the statewide prepaid dental program;
   12         directing the agency to issue a competitive
   13         procurement to licensed prepaid dental health plans to
   14         implement the program; requiring that the agency
   15         include all counties in the procurement; providing
   16         that all existing contracts become null and void upon
   17         procurement of new contracts; providing that
   18         enrollment in the statewide prepaid dental program
   19         shall not begin until the necessary state plan
   20         amendments or waivers of applicable federal laws and
   21         regulations are obtained and implemented; providing
   22         that a child who is eligible to receive Medicaid
   23         benefits during a specified period shall receive
   24         dental services through the Medicaid managed medical
   25         assistance program; directing the agency to provide
   26         any required notice to recipients regarding the
   27         transition from the Medicaid managed medical
   28         assistance program to the statewide prepaid dental
   29         program; providing that the agency may assess the
   30         costs incurred in providing the notice to plans
   31         participating in the statewide prepaid dental program;
   32         requiring prepaid dental plans participating in the
   33         statewide prepaid dental program to submit encounter
   34         data; providing that the agency shall require a
   35         medical loss ratio for prepaid dental plans
   36         participating in the statewide prepaid dental program;
   37         requiring the agency to submit an annual report to the
   38         Governor and Legislature; specifying the contents of
   39         the report; amending s. 409.973, F.S.; removing the
   40         requirement that managed care plans participating in
   41         the Medicaid managed assistance program provide
   42         pediatric dental services; providing an effective
   43         date.
   44          
   45  Be It Enacted by the Legislature of the State of Florida:
   46  
   47         Section 1. Section 409.91205, Florida Statutes, is created
   48  to read:
   49         409.91205 Statewide prepaid dental program.—
   50         (1) The Legislature finds and declares that the design and
   51  delivery of children’s Medicaid dental services should be
   52  directed by the principle that the health of children is an
   53  overriding concern. The Legislature also finds that the delivery
   54  of dental services as compared to other health care services is
   55  considerably different and, considering the historical
   56  shortcomings of access to dental care in Florida, special
   57  attention must be given to children’s accessibility to dental
   58  care and provider network sustainability. Therefore, it is the
   59  intent of the Legislature that a Medicaid prepaid dental program
   60  be established, on a statewide basis in all counties, separate
   61  and apart from the Medicaid managed medical assistance program
   62  described in ss. 409.961-409.985. Further, the Legislature finds
   63  that it is of paramount interest to the Medicaid program that
   64  continuous and high-quality dental care be provided to Medicaid
   65  recipients, and thus the agency shall ensure a seamless
   66  transition of the responsibility for the provision of dental
   67  services to children from the managed medical assistance program
   68  to the statewide prepaid dental program.
   69         (2) Notwithstanding ss. 409.961–409.985, the agency shall
   70  implement the statewide prepaid dental program by contracting on
   71  a prepaid or fixed-sum basis with at least two appropriately
   72  licensed prepaid dental health plans to provide dental services
   73  to children statewide that demonstrate extensive experience in
   74  administering dental benefits for children enrolled in Medicaid
   75  and that have experience in constructing and maintaining
   76  statewide dental and specialty dental provider networks for
   77  Medicaid programs.
   78         (a) The agency shall apply for and implement state plan
   79  amendments or waivers of applicable federal laws and regulations
   80  necessary to implement the statewide prepaid dental program.
   81         (b) Upon receiving the necessary federal approval for the
   82  statewide prepaid dental program and in order to ensure that
   83  high-quality dental care is provided to Medicaid recipients, the
   84  agency shall issue a competitive procurement to licensed prepaid
   85  dental health plans to implement the dental health program. The
   86  agency shall include all counties in the competitive
   87  procurement. All existing contracts entered into with licensed
   88  prepaid dental health plans become null and void upon
   89  procurement of new contracts.
   90         (c) Enrollment in the statewide prepaid dental program
   91  shall not begin until the necessary state plan amendments or
   92  waivers of applicable federal laws and regulations are obtained
   93  and implemented; however, enrollment shall begin no later than
   94  September 1, 2015.
   95         (d) A child who is eligible to receive Medicaid benefits
   96  between the date that this act takes effect and the
   97  implementation of the statewide prepaid dental plans shall
   98  receive dental services as provided in ss. 409.961–409.985 until
   99  the child is eligible to enroll in the statewide prepaid dental
  100  program.
  101         (e) Before enrollment in the statewide prepaid dental
  102  program, the agency shall provide any required notice to
  103  recipients regarding the transition. The agency may assess the
  104  costs incurred in providing the notice to the plans
  105  participating in the statewide prepaid dental program.
  106         (f) The prepaid dental plans participating in the statewide
  107  prepaid dental program shall be required by contract to submit
  108  encounter data as described in s. 409.967(2)(d).
  109         (g) The agency shall require a medical loss ratio of 85
  110  percent for prepaid dental plans participating in the statewide
  111  prepaid dental program. The calculation shall use uniform
  112  financial data collected from all plans and shall be computed
  113  for each plan on a statewide basis. The method for calculating
  114  the medical loss ratio shall require that expenditures be
  115  classified in a manner consistent with 45 C.F.R. part 158.
  116         (3) The agency shall submit a report by January 15 of each
  117  year on operation of the statewide prepaid dental program to the
  118  Governor, the President of the Senate, and the Speaker of the
  119  House of Representatives which compares the combined annual
  120  benefits utilization and encounter data reported by all
  121  participating prepaid dental plans, along with the agency’s
  122  findings with respect to projected and budgeted annual program
  123  costs, the extent to which each plan is complying with all
  124  contract terms and conditions, the effect that each plan’s
  125  operation is having on access to care for Medicaid recipients in
  126  the plan’s service area, and the statistical trends associated
  127  with indicators of good oral health among all recipients served
  128  in comparison with the state’s population as a whole.
  129         Section 2. Paragraph (e) of subsection (1) of section
  130  409.973, Florida Statutes, is amended to read:
  131         409.973 Benefits.—
  132         (1) MINIMUM BENEFITS.—Managed care plans shall cover, at a
  133  minimum, the following services:
  134         (e) Adult dental services as described in s. 409.906(1).
  135         Section 3. This act shall take effect upon becoming a law.