Florida Senate - 2015 SB 350 By Senator Flores 37-00487-15 2015350__ 1 A bill to be entitled 2 An act relating to the statewide prepaid dental 3 program for Medicaid-eligible children; creating s. 4 409.91205, F.S.; providing legislative findings and 5 intent; establishing the statewide prepaid dental 6 program for Medicaid-eligible children; requiring the 7 Agency for Health Care Administration to contract with 8 prepaid dental health plans meeting specified 9 criteria; requiring the agency to apply for and 10 implement state plan amendments or waivers of 11 applicable federal laws and regulations necessary to 12 implement the program; requiring the agency to issue a 13 competitive procurement to licensed prepaid dental 14 health plans to implement the program; requiring the 15 agency to include all counties in the procurement; 16 providing that enrollment in the program shall begin 17 by a specified date, but not until necessary state 18 plan amendments or waivers of applicable federal laws 19 and regulations are implemented; providing that a 20 Medicaid-eligible child shall receive dental services 21 through the Medicaid managed medical assistance 22 program during a specified period; requiring the 23 agency to provide any required notice to Medicaid 24 recipients regarding the transition to the program; 25 providing that the agency may assess the costs 26 incurred in providing the notice to prepaid dental 27 health plans participating in the program; requiring 28 participating plans to submit encounter data and to 29 comply with a specified medical loss ratio; requiring 30 the agency to submit an annual report to the Governor 31 and Legislature; specifying the contents of the 32 report; amending s. 409.973, F.S.; deleting the 33 requirement that managed care plans participating in 34 the Medicaid managed medical assistance program 35 provide children’s dental services; providing an 36 effective date. 37 38 Be It Enacted by the Legislature of the State of Florida: 39 40 Section 1. Section 409.91205, Florida Statutes, is created 41 to read: 42 409.91205 Statewide prepaid dental program for Medicaid 43 eligible children.— 44 (1) The Legislature finds that an overriding concern in the 45 design and delivery of Medicaid dental services is ensuring the 46 dental health of children. Due to the unique challenges that 47 exist in the delivery of Medicaid dental services and 48 considering the historical shortcomings of access to such 49 services in this state, special attention must be given to the 50 issues of children’s access to dental services and provider 51 network sustainability. Therefore, it is the intent of the 52 Legislature that the agency establish a high-quality, prepaid 53 dental program for Medicaid-eligible children on a statewide 54 basis, separate from the Medicaid managed medical assistance 55 program described in part IV. The agency shall ensure a seamless 56 transition of responsibility from the Medicaid managed medical 57 assistance program to the new program so that continuous access 58 to dental services is provided. 59 (2) Notwithstanding part IV, the agency shall establish the 60 statewide prepaid dental program for Medicaid-eligible children 61 by contracting on a prepaid or fixed-sum basis with at least two 62 appropriately licensed prepaid dental health plans to provide 63 dental services. Such plans must demonstrate extensive 64 experience in administering dental benefits for children 65 enrolled in Medicaid and in developing and maintaining statewide 66 dental and specialty dental provider networks for Medicaid 67 programs. 68 (a) The agency shall apply for and implement state plan 69 amendments or waivers of applicable federal laws and regulations 70 necessary to implement the program. 71 (b) The agency shall issue a competitive procurement to 72 licensed prepaid dental health plans to implement the program. 73 The agency shall include all counties in the competitive 74 procurement. 75 (c) Enrollment in the program may not begin until the 76 necessary state plan amendments or waivers of applicable federal 77 laws and regulations are implemented; however, the Legislature 78 intends that enrollment begin no later than September 1, 2016. 79 (d) Between the date this act takes effect and the 80 implementation of the program, each Medicaid-eligible child 81 shall receive dental services as provided in part IV until he or 82 she is eligible to enroll in the program. 83 (e) Before enrollment begins for the program, the agency 84 shall provide any required notice to Medicaid recipients 85 regarding the transition. The agency may assess the costs 86 incurred in providing such notice to the participating plans. 87 (f) The agency’s contract with each participating plan 88 shall require the plan to submit encounter data as described in 89 s. 409.967(2)(d) and to comply with a medical loss ratio of 85 90 percent. The medical loss ratio calculation must use uniform 91 financial data collected from all plans, must be computed for 92 each plan on a statewide basis, and must require that 93 expenditures be classified in a manner consistent with 45 C.F.R. 94 part 158. 95 (3) The agency shall submit a report by January 15 of each 96 year to the Governor, the President of the Senate, and the 97 Speaker of the House of Representatives on the operation of the 98 statewide prepaid dental program. The report must compare the 99 combined annual benefits utilization and encounter data reported 100 by all participating plans with the agency’s projected and 101 budgeted annual program costs; must evaluate the extent to which 102 each participating plan is complying with the contract terms and 103 conditions; must address the effect that each participating 104 plan’s operation is having on access to dental services for 105 Medicaid-eligible children in the plan’s service area; and must 106 address the statistical trends associated with indicators of 107 good oral health for the children served, as compared to the 108 general population of the state. 109 Section 2. Paragraph (e) of subsection (1) of section 110 409.973, Florida Statutes, is amended to read: 111 409.973 Benefits.— 112 (1) MINIMUM BENEFITS.—Managed care plans shall cover, at a 113 minimum, the following services: 114 (e) Adult dental services as described in s. 409.906(1). 115 Section 3. This act shall take effect upon becoming a law.