HOUSE BILL REPORT

HB 1225

BYRepresentatives Brekke, Sayan, Lewis, Braddock, Sprenkle, Nelson, Allen, Jacobsen, Grimm, Appelwick, Wineberry, Hine, Niemi, Hargrove, Bristow, Belcher, Lux and P. King 

Developing and implementing prepaid capitated dental hygiene and care programs for medical assistance recipients.

House Committe on Health Care

Majority Report:  The substitute bill be substituted therefor and the substitute bill do pass.  (8)

      Signed by Representatives Braddock, Chair; Bristow, Brooks, Cantwell, Lux, D. Sommers, Sprenkle and Vekich.

House Staff:Bill Hagens (786-7131)

AS REPORTED BY COMMITTEE ON HEALTH CARE APRIL 16, 1987

BACKGROUND:

The purpose of this bill is to develop and implement a prepaid capitated dental care program for medical assistance recipients.

Presently, full-scope dental coverage under the Medical Assistance program is currently available only to Categorically Needy and Medically Needy children under the division's Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program.  Dental coverage for all other eligible persons in the Medical Assistance program is restricted to dentures, services required to be performed in an inpatient setting, and dental services considered medical in nature, e.g., tumors and fractures.  Covered dental services are currently paid on a fee-for-service basis using a schedule of maximum allowances.

The present limited coverage for adults contrasts significantly with the dental coverage available prior to March 1, 1981.  On that date dental services for adult Medical Assistance clients were eliminated from the program as a cost saving measure during a period of severe fiscal constraints.

For the 1987-89 biennium, the Legislature has proposed to reinstate the full-scope dental coverage for categorically needy and medically needy clients at an estimated cost of $41.1 million ($18.5 million state share).  This proposal includes a proviso that 20,000 eligible recipients be enrolled in capitated dental programs by January 1, 1989.  Under capitation arrangements, a fixed monthly rate would be prepaid to a contractor for each eligible recipient.  The contractor would enroll dentists to participate in the program and make payments for necessary services provided to recipients.

SUMMARY:

SUBSTITUTE BILL:  Sets forth legislative findings that:  good dental care and hygiene is important; managed prepaid capitated approaches have been found to be effective in controlling costs, while maintaining good care; and enrolling medical assistance recipients in such programs is a prudent use of state funds.

A definition of "managed dental care services" is added to RCW 74.09.010 meaning "dental hygiene and dental care services covered under this chapter provided to medical assistance recipients by health care providers licensed under chapters 18.29 and 18.32 RCW on a managed prepaid capitated basis."

The Department of Social and Health Services is required to:  promulgate appropriate rules within 180 days of the effective date of the act; enter into prepaid capitated agreements for comprehensive dental care services but permits an exception for oral surgery; enter, to the extent possible, into agreements for dental hygiene services to be provided in certain health care facilities; meet the following implementation schedule:  by January 1, 1989, 20,000 recipients, by January 1, 1991, 40,000 recipients, by January 1, 1993, 60,000 recipients; ensure, to the extent possible, recipient choice of provider; seek federal waivers; and report periodically to the Legislature.

This bill is necessary to implement Section 210(1) of the House budget and is, therefore, exempt for legislative deadlines.

SUBSTITUTE BILL COMPARED TO ORIGINAL:  The Department of Social and Health Services is given greater flexibility in implementation.

Fiscal Note:      Requested April 14, 1987.

House Committee ‑ Testified For:    Ron Kero, Department of Social and Health Services; and Jeff Larsen, Washington Assembly for Citizens With Disabilities.

House Committee - Testified Against:      Stuart Bender, Washington State Dental Association; Larry Mast, Dentist; and Charles Paxton, Washington State Dental Association.

House Committee - Testimony For:    Prepaid capitated programs are a good tool for controlling cost and provide good care.

House Committee - Testimony Against:      Dental care is not like health care.  Therefore the same benefits should not be assumed.  With the low rate of reimbursement few dentists with contract.