Washington State House of Representatives Office of Program Research | BILL ANALYSIS |
Health Care & Wellness Committee |
2SSB 5540
This analysis was prepared by non-partisan legislative staff for the use of legislative members in their deliberations. This analysis is not a part of the legislation nor does it constitute a statement of legislative intent. |
Brief Description: Creating an oral health pilot program for adults with diabetes and pregnant women.
Sponsors: Senate Committee on Ways & Means (originally sponsored by Senators Walsh, Darneille, Rivers, Braun and Keiser).
Brief Summary of Second Substitute Bill |
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Hearing Date: 3/15/17
Staff: Jim Morishima (786-7191).
Background:
The Health Care Authority (Authority) administers the Medicaid program which is a state-federal program that pays for health care for low-income state residents who meet certain eligibility criteria. Benefits under the program vary according to a person's eligibility category which is determined by several factors, including income, age, health condition, and disability status. Dental services for Medicaid clients are provided through a fee-for-service arrangement in which the dentist bills the Authority directly.
Children under six years old who are enrolled in Medicaid may participate in the Access to Baby and Child Dentistry (ABCD) program at the Authority which provides enhanced fees to participating health care providers who provide additional services to participating children. The Washington Dental Service Foundation provides management services, funding, technical assistance, and provider recruitment and training for the ABCD program. The objective of the ABCD program is to identify and remove obstacles related to early preventive treatment. The additional services include family oral health education, application of fluoride, oral evaluations, restorations, therapeutic pulpotomies, amalgam and resin restoration on primary teeth, and services related to crowns. Participating providers include ABCD program-certified dental providers and other health care providers who have been approved by the Authority, including physicians, osteopathic physicians, advanced registered nurse practitioners, physician assistants, and osteopathic physician assistants.
Summary of Bill:
The Oral Health Connections program (program) is established as a three-year pilot program to test enhanced dental benefits for Medicaid Apple Health enrollees who are either adults with diabetes or pregnant women. The goal of the program is to better integrate medical and oral health care to improve health outcomes and control chronic disease.
The Health Care Authority (Authority) and the Washington Dental Service Foundation (Foundation) must jointly establish the program according to the model of the Access to Baby and Child Dentistry (ABCD) program. Specifically, the program must enhance reimbursement rates to participating dental providers and increase the allowable number of periodontal visits per year to four. The Authority must work with the Foundation to provide wraparound services to link patients to care, including outreach to and support for medical providers, dental providers, care coordinators, accountable communities of health, managed care organizations, and eligible Medicaid enrollees.
The Authority and the Foundation must provide joint progress reports to legislative committees on December 1 of each year. The program is subject to available funds and expires June 30, 2022.
Findings are made that cite the success of providing dental services to children through higher reimbursement rates and the public-private partnership of the ABCD program. Findings are also made regarding the difficulty of adults enrolled in Medicaid to access dental care and the susceptibility of pregnant women and adults with diabetes to oral health problems.
Appropriation: None.
Fiscal Note: Available.
Effective Date: The bill takes effect 90 days after adjournment of the session in which the bill is passed.