Brief Summary of Second Substitute Bill

(As Amended by Committee)

Directs the Health Care Authority and the Washington Dental Service Foundation to establish a pilot program to test the provision of enhanced dental benefits for Medicaid Apple Health enrollees who are either adults with diabetes or pregnant women.
Provides enhanced reimbursement rates to dentists participating in the pilot program.

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.

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Summary of Amended 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 stated 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 final report must include an assessment of the effectiveness of the Program at reducing health care costs and improving health outcomes for pregnant women and adults with diabetes. 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. Legislative intent is declared to reduce the prevalence of preeclampsia and gestational diabetes in pregnant women and the incidence of heart disease, kidney disease, blindness, and amputation in adults with diabetes.

Amended Bill Compared to Second Substitute Bill:

The amended bill states the Legislature's intent to reduce the prevalence of preeclampsia and gestational diabetes in pregnant women and the incidence of heart disease, kidney disease, blindness, and amputation in adults with diabetes. The final report must include an assessment of the effectiveness of the pilot at reducing health care costs and improving health outcomes for pregnant women and adults with diabetes.

Staff Summary of Public Testimony:

(In support) This pilot program will test the model for improving the health of pregnant women and patients with diabetes by increasing their access to dental care and facilitating care coordination between dental and medical providers. This pilot program is modeled after the successful Access to Baby and Child Dentistry program and could be the beginning of applying that work to adults. This bill aligns with health transformation work that is already underway in this state. The state investment in the pilot program will leverage private money to provide outreach and other activities. When pregnant women and persons with diabetes have untreated periodontal disease, the repercussions on their medical conditions can be significant. Research in the commercial market shows that treating periodontal disease in pregnant women and persons with diabetes can produce medical savings of up to $2,800 per person per year.

Only one in five adults with Medicaid coverage went to a dentist for care last year and this program promises to increase access. Washington is facing a dental access crisis. The integration of care creates a one-stop shop for patients. This bill will increase the number of periodontal visits to the standard of care in the private sector for this population. This is a great idea to try as a pilot to see if it reduces costs. This is an investment to see if this group of people will avoid catastrophic costs by getting the care that they need.

(Opposed) None.