AN ACT CONCERNING ACCESS TO ORAL HEALTH CARE.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. Section 17b-282b of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) Not later than July 1, 2004, and prior to the implementation of a state-wide dental plan that provides for the administration of the dental services portion of the department's medical assistance, the Commissioner of Social Services shall amend the federal waiver approved pursuant to Section 1915(b) of the Social Security Act. Such waiver amendment shall be submitted to the joint standing committees of the General Assembly having cognizance of matters relating to human services and appropriations and the budgets of state agencies in accordance with the provisions of section 17b-8.

(b) Prior to the implementation of a state-wide dental plan that provides for the administration of the dental services portion of the department's medical assistance program, the Commissioner of Social Services shall review eliminating prior authorization requirements for basic and routine dental services. In the event the commissioner adopts regulations to eliminate such prior authorization requirements, the commissioner may implement policies and procedures for the purposes of this subsection while in the process of adopting such regulations, provided the commissioner prints notice of intention to adopt the regulations in the Connecticut Law Journal not later than twenty days after implementing the policies and procedures.

(c) The Commissioner of Social Services shall establish a fee schedule, to be effective from July 1, 2006, to July 1, 2008, for dental services provided under the medical assistance program to children under the age of thirteen. The schedule shall provide for a fee for each dental service that is equal to seventy per cent of the average insurance reimbursement for such dental service in this state.

(d) The Commissioner of Social Services shall evaluate whether the fee schedule established pursuant to subsection (c) of this section results in improved access to oral health care for medical assistance recipients under the age of thirteen and shall submit a report of the evaluation, along with any recommendations, not later than December 31, 2007, to the joint standing committees of the General Assembly having cognizance of matters relating to human services and public health, in accordance with the provisions of section 11-4a.

Sec. 2. Section 17b-296 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) Each managed care plan shall include sufficient numbers of appropriately trained and certified clinicians of pediatric care, including primary, medical subspecialty and surgical specialty physicians, as well as providers of necessary related services such as dental services, mental health services, social work services, developmental evaluation services, occupational therapy services, physical therapy services, speech therapy and language services, school-linked clinic services and other public health services to assure enrollees the option of obtaining benefits through such providers.

(b) Each managed care organization that on or after October 1, 2001, enters into a contract with the department to provide comprehensive services under the HUSKY Plan, Part A or the HUSKY Plan, Part B, or both, shall have primary responsibility for ensuring that its behavioral health and dental subcontractors adhere to the contract between the department and the managed care organization, including the provision of timely payments to providers and interest payments in accordance with subdivision (15) of section 38a-816, as amended. The managed care organization shall submit to the department a claims aging inventory report including all data on all services paid by subcontractors in accordance with the terms of the contract with the department.

(c) Upon the initial contract or the renewal of a contract between a managed care organization and a behavioral health or dental subcontractor, the department shall require that the managed care organizations impose a performance bond, letter of credit, statement of financial reserves or payment withhold for behavioral health and dental subcontractors that provide services under the HUSKY Plan, Part A or the HUSKY Plan, Part B, or both. Any such performance bond, letter of credit, statement of financial reserves or payment withhold that may be required by the department pursuant to a contract with a managed care organization shall be in an amount sufficient to assure the settlement of provider claims in the event that the contract between the managed care organization and the behavioral health or dental subcontractor is terminated. Upon the initial contract or the renewal of a contract between a managed care organization and a behavioral health or dental subcontractor, the managed care organization shall negotiate and enter into a contract termination agreement with its behavioral health and dental subcontractors that shall include, but not be limited to, provisions concerning financial responsibility for the final settlement of provider claims and data reporting to the department. The managed care organization shall submit reports to the department, at such times as the department shall determine, concerning any payments made from such performance bond or any payment withholds, the timeliness of claim payments to providers and the payment of any interest to providers.

(d) Prior to the approval by the department of a contract between a managed care organization and a behavioral health and dental subcontractor for services provided under the HUSKY Plan, Part A or the HUSKY Plan, Part B, or both, the managed care organization shall submit a plan to the department for the resolution of any outstanding claims submitted by providers to a previous behavioral health or dental subcontractor of the managed care organization for services provided to members enrolled in the HUSKY Plan, Part A or the HUSKY Plan, Part B, or both. Such plan for the resolution of outstanding claims shall include a claims aging inventory report and shall comply with the terms of the contract between the department and the managed care organization.

(e) The Commissioner of Social Services shall establish a fee schedule, to be effective from July 1, 2006, to July 1, 2008, for dental services provided under the HUSKY Plan to children under the age of thirteen. The schedule shall provide for a fee for each dental service that is equal to seventy per cent of the average insurance reimbursement for such dental service in this state.

(f) The Commissioner of Social Services shall evaluate whether the fee schedule established pursuant to subsection (e) of this section results in improved access to oral health care for enrollees under the age of thirteen and shall submit a report of the evaluation, along with any recommendations, not later than December 31, 2007, to the joint standing committees of the General Assembly having cognizance of matters relating to human services and public health, in accordance with the provisions of section 11-4a.

Sec. 3. Section 20-113b of the 2006 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2006):

(a) Any person who practices dentistry for no fee, for at least one hundred hours per year at a public health facility, as defined in section 20-126l, as amended, and does not otherwise engage in the practice of dentistry, shall be eligible to renew a license, as provided in subsection (a) of section 19a-88, as amended, without payment of the professional services fee specified in said subsection (a).

(b) Any person licensed under this chapter who provides dental services to Medicaid recipients for at least one hundred hours per year shall be eligible to renew a license, as provided in subsection (a) of section 19a-88, as amended, for a fee of two hundred twenty-five dollars.

Sec. 4. (NEW) (Effective from passage) Not later than January 1, 2007, the Department of Public Health shall appoint a community oral health coordinator for each region of the state with few or no programs designed to expand dental services to populations that have limited access to dental care. Community oral health coordinators shall be responsible for helping parents or legal guardians secure dental care for children residing in such regions who have been identified as needing dental care by a school nurse, or in the absence of such nurse, any other nurse licensed pursuant to the provisions of chapter 378 of the general statutes, including a nurse employed by, or providing services under the direction of a local or regional board of education at, a school-based health clinic.

Statement of Purpose:

To increase the reimbursement rate for dentists who provide dental services under the state's medical assistance program or the HUSKY Plan and to improve access to oral health care.

[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.]