OFA Bill Analysis

HR 8

RESOLUTION APPROVING THE SETTLEMENT AGREEMENT IN CARR V. WILSON-COKER, COMMISSIONER, DEPARTMENT OF SOCIAL SERVICES.

SUMMARY:

The settlement requires increased state funding during the term of the agreement. Such required funding has been included in the current year's budget and in the Governor's recommended budget for fiscal year 2008-2009 with language that allows for a carry over of unused funds from the current year.

The settlement term is four years, commencing on the date that the District Court approves the Settlement Agreement. Under the settlement, the state takes HUSKY dental services from the managed care companies and administers dental services through an administrative services organization that will be responsible for acting as the Department's agent for such purposes as provider enrollment and utilization review. The Department of Social Services (DSS) must aggressive recruit new dental care providers and provide scheduling assistance for children who need help setting up dental appointments. DSS must track dental services for each HUSKY child utilizing claims data. Reminder notices will be sent to a child who is overdue for a dental appointment.

DSS must also send notices to clients informing them of the availability of EPSDT dental services, implement EPSDT dental case management, conduct outreach to clients, establish a Dental Policy Advisory Committee, reimburse pediatricians who provide oral health education and services to young children, allow Federally Qualified Health Centers (FQHC's) to bill for covered services that they provide even if the dentist is not enrolled in the HUSKY program.

DSS must provide $ 5 million in grants to non-profit, non-FQHC safety net providers, such as school based health clinics and hospital outpatient clinics, for the purposes of expanding access to services.

DSS must increase its dental services reimbursement rates to prescribed levels in accordance with a negotiated fee schedule which is attached to the agreement. It also pledges that the amount expended for child dental services will increase by at least $ 20 million over baseline expenditures, which should not be an issue given the negotiated fee increases.

The state must pay $ 300,000 in attorneys' fees.

EFFECTIVE DATE: Upon passage

Federal Court jurisdiction:

For four years from the date of the settlement, the plaintiffs may seek federal court enforcement of the settlement terms if the state is not in substantial compliance with the terms of the settlement.

COMMITTEE ACTION

Appropriations Committee

House Favorable