Bill Text: DE SB56 | 2013-2014 | 147th General Assembly | Draft
Bill Title: An Act To Amend Title 31 Of The Delaware Code Relating To Preventative And Urgent Dental Care For Medicaid Recipients.
Spectrum: Strong Partisan Bill (Democrat 10-1)
Status: (Introduced - Dead) 2013-06-12 - Reported Out of Committee (HEALTH & SOCIAL SERVICES) in Senate with 5 On Its Merits [SB56 Detail]
Download: Delaware-2013-SB56-Draft.html
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SPONSOR: |
Sen. Hall-Long & Rep. Keeley & Rep. Miro & Rep. Scott |
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Sens. Ennis, Marshall, Sokola; Reps. Carson, Kowalko, Mitchell |
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DELAWARE STATE SENATE 147th GENERAL ASSEMBLY |
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SENATE BILL NO. 56 |
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AN ACT TO AMEND TITLE 31 OF THE DELAWARE CODE RELATING TO PREVENTATIVE AND URGENT DENTAL CARE FOR MEDICAID RECIPIENTS. |
Section 1.Amend Chapter 5, Title 31 of the Delaware Code by making insertions as shown by underlining and deletions as shown by strikethrough and renumbering where appropriate as follows:
§502 Definitions.
As used in this chapter:
(1) "Applicant" means any person or family who applies for assistance or welfare services or on whose behalf such application is made under the terms of this chapter.
(2) "Assistance" means assistance to or on behalf of eligible needy persons or eligible families to enable them to improve their standard of living, including money payments, child care, job training, education, other support services, medical or surgical care, preventative or urgent dental care, nursing, burial, board and care in a private institution, adult foster care, rest residential facility for adults, public medical institution as a patient, or such other aid as may be deemed necessary.
(3) "Employable" refers to any person who:
a. Is between the ages of 18 and 54; and who
b. Is determined by the Department of Health and Social Services (pursuant to published regulations developed in consultation with the Department of Labor) to be physically and mentally able to work.
(4) "Medical advisory committee" means a committee appointed by the Secretary of the Department of Health and Social Services, composed of representatives from the field of medicine, osteopathy, dentistry, nursing, pharmacy, hospital services and such other fields concerned with health as the Secretary of the Department of Health and Social Services may deem appropriate, to provide to the board advice, recommendations and assistance in the formulation and administration of programs of medical and health care.
(5) "Medical assistance" means medical care, including preventative or urgent dental care, furnished on behalf of recipients who are eligible for assistance in any of the categories in §505 of this title.
(6) "Medical Care" means payment of all or part of the costs on behalf of eligible recipients; provided, that such payments are within the limitations of the funds appropriated by the General Assembly and the United States Congress for this purpose, for:
a. Inpatient hospital services;
b. Outpatient hospital services;
c. Other laboratory and X-ray services;
d. Nursing services;
e. Physician's services, whether furnished in the office, the patient's house, a hospital, a skilled nursing home or elsewhere;
f. Drugs and medicine; or
g Such other health services and supplies as specified by the Department on recommendation by the Medical Advisory Committee.
Such payments shall be made only to persons, institutions and entities which meet the standards as established by the Department of Health and Social Services and which promote safe and adequate treatment of individuals in the interest of public health and safety.
(7) "Preventative dental care" means payment of all or part of the costs on behalf of eligible recipients for fluoride treatments, teeth cleaning, restorative treatments, treatments to prevent periodontal disease and dental caries disease, and any other dental care or treatment which the Department of Health and Social Services shall authorize by regulation.
(7)(8)
"Recipient" means any person or family to whom or for whom assistance is
paid under this chapter.
(8)(9)
"Standard of need" means the subsistence level for a decent standard of
living established by regulations of the Department of Health and Social
Services.
(9)(10)
"Unemployable" means not employable.
(10)(11)
"Underemployment" and "unemployment" means as defined pursuant to regulations
of the Department of Social Services in consultation with the Department of
Labor.
(12) "Urgent dental care" means payment of all or part of the costs on behalf of eligible recipients for examinations, diagnostic radiographs, treatment of pain or infections, including tooth extractions, incisions and drainage, and any other dental care or treatment which the Department of Health and Social Services shall authorize by regulation.
§503Eligability for assistance; amount; method of payment.
(b)
Medicaid -- Medical assistance may be granted to medically and financially
eligible persons in accordance with Titles IV-A, IV-E, XVI, and XIX of the
Social Security Act [42 U.S.C. §§601 et seq., 670 et seq., 1381 et seq., and
1396 et seq.], federally approved waivers of these sections of the act, and
rules and regulations established by the Department of Health and Social
Services. Eligibility for and payment of medical assistance shall be determined
under policies and regulations established by the Department of Health and
Social Services. Eligibility standards, recipient copay and provider
reimbursement shall be set in accordance with state and federal mandates, state
and federal funding levels, approved waivers and rules and regulations
established by the Department. The amount of assistance in each case of medical
care shall not duplicate any other coverage or payment made or available for
the costs of such health services and supplies.
(1) Medicaid - Medical assistance, including preventative or urgent dental care, may be granted to medically and financially eligible persons in accordance with Titles IV-A, IV-E, XVI, and XIX of the Social Security Act [42 U.S.C. §§601 et. seq., 1381 et. seq., and 1396 et. seq.], federally approved waivers of these sections of the act, and rules and regulations established by the Department of Health and Social Services.Eligibility for and payment of medical assistance shall be determined under policies and regulations established by the Department of Health and Social Services.Eligibility standards, recipient co-pay and provider reimbursement shall be set in accordance with state and federal mandates, state and federal funding levels, approved waivers and rules and regulations established by the Department.The amount of assistance in each case of medical care shall not duplicate any other coverage or payment made or available for the costs of such health services and supplies.
(2) The amount of assistance provided to a recipient for preventative or urgent dental care, or any combination thereof, shall not exceed $1000.00 per year; provided, however, that in cases where multiple conditions which can or are causing pain exist, the State Dental Director may establish a review process through which extra benefit dollars, not exceeding an additional $1500.00 per eligible participant, may be authorized on an emergency basis for urgent dental care treatments.The reimbursement rate to participating dentists providing preventative or urgent dental care shall be the same as the reimbursement rate to participating dentists providing dental care to children enrolled in the Medicaid program.All payments for preventative or urgent dental care treatments shall be subject to a $10.00 recipient co-pay.
§505Categories of Assistance.
(3) Medicaid assistance; assistance granted in the form of medical care, including preventative or urgent dental care, to individuals eligible in accordance with Title IV-A, XVI, XIX of the Social Security Act [42 U.S.C. §§ 601 et seq., 1381 et seq., and 1396 et seq.], federally approved waivers, and rules and regulations established by the Department of Health and Social Services.
§512 Administration.
(7) Guarantee that assistance provided as medical care, including preventative or urgent dental care, when paid to providers of such medical care shall be on a prompt basis, usually not later than 30 days from the report of services by a physician, pharmacist or other professional health care provider, or 20 days from the report of services by a hospital or skilled nursing facility; provided, however, that should financial advances from the Department of Finance be necessary to carry out this chapter, they shall be permitted upon the concurrence of the Secretary of the Department of Finance and the Secretary of the Department of Health and Social Services.
Section 2.Effective Date.
This Act shall become effective upon appropriation by the General Assembly of funds sufficient to accomplish the purposes of this Act.
SYNOPSIS
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This Bill
expands |
Author: Senator Hall-Long
