Bill Text: NH HB692 | 2019 | Regular Session | Amended


Bill Title: Relative to dental care for Medicaid recipients.

Spectrum: Partisan Bill (Democrat 7-0)

Status: (Enrolled) 2019-06-27 - Enrolled (In recess 06/27/2019); Senate Journal 21 [HB692 Detail]

Download: New_Hampshire-2019-HB692-Amended.html

HB 692-FN - AS AMENDED BY THE SENATE

 

14Mar2019... 0748h

04/18/2019   1465s

2019 SESSION

19-0668

01/03

 

HOUSE BILL 692-FN

 

AN ACT relative to dental care for Medicaid recipients.

 

SPONSORS: Rep. Bernet, Hills. 4; Rep. Thompson, Ches. 14; Rep. Schapiro, Ches. 16; Rep. Swinburne, Ches. 10; Rep. Von Plinsky, Ches. 7; Sen. Chandley, Dist 11; Sen. Feltes, Dist 15

 

COMMITTEE: Health, Human Services and Elderly Affairs

 

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AMENDED ANALYSIS

 

This bill authorizes the Medicaid managed care program to provide dental benefits to covered persons.  Under this bill, the commissioner of the department of health and human services shall convene a working group to develop a value-based dental benefit.

 

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Explanation: Matter added to current law appears in bold italics.

Matter removed from current law appears [in brackets and struckthrough.]

Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

14Mar2019... 0748h

04/18/2019   1465s 19-0668

01/03

 

STATE OF NEW HAMPSHIRE

 

In the Year of Our Lord Two Thousand Nineteen

 

AN ACT relative to dental care for Medicaid recipients.

 

Be it Enacted by the Senate and House of Representatives in General Court convened:

 

1  Medicaid Managed Care Program; Dental Benefits.  Amend RSA 126-A:5, XIX(a) to read as follows:

XIX.(a)  The commissioner shall employ a managed care model for administering the Medicaid program and its enrollees to provide for managed care services for all Medicaid populations throughout New Hampshire consistent with the provisions of 42 U.S.C. section 1396u-2.  Models for managed care may include, but not be limited to, a traditional capitated managed care organization contract, an administrative services organization, an accountable care organization, or a primary care case management model, or a combination thereof, offering the best value, quality assurance, and efficiency, maximizing the potential for savings, and presenting the most innovative approach compared to other externally administered models.  The department shall present the opportunities of the various models or combination of models with a recommendation for the best managed care model for New Hampshire, no later than July 15, 2011, to the fiscal committee of the general court which shall consult with the oversight committee on health and human services.  Services to be managed within the model shall include all mandatory Medicaid covered services and may include, but shall not be limited to, care coordination, utilization management, disease management, pharmacy benefit management, provider network management, quality management, and customer services.  [The model shall not include mandatory dental services.] The commissioner shall issue a 5-year request for proposals to enter into contracts with the vendors that demonstrate the greatest ability to satisfy the state's need for value, quality, efficiency, innovation, and savings.  The request for proposals shall be released no later than October 15, 2011.  The vendors of the managed care model or combination of models demonstrating the greatest ability to satisfy the state's need for value, quality, efficiency, innovation, and savings shall be selected no later than January 15, 2012 with final contracts submitted to the governor and council no later than March 15, 2012 unless this date is extended by the fiscal committee.  After the bidding process, the commissioner shall establish a capitated rate based on the bids by the appropriate model for the contract that is full risk to the vendors.  The capitated rate shall be broken down into rate cells for each population including, but not limited to, the persons eligible for temporary assistance to needy families (TANF), aid for the permanently and totally disabled (APTD), breast and cervical cancer program (BCCP), home care for children with severe disabilities (HC-CSD), and those residing in nursing facilities.  The capitated rate shall be approved by the fiscal committee of the general court.  The managed care model or models' selected vendors providing the Medicaid services shall establish medical homes and all Medicaid recipients shall receive their care through a medical home.  In contracting for a managed care model and the various rate cells, the department shall ensure no reduction in the quality of care of services provided to enrollees in the managed care model and shall exercise all due diligence to maintain or increase the current level of quality of care provided.  The target date for implementation of the contract is July 1, 2012.  The commissioner may, in consultation with the fiscal committee, adopt rules, if necessary, to implement the provisions of this paragraph.  The department shall seek, with the approval of the fiscal committee, all necessary and appropriate waivers to implement the provisions of this paragraph.

2  Department of Health and Human Services; Adult Dental Benefit; Development of Plan.  The department of health and human services shall develop a plan for the incorporation of an adult dental benefit into a value-based care platform, as follows:

I.  In this section, "value-based care" means an oral health care delivery model in which providers are paid based upon making positive health outcomes while reducing costs.

II.  No later than 30 days after the effective date of this section, the department shall convene a working group consisting, at a minimum, of representatives of the following stakeholders: each managed care plan under contract with the state, the New Hampshire Oral Health Coalition, a public health dentist and a solo private practice dentist recommended by the New Hampshire Dental Society, the New Hampshire Dental Hygienist Association, and the Bi-State Primary Care Association, a representative of a New Hampshire dental insurance carrier designated by the governor, 2 members of the house of representatives, one of whom shall be from the majority party and one of whom shall be from the minority party, appointed by the speaker of the house of representatives, 2 members of the senate, one of whom shall be from the majority party and one of whom shall be from the minority party,  appointed by the president of the senate, a member of the commission to evaluate the effectiveness and future of the New Hampshire granite advantage health care program designated by the commission, and 2 members of the New Hampshire medical care advisory committee, one of whom shall be a consumer advocate, designated by the committee.

III.  The working group shall be convened by the commissioner of health and human services and shall be subject to RSA 91-A.  The department, in consultation with the working group, shall prepare a plan for the implementation of an adult dental benefit into a value-based care platform.  Each plan shall include, at a minimum, a detailed description of the following: eligibility and enrollment covered benefits and scope of services, cost benefit analysis including projected expenditures and anticipated cost savings, transition planning, prior authorization, transportation, pharmacy, case management, network adequacy, credentialing, quality metrics and outcome measurements, patient safety, utilization management, finance and reimbursement, rates and payment, grievance and appeals, and office of ombudsman.  Each plan shall also address how the incorporation of the services into a value-based care platform shall achieve the legislative intent of providing value, quality, efficiency, innovation, and savings.

IV.  Under no circumstances shall a fee for service model be included in the plan.  The plan shall promote the development of an adult value-based dental benefit and/or an alternative payment model.

3  Reports.

I.  The department of health and human services shall present an update on the status of the plan preparation each month to the fiscal committee of the general court and the oversight committee on health and human services, established in RSA 126-A:13, until the plan has been implemented.  The department's updates shall also include managed care organization and department readiness for implementation.

II.  No later than October 1, 2019, the commissioner shall submit to the speaker of the house of representatives, the president of the senate, and the governor, all proposed changes to state law the commissioner believes may be necessary for the incorporation of an adult dental benefit into a value-based care platform.

4  Effective Date.  This act shall take effective July 1, 2019.

 

LBAO

19-0668

Amended 3/18/19

 

HB 692-FN- FISCAL NOTE

AS AMENDED BY THE HOUSE (AMENDMENT #2019-0748h)

 

AN ACT relative to dental care for Medicaid recipients.

 

FISCAL IMPACT:      [ X ] State              [    ] County               [    ] Local              [    ] None

 

 

 

Estimated Increase / (Decrease)

STATE:

FY 2020

FY 2021

FY 2022

FY 2023

   Appropriation

$0

$0

$0

$0

   Revenue

$0

$0

$0

$0

   Expenditures

Indeterminable Increase

Indeterminable Increase

Indeterminable Increase

Indeterminable Increase

Funding Source:

  [ X ] General            [    ] Education            [    ] Highway           [    ] Other

 

 

 

 

 

METHODOLOGY:

This bill amends RSA 126-A:5, XIX by removing the prohibition against including dental services under Medicaid managed care and requires the Commissioner of the Department of Health and Services to develop and implement a program to allow the Medicaid managed care organizations to provide dental benefits to its enrollees.

 

The Department states there were 84,724 adults aged 21 and older enrolled in the Medicaid program, of which 47,937 were participating via Medicaid Expansion as of January 1, 2019.  The Department also notes New Hampshire Medicaid currently provides dental services to children enrolled in the Medicaid program and provides limited emergency dental services on a fee for service basis to adult Medicaid enrollees.  However, the Department states it is unable to provide cost estimates without sufficient information about the program or benefit design, which the bill does not include.

 

AGENCIES CONTACTED:

Department of Health and Human Services

 

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