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General Assembly Raised Bill No. 1299
January Session, 2025
LCO No. 4402
Referred to Committee on HUMAN SERVICES
Introduced by:
(HS)
AN ACT CONCERNING MEDICAID -COVERED DENTAL CARE.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Section 17b-282c of the general statutes is repealed and the 1
following is substituted in lieu thereof (Effective July 1, 2025): 2
(a) All nonemergency dental services provided under the 3
Department of Social Services' dental programs, as described in section 4
17b-282b, shall be subject to prior authorization. Nonemergency 5
services that are exempt from the prior authorization process shall 6
include diagnostic, prevention, basic restoration procedures and 7
nonsurgical extractions that are consistent with standard and reasonable 8
dental practices. Payment for nonemergency dental services shall not 9
exceed one thousand dollars per calendar year for an individual adult, 10
provided prevention services such as oral exams and dental cleanings 11
and services determined to be medically necessary, as defined in section 12
17b-259b, including dentures, shall not be subject to such payment cap. 13
Dental benefit limitations shall apply to each client regardless of the 14
number of providers serving the client. The commissioner may recoup 15
payments for services that are determined not to be for an emergency 16
condition or otherwise in excess of what is medically necessary. The 17 Raised Bill No. 1299
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commissioner shall periodically, but not less than quarterly, review 18
payments for emergency dental services and basic restoration 19
procedures for appropriateness of payment. For the purposes of this 20
section, "emergency condition" means a dental condition manifesting 21
itself by acute symptoms of sufficient severity, including severe pain, 22
such that a prudent layperson, who possesses an average knowledge of 23
health and medicine, could reasonably expect the absence of immediate 24
dental attention to result in placing the health of the individual, or with 25
respect to a pregnant woman, the health of the woman or her unborn 26
child, in serious jeopardy, cause serious impairment to body functions 27
or cause serious dysfunction of any body organ or part. 28
(b) The Commissioner of Social Services may implement policies and 29
procedures necessary to administer the provisions of this section while 30
in the process of adopting such policies and procedures as regulation, 31
provided the commissioner [prints] posts notice of intent to adopt 32
regulations [in] on the [Connecticut Law Journal] eRegulations System 33
not later than twenty days after the date of implementation. Policies and 34
procedures implemented pursuant to this section shall be valid until the 35
time final regulations are adopted. 36
Sec. 2. Section 17b-282d of the general statutes is repealed and the 37
following is substituted in lieu thereof (Effective July 1, 2025): 38
(a) The Commissioner of Social Services shall modify the extent of 39
nonemergency adult dental services provided under the Medicaid 40
program. Such modifications shall include, but are not limited to, 41
providing one periodic dental exam, [one dental cleaning] two dental 42
cleanings, periodontal therapy and one set of bitewing x-rays each year 43
for a healthy adult. For purposes of this section, "healthy adult" means 44
a person twenty-one years of age or older for whom there is no evidence 45
indicating that dental disease is an aggravating factor for the person's 46
overall health condition. 47
(b) The commissioner may implement policies and procedures 48
necessary to administer the provisions of this section while in the 49 Raised Bill No. 1299
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process of adopting such policies and procedures in regulation form, 50
provided the commissioner [prints] posts notice of intent to adopt 51
regulations [in] on the [Connecticut Law Journal] eRegulations System 52
not later than twenty days after the date of implementation. [Such 53
policies and procedures shall remain valid for three years following the 54
date of publication in the Connecticut Law Journal unless otherwise 55
provided for by the General Assembly. Notwithstanding the time 56
frames established in subsection (c) of section 17b-10, the commissioner 57
shall submit such policies and procedures in proposed regulation form 58
to the legislative regulation review committee not later than three years 59
following the date of publication of its intent to adopt regulations as 60
provided for in this subsection. In the event that the commissioner is 61
unable to submit proposed regulations prior to the expiration of the 62
three-year time period as provided for in this subsection, the 63
commissioner shall submit written notice, not later than thirty-five days 64
prior to the date of expiration of such time period, to the legislative 65
regulation review committee and the joint standing committees of the 66
General Assembly having cognizance of matters relating to human 67
services and appropriations and the budgets of state agencies indicating 68
that the department will not be able to submit the proposed regulations 69
on or before such date and shall include in such notice (1) the reasons 70
why the department will not submit the proposed regulations by such 71
date, and (2) the date by which the department will submit the proposed 72
regulations. The legislative regulation review committee may require 73
the department to appear before the committee at a time prescribed by 74
the committee to further explain such reasons and to respond to any 75
questions by the committee about the policy. The legislative regulation 76
review committee may request the joint standing committee of the 77
General Assembly having cognizance of matters relating to human 78
services to review the department's policy, the department's reasons for 79
not submitting the proposed regulations by the date specified in this 80
section and the date by which the department will submit the proposed 81
regulations. Said joint standing committee may review the policy, such 82
reasons and such date, may schedule a hearing thereon and may make 83
a recommendation to the legislative regulation review committee.] 84 Raised Bill No. 1299
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Sec. 3. (NEW) (Effective July 1, 2025) (a) As used in this section, (1) 85
"mobile dental clinic" has the same meaning as provided in section 17b-86
282f of the general statutes, and (2) "school-based health center" and 87
"expanded school health site" have the same meanings as provided in 88
section 19a-6r of the general statutes. 89
(b) The Commissioner of Social Services shall not require that 90
separate dental services and procedures be provided to a patient in a 91
single visit as a condition of Medicaid payment for Medicaid-eligible 92
dental services or treatment provided at a mobile dental clinic, school-93
based health center or expanded school health site. The commissioner 94
shall provide Medicaid payment for each Medicaid-eligible service and 95
procedure separately billed and not require that reimbursement be 96
provided through a bundled payment methodology that provides one 97
aggregate payment for separate dental services and procedures. The 98
commissioner shall, in accordance with the provisions of chapter 54 of 99
the general statutes, adopt regulations to implement the provisions of 100
this section. The commissioner may implement policies and procedures 101
necessary to administer the provisions of this section while in the 102
process of adopting such policies and procedures as regulation, 103
provided the commissioner posts notice of intent to adopt regulations 104
on the eRegulations System not later than twenty days after the date of 105
implementation. Policies and procedures implemented pursuant to this 106
section shall be valid until the time final regulations are adopted. 107
This act shall take effect as follows and shall amend the following
sections:
Section 1 July 1, 2025 17b-282c
Sec. 2 July 1, 2025 17b-282d
Sec. 3 July 1, 2025 New section
HS Joint Favorable