Florida Senate - 2023 SB 984 By Senator Osgood 32-01809-23 2023984__ 1 A bill to be entitled 2 An act relating to dental services under the Medicaid 3 program; amending s. 409.906, F.S.; revising adult 4 dental services as optional Medicaid services for 5 which the Agency for Health Care Administration may 6 pay; amending s. 409.973, F.S.; deleting provisions 7 relating to a specified report; deleting obsolete 8 language; extending the date by which the agency may 9 seek state plan amendments and federal waivers to 10 commence enrollment in the Medicaid prepaid dental 11 health program; extending the term of existing program 12 contracts with dental managed care providers; 13 providing requirements for minimum benefits provided 14 by the program; providing an effective date. 15 16 Be It Enacted by the Legislature of the State of Florida: 17 18 Section 1.Paragraphs (a) and (b) of subsection (1) of 19 section 409.906, Florida Statutes, are amended to read: 20 409.906Optional Medicaid services.Subject to specific 21 appropriations, the agency may make payments for services which 22 are optional to the state under Title XIX of the Social Security 23 Act and are furnished by Medicaid providers to recipients who 24 are determined to be eligible on the dates on which the services 25 were provided. Any optional service that is provided shall be 26 provided only when medically necessary and in accordance with 27 state and federal law. Optional services rendered by providers 28 in mobile units to Medicaid recipients may be restricted or 29 prohibited by the agency. Nothing in this section shall be 30 construed to prevent or limit the agency from adjusting fees, 31 reimbursement rates, lengths of stay, number of visits, or 32 number of services, or making any other adjustments necessary to 33 comply with the availability of moneys and any limitations or 34 directions provided for in the General Appropriations Act or 35 chapter 216. If necessary to safeguard the states systems of 36 providing services to elderly and disabled persons and subject 37 to the notice and review provisions of s. 216.177, the Governor 38 may direct the Agency for Health Care Administration to amend 39 the Medicaid state plan to delete the optional Medicaid service 40 known as Intermediate Care Facilities for the Developmentally 41 Disabled. Optional services may include: 42 (1)ADULT DENTAL SERVICES. 43 (a)The agency may pay for services medically necessary to 44 prevent disease and promote oral health, restore oral structures 45 to health and function, and treat emergency conditions, 46 emergency dental procedures to alleviate pain or infection. 47 Emergency dental care shall be limited to emergency oral 48 examinations, necessary radiographs, extractions, and incision 49 and drainage of abscess, for a recipient who is 21 years of age 50 or older. Such services include, but are not limited to, routine 51 diagnostic and preventive care, such as dental cleanings, 52 examinations, and X-rays; basic dental services, such as 53 fillings and extractions; major dental services, such as root 54 canals, crowns, and dentures and other dental prostheses; 55 emergency dental care; and other necessary services related to 56 dental and oral health. 57 (b)The agency may pay for full or partial dentures, the 58 procedures required to seat full or partial dentures, and the 59 repair and reline of full or partial dentures, provided by or 60 under the direction of a licensed dentist, for a recipient who 61 is 21 years of age or older. 62 Section 2.Subsection (5) of section 409.973, Florida 63 Statutes, is amended to read: 64 409.973Benefits. 65 (5)PROVISION OF DENTAL SERVICES. 66 (a)The Legislature may use the findings of the Office of 67 Program Policy Analysis and Government Accountabilitys report 68 no. 16-07, December 2016, in setting the scope of minimum 69 benefits set forth in this section for future procurements of 70 eligible plans as described in s. 409.966. Specifically, the 71 decision to include dental services as a minimum benefit under 72 this section, or to provide Medicaid recipients with dental 73 benefits separate from the Medicaid managed medical assistance 74 program described in this part, may take into consideration the 75 data and findings of the report. 76 (a)(b)In the event the Legislature takes no action before 77 July 1, 2017, with respect to the report findings required under 78 paragraph (a), The agency shall implement a statewide Medicaid 79 prepaid dental health program for children and adults with a 80 choice of at least two licensed dental managed care providers 81 who must have substantial experience in providing dental care to 82 Medicaid enrollees and children eligible for medical assistance 83 under Title XXI of the Social Security Act and who meet all 84 agency standards and requirements. To qualify as a provider 85 under the prepaid dental health program, the entity must be 86 licensed as a prepaid limited health service organization under 87 part I of chapter 636 or as a health maintenance organization 88 under part I of chapter 641. The contracts for program providers 89 shall be awarded through a competitive procurement process. 90 Beginning with the contract procurement process initiated during 91 the 2023 calendar year, the contracts must be for 6 years and 92 may not be renewed; however, the agency may extend the term of a 93 plan contract to cover delays during a transition to a new plan 94 provider. The agency shall include in the contracts a medical 95 loss ratio provision consistent with s. 409.967(4). The agency 96 is authorized to seek any necessary state plan amendment or 97 federal waiver to commence enrollment in the Medicaid prepaid 98 dental health program no later than March 1, 2024 2019. The 99 agency shall extend until December 31, 2025 2024, the term of 100 existing plan contracts awarded pursuant to the invitation to 101 negotiate published in October 2017. 102 (b)The minimum benefits provided by the Medicaid prepaid 103 dental health program for children younger than 21 years of age 104 must include all dental benefits required under the early and 105 periodic screening, diagnostic, and treatment services in 106 accordance with 42 U.S.C. s. 1396d(r)(3) and (5). 107 (c)The minimum benefits provided by the Medicaid prepaid 108 dental health program for enrollees aged 21 years of age or 109 older must cover services necessary to prevent disease and 110 promote oral health, restore oral structures to health and 111 function, and treat emergency conditions. Such services include, 112 but are not limited to, routine diagnostic and preventive care, 113 such as dental cleanings, examinations, and X-rays; basic dental 114 services, such as fillings and extractions; major dental 115 services, such as root canals, crowns, and dentures and other 116 dental prostheses; emergency dental care; and other necessary 117 services related to dental and oral health. 118 Section 3.This act shall take effect July 1, 2023.