89R14175 JG-D
By: Blanco S.B. No. 2628
A BILL TO BE ENTITLED
AN ACT
relating to the provision and evaluation of Medicaid reimbursement
for dental services provided to certain Medicaid recipients.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 32.054, Human Resources Code, is amended
by adding Subsections (g) and (h) to read as follows:
(g) In addition to dental services already covered under the
medical assistance program, the commission shall provide medical
assistance reimbursement for recipients who are 21 years of age or
older, including recipients with a disability, for dental services
needed for pain relief, infections, restoration of teeth, and
maintenance of dental health, including:
(1) preventative services; and
(2) therapeutic services for dental disease that, if
left untreated, may become acute dental problems or may cause
irreversible damage to the teeth or supporting structures.
(h) Notwithstanding Subsection (g), the commission may not
provide medical assistance reimbursement for the provision of
dental services under that subsection if, based on the data
evaluated under Section 32.0545, the Legislative Budget Board finds
that the provision of medical assistance reimbursement for those
services resulted in an increase in overall spending under the
medical assistance program.
SECTION 2. Subchapter B, Chapter 32, Human Resources Code,
is amended by adding Section 32.0545 to read as follows:
Sec. 32.0545. EVALUATION OF REIMBURSEMENT FOR CERTAIN
DENTAL SERVICES. (a) The commission shall:
(1) analyze data related to the provision of medical
assistance reimbursement for dental services provided to
recipients under Section 32.054(g); and
(2) provide to the Legislative Budget Board the data
described by Subdivision (1) in the form and manner the board
requires.
(b) The data analyzed by the commission and provided to the
Legislative Budget Board under Subsection (a) must:
(1) relate to three consecutive years, beginning with
the year immediately preceding the year in which medical assistance
reimbursement for the provision of dental services under Section
32.054(g) is initially provided; and
(2) include at least the following:
(A) the number of recipients who received those
dental services; and
(B) the type of dental services for which medical
assistance reimbursement was provided.
(c) The commission shall ensure the analysis under
Subsection (a) includes:
(1) appropriate demographic categories, including
recipient age, disability, and income; and
(2) the average cost per recipient for providing
dental services under the medical assistance program.
(d) Using the data the commission provides under Subsection
(a), the Legislative Budget Board shall evaluate cost and
utilization trends to determine whether providing medical
assistance reimbursement for the provision of dental services to
recipients under Section 32.054(g) resulted in an increase in
overall spending on the provision of dental services under the
medical assistance program.
(e) Not later than February 1, 2029, the Legislative Budget
Board shall:
(1) prepare and publish on the board's Internet
website a written report of its evaluation under Subsection (d);
and
(2) publish a summary of its findings, including a
specific finding regarding whether providing medical assistance
reimbursement for the provision of dental services to recipients
under Section 32.054(g) resulted in an increase in overall spending
on the provision of dental services under the medical assistance
program.
(f) The Legislative Budget Board shall provide to the
commission a draft of the report described by Subsection (e)(1) not
later than the 30th day before the date the board publishes the
report on the board's Internet website.
(g) If the Legislative Budget Board finds that:
(1) providing medical assistance reimbursement for
the provision of dental services under Section 32.054(g) resulted
in an increase in overall spending on the provision of dental
services under the medical assistance program:
(A) the commission shall immediately discontinue
providing reimbursement for those services; and
(B) Sections 32.054(g) and (h) and this section
expire; or
(2) providing medical assistance reimbursement for
the provision of dental services under Section 32.054(g) did not
result in an increase in overall spending on the provision of dental
services under the medical assistance program, Section 32.054(h)
and this section expire.
SECTION 3. If before implementing any provision of this Act
a state agency determines that a waiver or authorization from a
federal agency is necessary for implementation of that provision,
the agency affected by the provision shall request the waiver or
authorization and may delay implementing that provision until the
waiver or authorization is granted.
SECTION 4. This Act takes effect September 1, 2025.