Utah Code 26B-3-208. Medicaid waiver for delivery of adult dental services
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(1)
Terms Used In Utah Code 26B-3-208
- Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
- CMS: means the Centers for Medicare and Medicaid Services within the United States Department of Health and Human Services. See Utah Code 26B-3-101
- Contract: A legal written agreement that becomes binding when signed.
- Division: means the Division of Integrated Healthcare within the department, established under Section 26B-3-102. See Utah Code 26B-3-101
- Equal: means , with respect to biological sex, of the same value. See Utah Code 68-3-12.5
- Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
- Medicaid program: means the state program for medical assistance for persons who are eligible under the state plan adopted pursuant to Title XIX of the federal Social Security Act. See Utah Code 26B-3-101
- State: when applied to the different parts of the United States, includes a state, district, or territory of the United States. See Utah Code 68-3-12.5
(1)(a) Before June 30, 2016, the department shall ask CMS to grant waivers from federal statutory and regulatory law necessary for the Medicaid program to provide dental services in the manner described in Subsection (2)(a).
(1)(b) Before June 30, 2018, the department shall submit to CMS a request for waivers, or an amendment of existing waivers, from federal law necessary for the state to provide dental services, in accordance with Subsections (2)(b)(i) and (d) through (f), to an individual described in Subsection (2)(b)(i).
(1)(c) Before June 30, 2019, the department shall submit to CMS a request for waivers, or an amendment to existing waivers, from federal law necessary for the state to:
(1)(c)(i) provide dental services, in accordance with Subsections (2)(b)(ii) and (d) through (f) to an individual described in Subsection (2)(b)(ii); and
(1)(c)(ii) provide the services described in Subsection (2)(g).
(1)(d) On or before January 1, 2024, the department shall submit to CMS a request for waivers, or an amendment of existing waivers, from federal law necessary for the state to provide dental services, in accordance with Subsections (2)(b)(iii) and (d) through (f), to an individual described in Subsection (2)(b)(iii).
(2)
(2)(a) To the extent funded, the department shall provide dental services to only blind or disabled individuals, as defined in 42 U.S.C. § 1382c(a)(1), who are 18 years old or older and eligible for the program.
(2)(b) Notwithstanding Subsection (2)(a):
(2)(b)(i) if a waiver is approved under Subsection (1)(b), the department shall provide dental services to an individual who:
(2)(b)(i)(A) qualifies for the health coverage improvement program described in Section 26B-3-207; and
(2)(b)(i)(B) is receiving treatment in a substance abuse treatment program, as defined in Section 26B-2-101, licensed under Chapter 2, Part 1, Human Services Programs and Facilities;
(2)(b)(ii) if a waiver is approved under Subsection (1)(c)(i), the department shall provide dental services to an individual who is an aged individual as defined in 42 U.S.C. § 1382c(a)(1); and
(2)(b)(iii) if a waiver is approved under Subsection (1)(d), the department shall provide dental services to an individual who is:
(2)(b)(iii)(A) not described in Subsection (2)(a);
(2)(b)(iii)(B) not described in Subsection (2)(b)(i);
(2)(b)(iii)(C) not described in Subsection (2)(b)(ii);
(2)(b)(iii)(D) not pregnant;
(2)(b)(iii)(E) 21 years old or older; and
(2)(b)(iii)(F) eligible for full services through the Medicaid program.
(2)(c) To the extent possible, services to individuals described in Subsection (2)(a) shall be provided through the University of Utah School of Dentistry and the University of Utah School of Dentistry’s associated statewide network.
(2)(d) The department shall provide the services to individuals described in Subsection (2)(b):
(2)(d)(i) by contracting with an entity that:
(2)(d)(i)(A) has demonstrated experience working with individuals who are being treated for both a substance use disorder and a major oral health disease;
(2)(d)(i)(B) operates a program, targeted at the individuals described in Subsection (2)(b), that has demonstrated, through a peer-reviewed evaluation, the effectiveness of providing dental treatment to those individuals described in Subsection (2)(b);
(2)(d)(i)(C) is willing to pay for an amount equal to the program’s non-federal share of the cost of providing dental services to the population described in Subsection (2)(b); and
(2)(d)(i)(D) is willing to pay all state costs associated with applying for the waiver described in Subsection (1)(b) and administering the program described in Subsection (2)(b); and
(2)(d)(ii) through a fee-for-service payment model.
(2)(e) The entity that receives the contract under Subsection (2)(d)(i) shall cover all state costs of the program described in Subsection (2)(b).
(2)(f) Each fiscal year, the University of Utah School of Dentistry shall, in compliance with state and federal regulations regarding intergovernmental transfers, transfer funds to the program in an amount equal to the program’s non-federal share of the cost of providing services under this section through the school during the fiscal year.
(2)(g) If a waiver is approved under Subsection (1)(c)(ii), the department shall provide coverage for porcelain and porcelain-to-metal crowns if the services are provided:
(2)(g)(i) to an individual who qualifies for dental services under Subsection (2)(b); and
(2)(g)(ii) by an entity that covers all state costs of:
(2)(g)(ii)(A) providing the coverage described in this Subsection (2)(g); and
(2)(g)(ii)(B) applying for the waiver described in Subsection (1)(c).
(2)(h) Where possible, the department shall ensure that dental services described in Subsection (2)(a) that are not provided by the University of Utah School of Dentistry or the University of Utah School of Dentistry’s associated network are provided:
(2)(h)(i) through free-for-service reimbursement until July 1, 2018; and
(2)(h)(ii) after July 1, 2018, through the method of reimbursement used by the division for Medicaid dental benefits.
(2)(i) Subject to appropriations by the Legislature, and as determined by the department, the scope, amount, duration, and frequency of services provided under this section may be limited.
(3)
(3)(a) If the waivers requested under Subsection (1)(a) are granted, the Medicaid program shall begin providing dental services in the manner described in Subsection (2) no later than July 1, 2017.
(3)(b) If the waivers requested under Subsection (1)(b) are granted, the Medicaid program shall begin providing dental services to the population described in Subsection (2)(b) within 90 days from the day on which the waivers are granted.
(3)(c) If the waivers requested under Subsection (1)(c)(i) are granted, the Medicaid program shall begin providing dental services to the population described in Subsection (2)(b)(ii) within 90 days after the day on which the waivers are granted.
(3)(d) If the waivers requested under Subsection (1)(d) are granted, the Medicaid program shall begin providing dental services to the population described in Subsection (2)(b)(iii) within 90 days after the day on which the waivers are granted.
(4) If the federal share of the cost of providing dental services under this section will be less than 55% during any portion of the next fiscal year, the Medicaid program shall cease providing dental services under this section no later than the end of the current fiscal year.