CS/CS/HB 27 Summary

• Creates a statewide Medicaid prepaid dental program (section 409.91205) separate from the managed medical assistance program, to be administered by contracting with at least two licensed prepaid dental health plans statewide.

• Requires the Agency for Health Care Administration to apply for federal state plan amendments or waivers necessary for implementation, with enrollment intended to begin no later than September 1, 2015.

• Prohibits the agency from extending existing prepaid dental health plan contracts and mandates competitive procurement of licensed plans that demonstrate extensive experience administering Medicaid dental benefits and maintaining statewide provider networks.

• Requires prepaid dental plans to submit encounter data and maintain a medical loss ratio of 85 percent, calculated on a statewide basis using uniform financial data consistent with 45 C.F.R. part 158.

• Directs the agency to submit annual reports by January 15 to the Governor and Legislature comparing benefits utilization, encounter data, program costs, contract compliance, access to care, and oral health indicators among enrolled recipients.

• Removes the requirement that managed care plans provide pediatric dental services under the Medicaid managed assistance program (amends section 409.973).