NC H883

Department of Health and Human Services shall enter into capitated contracts with at least two prepaid dental plans to provide dental services to Medicaid and NC Health Choice recipients statewide across all 100 counties.

Prepaid dental plans must be licensed as prepaid ambulatory health plans, prohibited from outsourcing without DHHS authorization, and compensated on a prepaid capitated basis with rates that are actuarially sound and risk-adjusted.

At least 85% of contracting fees must directly offset patient care costs and health quality improvements, with no more than 15% spent on administrative costs.

Prepaid dental plans and providers must submit data through the Health Information Exchange Network and track operational metrics including patient access, provider networks, claims processing timelines, enrollee complaints, emergency room utilization, and oral health improvements.

DHHS shall submit any necessary waiver applications and State Plan amendments to the Centers for Medicare & Medicaid Services by January 1, 2020 to align implementation with overall Medicaid transformation.