2022 -- S 2693 | |
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LC005037 | |
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STATE OF RHODE ISLAND | |
IN GENERAL ASSEMBLY | |
JANUARY SESSION, A.D. 2022 | |
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A N A C T | |
RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE | |
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Introduced By: Senators Mendes, Calkin, Bell, Anderson, Mack, and Acosta | |
Date Introduced: March 17, 2022 | |
Referred To: Senate Finance | |
It is enacted by the General Assembly as follows: | |
1 | Legislative intent. |
2 | (1) Every child is born with the foundations to have good oral health which should last |
3 | throughout their lifetime. What alters an individual’s ability to receive basic, quality oral health |
4 | care depends on their ability to access dental providers and obtain treatments is often equated to |
5 | insurance coverage determined by their socioeconomic status. |
6 | (2) Good oral health from birth is a critical component of overall well-being and is essential |
7 | to an individual’s quality of life. A healthy mouth is meant to last a lifetime and contributes to an |
8 | individual's self-esteem as well as to their total overall health. |
9 | (3) Cavities remain the most prevalent, chronic and curable disease of childhood, but some |
10 | 100 million Americans fail to visit dental offices for routine and preventive care. |
11 | (4) Untreated dental decay can cause pain and infection and increases the problems with |
12 | eating, digestive disorders, and can affect speech development. Between the years 2015 and 2019, |
13 | an average of four hundred sixteen (416) children, under the age of twenty-one (21), were treated |
14 | for primary dental related conditions in RI emergency rooms. Between 2010 and 2019, an average |
15 | of seventy-six (76) children, under the age of twenty (20), were hospitalized with a diagnosis that |
16 | included oral health conditions. Within the same period eighteen (18) individuals, under the age of |
17 | twenty (20), were hospitalized for oral health conditions as the primary reason for admittance. |
18 | (5) Oral health inequities exists in all ages and if not addressed at an early age are |
19 | compounded with an exponential rise in the cost of care. Issues surrounding oral health disparities |
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1 | and equities are multifaceted, including workforce (recruitment, retention, advancement), oral |
2 | surgery access, preventive and restorative care. |
3 | (6) Children, adults (individuals over twenty-one (21) years old) and the elderly are reliant |
4 | on in-network Medicaid providers to provide basic essential dental care that adds to the overall |
5 | well-being and reduces the prevalence of natural dentition loss and emergency room care. |
6 | (7) Costs in providing dental care has increased significantly over the last thirty (30) years |
7 | and more with impact of COVID-19. Commercial and Medicaid reimbursements have not |
8 | maintained pace with inflation. |
9 | (8) Medicaid reimbursement rates for dental treatment and providers have not been |
10 | increased since 1992. As a result, fewer than nineteen percent (19%) of Rhode Island dentists |
11 | participate in Medicaid. Rhode Island dentist participation in Rhode Island is the third lowest in the |
12 | U.S. according to data from the American Dental Association. The reimbursement rate to private |
13 | practices is less than half of neighboring Massachusetts and Connecticut. |
14 | (9) Rhode Island increased its primary care investment by nearly forty percent (40%) |
15 | between 2008 and 2012 which led to ninety-five percent (95%) of practice sites achieving “medical |
16 | home” status. |
17 | (10) An increased investment in dental health care services which includes all ages for |
18 | treatment services, is anticipated to increase access to care and decrease overall costs to the health |
19 | care system by reducing hospital OR utilization and ER and inpatient care similar to the results |
20 | achieved by increasing primary care investment. |
21 | (11) Therefore, the state of Rhode Island reaffirms its commitment to achieving parity and |
22 | hereby requires all commercial and public payors to increase their rates of reimbursement for all |
23 | in-network dental care services. |
24 | SECTION 1. Chapter 40-8 of the General Laws entitled "Medical Assistance" is hereby |
25 | amended by adding thereto the following section: |
26 | 40-8-33. Rates of payment for in-network dental care services. |
27 | (a) Effective January 1, 2023, Rhode Island Medicaid and its contracted managed care |
28 | entities shall increase rates of reimbursement for each in-network dental care service, by a |
29 | minimum of sixty percent (60%) over the following five (5) years, with a minimum increase in the |
30 | first year of twenty-five percent (25%) and a minimum increase of eight and seventy-five |
31 | hundredths percent (8.75%) each year thereafter. The total minimum increase of sixty percent |
32 | (60%) must be completed on or before July 1, 2027. |
33 | (b) Each of Rhode Island Medicaid’s contracted managed care entities shall collect and |
34 | provide the executive office of health and human services (EOHHS), in a form and frequency |
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1 | acceptable to EOHHS, information and data reflecting its increase to reimbursement rates for each |
2 | in-network dental care service and hospital service. |
3 | (c) On or before July 1, 2023, EOHHS, in collaboration with the office of the insurance |
4 | commissioner shall issue a report to the general assembly which shall include recommendations |
5 | for evidence-based rate increases to be applied to each in-network dental care service. This report |
6 | shall include a justified cost estimate to implement such rate increase recommendations. |
7 | (d) EOHHS shall monitor how reimbursement rate increases described in this section affect |
8 | patient access to dental care services, including, but not limited to, any changes related to dental |
9 | health care network adequacy. On or before July 1, 2023, and each July 1 thereafter, EOHHS shall |
10 | report any changes to dental health care access and network adequacy to the general assembly. |
11 | (e) On or before July 1, 2027, EOHHS shall notify the general assembly in writing and post |
12 | a report to the general public on their website when each contracted managed care entity has met |
13 | their rate increase obligations as described in this section. |
14 | (f) Non-compliance with this section shall require a corrective plan of action within ninety |
15 | (90) days of notice by the EOHHS. |
16 | (g) EOHHS shall promulgate such rules and regulations to effectuate the purpose, efficient |
17 | administration and enforcement of this section. |
18 | SECTION 2. This act shall take effect upon passage. |
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EXPLANATION | |
BY THE LEGISLATIVE COUNCIL | |
OF | |
A N A C T | |
RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE | |
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1 | This act would increase the Medicaid rate of reimbursement for in-network dental care |
2 | services. |
3 | This act would take effect upon passage. |
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