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

     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:

     Legislative intent.

     (1) Every child is born with the foundations to have good oral health which should last

throughout their lifetime. What alters an individual’s ability to receive basic, quality oral health

care depends on their ability to access dental providers and obtain treatments is often equated to

insurance coverage determined by their socioeconomic status.

     (2) Good oral health from birth is a critical component of overall well-being and is essential

to an individual’s quality of life. A healthy mouth is meant to last a lifetime and contributes to an

individual's self-esteem as well as to their total overall health.

     (3) Cavities remain the most prevalent, chronic and curable disease of childhood, but some

100 million Americans fail to visit dental offices for routine and preventive care.

     (4) Untreated dental decay can cause pain and infection and increases the problems with

eating, digestive disorders, and can affect speech development. Between the years 2015 and 2019,

an average of four hundred sixteen (416) children, under the age of twenty-one (21), were treated

for primary dental related conditions in RI emergency rooms. Between 2010 and 2019, an average

of seventy-six (76) children, under the age of twenty (20), were hospitalized with a diagnosis that

included oral health conditions. Within the same period eighteen (18) individuals, under the age of

twenty (20), were hospitalized for oral health conditions as the primary reason for admittance.

     (5) Oral health inequities exists in all ages and if not addressed at an early age are

compounded with an exponential rise in the cost of care. Issues surrounding oral health disparities

and equities are multifaceted, including workforce (recruitment, retention, advancement), oral

surgery access, preventive and restorative care.

     (6) Children, adults (individuals over twenty-one (21) years old) and the elderly are reliant

on in-network Medicaid providers to provide basic essential dental care that adds to the overall

well-being and reduces the prevalence of natural dentition loss and emergency room care.

     (7) Costs in providing dental care has increased significantly over the last thirty (30) years

and more with impact of COVID-19. Commercial and Medicaid reimbursements have not

maintained pace with inflation.

     (8) Medicaid reimbursement rates for dental treatment and providers have not been

increased since 1992. As a result, fewer than nineteen percent (19%) of Rhode Island dentists

participate in Medicaid. Rhode Island dentist participation in Rhode Island is the third lowest in the

U.S. according to data from the American Dental Association. The reimbursement rate to private

practices is less than half of neighboring Massachusetts and Connecticut.

     (9) Rhode Island increased its primary care investment by nearly forty percent (40%)

between 2008 and 2012 which led to ninety-five percent (95%) of practice sites achieving “medical

home” status.

     (10) An increased investment in dental health care services which includes all ages for

treatment services, is anticipated to increase access to care and decrease overall costs to the health

care system by reducing hospital OR utilization and ER and inpatient care similar to the results

achieved by increasing primary care investment.

     (11) Therefore, the state of Rhode Island reaffirms its commitment to achieving parity and

hereby requires all commercial and public payors to increase their rates of reimbursement for all

in-network dental care services.

     SECTION 1. Chapter 40-8 of the General Laws entitled "Medical Assistance" is hereby

amended by adding thereto the following section:

     40-8-33. Rates of payment for in-network dental care services.

     (a) Effective January 1, 2023, Rhode Island Medicaid and its contracted managed care

entities shall increase rates of reimbursement for each in-network dental care service, by a

minimum of sixty percent (60%) over the following five (5) years, with a minimum increase in the

first year of twenty-five percent (25%) and a minimum increase of eight and seventy-five

hundredths percent (8.75%) each year thereafter. The total minimum increase of sixty percent

(60%) must be completed on or before July 1, 2027.

     (b) Each of Rhode Island Medicaid’s contracted managed care entities shall collect and

provide the executive office of health and human services (EOHHS), in a form and frequency

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acceptable to EOHHS, information and data reflecting its increase to reimbursement rates for each

in-network dental care service and hospital service.

     (c) On or before July 1, 2023, EOHHS, in collaboration with the office of the insurance

commissioner shall issue a report to the general assembly which shall include recommendations

for evidence-based rate increases to be applied to each in-network dental care service. This report

shall include a justified cost estimate to implement such rate increase recommendations.

     (d) EOHHS shall monitor how reimbursement rate increases described in this section affect

patient access to dental care services, including, but not limited to, any changes related to dental

health care network adequacy. On or before July 1, 2023, and each July 1 thereafter, EOHHS shall

report any changes to dental health care access and network adequacy to the general assembly.

     (e) On or before July 1, 2027, EOHHS shall notify the general assembly in writing and post

a report to the general public on their website when each contracted managed care entity has met

their rate increase obligations as described in this section.

     (f) Non-compliance with this section shall require a corrective plan of action within ninety

(90) days of notice by the EOHHS.

     (g) EOHHS shall promulgate such rules and regulations to effectuate the purpose, efficient

administration and enforcement of this section.

     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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     This act would increase the Medicaid rate of reimbursement for in-network dental care

services.

     This act would take effect upon passage.

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