LRB-3741/2
RLR:wlj:jf
2007 - 2008 LEGISLATURE
March 13, 2008 - Introduced by Senators Lassa and
Darling, cosponsored by
Representatives Mason, Sinicki, A. Williams and Zepnick. Referred to
Committee on Health, Human Services, Insurance, and Job Creation.
SB573,1,2
1An Act to create 49.45 (54) of the statutes;
relating to: dental services managed
2care pilot program under the Medical Assistance program.
Analysis by the Legislative Reference Bureau
Currently, the Department of Health and Family Services (DHFS) administers
the Medical Assistance (MA) program, which provides health care benefits for
certain low-income individuals. This bill requires DHFS to establish a pilot project
to provide dental services to MA recipients under a managed care system. The bill
requires DHFS to identify 15 to 25 counties, from a federal listing of counties with
health professional shortage areas for dental care, as the pilot area. Under the bill,
DHFS must contract with an entity to provide dental services, for a capitated
monthly payment, to MA recipients who are pregnant or under 21 years of age and
who reside in the pilot area. The entity must have a network of dentists who serve
the pilot area, and must allow each MA recipient in the pilot area who is pregnant
or under 21 years of age to select any dentist in the entity's network. The entity must
pay dentists in its network the same rate for serving an MA recipient who is pregnant
or under age 21 as for providing the same services to an individual who is not an MA
recipient. The bill ends the requirement that DHFS administer the pilot project on
January 1, 2014.
For further information see the state fiscal estimate, which will be printed as
an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
SB573, s. 1
1Section
1. 49.45 (54) of the statutes is created to read:
SB573,2,52
49.45
(54) Dental managed care pilot. (a) The department shall contract with
3an entity to provide, for a monthly capitated rate, dental services under sub. (2) (b)
41. to all recipients of medical assistance who reside in the pilot area under par. (b)
5and are pregnant or under 21 years of age.
SB573,2,106
(b) The department shall identify 15 to 25 counties, including Milwaukee
7County, from the list of Wisconsin counties with health professional shortage areas
8for dental care, compiled by the health resources and services administration of the
9federal department of health and human services. The counties identified by the
10department shall be the pilot area under this subsection.
SB573,2,1211
(c) The entity with which the department contracts under this subsection shall
12satisfy all of the following conditions:
SB573,2,1513
1. The entity shall have an agreement with more than one dentist in each
14county in the pilot area under par. (b) to participate in the entity's network of
15dentists.
SB573,2,1916
2. The entity shall allow each medical assistance recipient who is pregnant or
17under 21 years of age and is a resident of a county in the pilot area under par. (b) to
18obtain dental services from any dentist who participates in the entity's network of
19dentists.
SB573,2,2420
3. The reimbursement rates that the entity pays a dentist in its network for
21providing dental services under sub. (2) (b) 1. to a medical assistance recipient who
22is pregnant or under 21 years of age and resides in the pilot area shall be the same
23as the rates that the entity pays a dentist in its network to provide the same services
24to an individual who is not a medical assistance recipient.
SB573,3,2
1(d) The department shall enter into a contract under this subsection by
2January 1, 2010.
SB573,3,33
(e) This subsection does not apply after December 31, 2013.
