FIRST REGULAR SESSION
[PERFECTED]
HOUSE COMMITTEE SUBSTITUTE FOR
93RD GENERAL ASSEMBLY
Reported from the Committee on Insurance March 30, 2005 with recommendation that House Committee Substitute for House Bill No. 400 Do Pass. Referred to the Committee on Rules pursuant to Rule 25(26)(f).
Reported from the Committee on Rules April 4, 2005 with recommendation that House Committee Substitute for House Bill No. 400 Do Pass with no time limit for debate.
Taken up for Perfection April 19, 2005. House Committee Substitute for House Bill No. 400 ordered Perfected and printed as amended.
STEPHEN S. DAVIS, Chief Clerk
0214L.02P
AN ACT
To amend chapter 208, RSMo, by adding thereto five new sections relating to the dental carve-out act of 2005.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Chapter 208, RSMo, is amended by adding thereto five new sections, to be known as sections 208.675, 208.678, 208.680, 1 and 2, to read as follows:
208.675. Sections 208.675 to 208.680 shall be known and may be cited as the "Dental Carve-Out Act of 2005".
208.678. 1. The division of medical services within the department of social services shall maintain and implement a process for managing dental benefits to public assistance recipients. Such process may include, but is not limited to, innovative risk management payment methodologies, streamlined information systems, Health Insurance Portability and Accountability Act compliance, comprehensive quality programs, outreach programs, fraud and abuse processes, systematic claim interrogation processes, and case evaluations to determine the medical necessity and appropriateness of a patient's treatment. The division shall contract with a single source private entity to provide dental program management services in coordination with the division.
2. The division may place coverage limits on dental services and the frequency of services to:
(1) Prevent fraud, abuse, waste, and over utilization or inappropriate utilization; or
(2) Implement a dental benefit management program; except that, the division shall not limit or restrict access to federal and state-mandated benefits.
3. The division shall establish a statewide uniform dental program administered by a single private entity; except that, the division shall not require a dentist to alter a patient's previously authorized course of treatment unless such alteration is warranted by the patient's condition as initiated by the dentist. Any decision regarding limitations imposed on any dental benefit shall be based on sound clinical practice guidelines.
4. The single source private entity which receives the contract to provide the dental program management services shall not discriminate against any dentist licensed in this state who is willing to meet the terms and conditions set equally for all dentists for participation established by such entity.
208.680. 1. The division shall promulgate rules in accordance with state and federal law to implement the provisions of sections 208.675 to 208.680. Any rule or portion of a rule, as that term is defined in section 536.010, RSMo, that is created under the authority delegated in this section shall become effective only if it complies with and is subject to all of the provisions of chapter 536, RSMo, and, if applicable, section 536.028, RSMo. This section and chapter 536, RSMo, are nonseverable and if any of the powers vested with the general assembly pursuant to chapter 536, RSMo, to review, to delay the effective date, or to disapprove and annul a rule are subsequently held unconstitutional, then the grant of rulemaking authority and any rule proposed or adopted after August 28, 2005, shall be invalid and void.
2. If any provision of sections 208.675 to 208.680 or any application thereof is held invalid, such invalidity shall not affect any other provision or application of sections 208.675 to 208.680 which can be given effect without the invalid provisions or application.
Section 1. Any entity submitting a bid for a program established under the provisions of this act, shall be actuarially sound and shall provide proof of network and adequacy of network prior to the submission of the bid. No bid shall be accepted by the state of Missouri without meeting the provisions established by this section.
Section 2. The attorney general shall have full prosecutorial authority over any provider or recipient in any program established by this act.