Medicaid Dental For Adults Ends If It Raises Dental Spending

The text as introduced · 728 words

89R14175 JG-D

By: Blanco
S.B. No. 2628

A BILL TO BE ENTITLED

AN ACT

relating to the provision and evaluation of Medicaid reimbursement

for dental services provided to certain Medicaid recipients.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Section 32.054, Human Resources Code, is amended

by adding Subsections (g) and (h) to read as follows:

(g) In addition to dental services already covered under the

medical assistance program, the commission shall provide medical

assistance reimbursement for recipients who are 21 years of age or

older, including recipients with a disability, for dental services

needed for pain relief, infections, restoration of teeth, and

maintenance of dental health, including:

(1) preventative services; and

(2) therapeutic services for dental disease that, if

left untreated, may become acute dental problems or may cause

irreversible damage to the teeth or supporting structures.

(h) Notwithstanding Subsection (g), the commission may not

provide medical assistance reimbursement for the provision of

dental services under that subsection if, based on the data

evaluated under Section 32.0545, the Legislative Budget Board finds

that the provision of medical assistance reimbursement for those

services resulted in an increase in overall spending under the

medical assistance program.

SECTION 2. Subchapter B, Chapter 32, Human Resources Code,

is amended by adding Section 32.0545 to read as follows:

Sec. 32.0545. EVALUATION OF REIMBURSEMENT FOR CERTAIN

DENTAL SERVICES. (a) The commission shall:

(1) analyze data related to the provision of medical

assistance reimbursement for dental services provided to

recipients under Section 32.054(g); and

(2) provide to the Legislative Budget Board the data

described by Subdivision (1) in the form and manner the board

requires.

(b) The data analyzed by the commission and provided to the

Legislative Budget Board under Subsection (a) must:

(1) relate to three consecutive years, beginning with

the year immediately preceding the year in which medical assistance

reimbursement for the provision of dental services under Section

32.054(g) is initially provided; and

(2) include at least the following:

(A) the number of recipients who received those

dental services; and

(B) the type of dental services for which medical

assistance reimbursement was provided.

(c) The commission shall ensure the analysis under

Subsection (a) includes:

(1) appropriate demographic categories, including

recipient age, disability, and income; and

(2) the average cost per recipient for providing

dental services under the medical assistance program.

(d) Using the data the commission provides under Subsection

(a), the Legislative Budget Board shall evaluate cost and

utilization trends to determine whether providing medical

assistance reimbursement for the provision of dental services to

recipients under Section 32.054(g) resulted in an increase in

overall spending on the provision of dental services under the

medical assistance program.

(e) Not later than February 1, 2029, the Legislative Budget

Board shall:

(1) prepare and publish on the board's Internet

website a written report of its evaluation under Subsection (d);

and

(2) publish a summary of its findings, including a

specific finding regarding whether providing medical assistance

reimbursement for the provision of dental services to recipients

under Section 32.054(g) resulted in an increase in overall spending

on the provision of dental services under the medical assistance

program.

(f) The Legislative Budget Board shall provide to the

commission a draft of the report described by Subsection (e)(1) not

later than the 30th day before the date the board publishes the

report on the board's Internet website.

(g) If the Legislative Budget Board finds that:

(1) providing medical assistance reimbursement for

the provision of dental services under Section 32.054(g) resulted

in an increase in overall spending on the provision of dental

services under the medical assistance program:

(A) the commission shall immediately discontinue

providing reimbursement for those services; and

(B) Sections 32.054(g) and (h) and this section

expire; or

(2) providing medical assistance reimbursement for

the provision of dental services under Section 32.054(g) did not

result in an increase in overall spending on the provision of dental

services under the medical assistance program, Section 32.054(h)

and this section expire.

SECTION 3. If before implementing any provision of this Act

a state agency determines that a waiver or authorization from a

federal agency is necessary for implementation of that provision,

the agency affected by the provision shall request the waiver or

authorization and may delay implementing that provision until the

waiver or authorization is granted.

SECTION 4. This Act takes effect September 1, 2025.