The proposed legislation, General Assembly Raised Bill No. 1299, aims to amend the current Medicaid-covered dental care provisions in Connecticut, effective July 1, 2025. Key changes include the requirement for prior authorization for all nonemergency dental services under the Department of Social Services' dental programs, with certain exceptions for diagnostic, preventive, and basic restoration procedures, as well as nonsurgical extractions. The bill establishes a payment cap of $1,000 per calendar year for adult nonemergency dental services, although prevention services like oral exams and dental cleanings, along with medically necessary services such as dentures, are exempt from this cap. Additionally, the Commissioner of Social Services is granted the authority to recoup payments for services deemed unnecessary or not related to emergency conditions.

Further modifications to the nonemergency adult dental services under Medicaid are outlined, including the provision of two dental cleanings and one set of bitewing x-rays annually for healthy adults. The bill also introduces a new section that mandates separate billing for dental services provided at mobile dental clinics, school-based health centers, or expanded school health sites, ensuring that Medicaid payments are made for each service rather than through a bundled payment system. The Commissioner is tasked with implementing necessary policies and procedures while adopting regulations, with a requirement to post notice of intent to adopt these regulations on the eRegulations System.

Statutes affected:
Raised Bill:
HS Joint Favorable:
File No. 88:
APP Joint Favorable: