The proposed General Assembly Raised Bill No. 1299 aims to amend the provisions related to Medicaid-covered dental care, 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 exemptions for diagnostic, preventive, and basic restoration procedures, as well as nonsurgical extractions. The bill establishes a payment cap of one thousand dollars per calendar year for adult individuals, although prevention services like oral exams and dental cleanings, along with medically necessary services such as dentures, will not be subject to this cap. Additionally, the bill allows the Commissioner of Social Services to recoup payments for services deemed unnecessary and mandates a quarterly review of payments for emergency dental services.

Further modifications include an increase in the number of dental cleanings provided annually to two for healthy adults, along with one periodic dental exam and one set of bitewing x-rays. The bill also introduces provisions for mobile dental clinics and school-based health centers, ensuring that separate dental services do not need to be bundled for Medicaid payment. The Commissioner is authorized to implement necessary policies and procedures while adopting regulations, with a requirement to post notice of intent to adopt regulations on the eRegulations System. The bill repeals and substitutes existing statutes to reflect these changes, streamlining the process for Medicaid dental care and enhancing access to necessary services.

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