Christine Jordan Sexton
The Legislative dogfight over Medicaid dental care appears to be resolved after a House panel on Wednesday amended its bill to allow dental care to continue to be provided by separate Medicaid managed care plans.
While the move brings HB 7047 closer to its Senate counterpart, the House bill still contains mandatory contracting requirements for faculty teaching plans and other hospital providers referred to in the bill as “essential providers.”
Sponsored by Rep. Sam Garrison, HB 7047 contains language that would prohibit the state from auto-assigning Medicaid beneficiaries who did not choose a health plan to any health plan that has more than a 50% market share in a region.
The language is meant to address Centene Corporation’s acquisition of WellCare Health Plans, Inc. in the Medicaid managed care market.
Neither the mandatory contracting requirements nor the auto assignment language is included in SB 1950, filed by Sen. Jason Brodeur. That bill has cleared two Senate panels and is waiting to be heard by the Senate Appropriations Committee.
Pensacola dentist Jacinta Watkins said the decision to keep dental bifurcated from the state’s mandatory Medicaid managed care program is a good move for the patients.
“Having dental carved back out as it has been in the past really means dental providers in our Medicaid managed dental plans have the opportunity to communicate with the (Agency for Health Care Administration) directly that communication is very valuable, and we all support that in the dental profession,” Watkins told Florida Politics on Wednesday.
“On the realistic side, it allows me as a provider to be able to contact insurance representatives if there is a patient that has to have treatment completed or needs to be sedated in a much more timely manner. When dentistry was carved in previously, it would take me a long time to be able to try to get treatment coordinated for a patient. So it’s a big win for us.”
While the House allows dental care to continue to operate independently, the House bill did include language to require dental plans and non-dental plans to have coordination of benefit agreements in place by Oct. 1. The amended bill also requires AHCA to establish provider network requirements for dental plans.
Florida has twice procured its Medicaid managed care program. The current contracts it has with managed medical assistance, long term care plans and specialty plans expire Dec. 31, 2024. The Medicaid dental contracts also expire Dec. 31, 2024.
The DeSantis administration has made revamping the state’s mandatory Medicaid managed care laws a priority during the 2022 Session. Medicaid officials want the changes to be passed now so they are in effect when developing the procurement documents.
Specifically, the agency wants to reduce the number of Medicaid regions from 11 to eight and wants to alter the law so it can issue one Medicaid managed care procurement instead of the 11 it has been issuing.
But with a little more than two weeks left in the 2022 Session, House and Senate Republicans still have differences to work out in their rival Medicaid bills.
“Everyone knows at the start of the negotiations what the outcome will be,” Garrison said. “I cannot imagine a scenario where these sophisticated parties can’t sit together and negotiate some of these terms.”
The House has not backed off its position that essential providers have contracts with every Medicaid managed care plan in the state. But the lengthy amendment members of the House Health & Human Services Committee tagged on Wednesday altered the contracting mandate for regional perinatal intensive care centers, requiring them to contract with all regionally contracted Medicaid managed care plans.
The amendment fleshes out the contracting requirement, adding mediation requirements and timelines. The bill would require any essential provider that does not have all the required contracts to enter mediation by June 30. Mediators must submit a report to AHCA by Oct. 1 showing the outcome of all mediation they presided over.
The state is required by Jan. 1 to withhold any supplemental payments from essential providers that do not have all the mandated contracts signed.
Safety Net Hospital Alliance of Florida CEO Justin Senior said his association continues to oppose the mandatory contracting language in the bill.
