Section 2127 - Oral health care1.Access to quality oral health services. The department shall develop access to quality oral health services for low-income residents with emphasis on underserved areas or populations by encouraging the development or expansion of community-operated, nonprofit oral health care programs that serve persons who are uninsured or underinsured for oral health care and that serve persons whose oral health care is covered by Medicaid. [1999, c. 401, Pt. MM, §1(NEW); 1999, c. 401, Pt. MM, §5(AFF).]
2. Development of oral health care programs. The department shall use funds appropriated for the purposes of this chapter, any available funds from Medicaid or other resources to provide funding for the start-up or expansion of public or nonprofit oral health care programs; to subsidize the provision of oral health care to persons without insurance coverage for that care in accordance with paragraph B; and to provide oral health case management and community oral health education designed to encourage good oral hygiene and to prevent oral diseases and tooth decay. Any oral health care program receiving funds under this chapter must: A. Serve persons whose oral health care is covered by Medicaid; [1999, c. 401, Pt. MM, §1(NEW); 1999, c. 401, Pt. MM, §5(AFF).]B. Provide oral health care services to persons whose gross income is below 200% of the nonfarm income official federal poverty guidelines for whom insurance coverage is not available for the same payment as provided by Medicaid for the service if the subsidy described in this subsection is available. Persons without insurance to cover the service required and who have an income under 200% of the nonfarm income official federal poverty guidelines must be charged fees for oral health care on a sliding scale. The department shall establish the sliding scale by routine technical rules adopted pursuant to Title 5, chapter 375, subchapter II-A. The difference between the Medicaid rate and the payment made by the patient under the sliding fee arrangement must be paid to the oral health care program by the department. If a Medicaid rate is not established for a particular service provided under this section, the department shall establish a rate for that service.(1) Persons with gross income less than 100% of the nonfarm official federal poverty guidelines may not be required to pay more than a nominal fee. For the purposes of this section, "nominal fee" has the same meaning as it has under Medicaid.(2) In determining gross income, the department shall permit the deduction of business-related expenses of those who are self-employed; [1999, c. 401, Pt. MM, §1(NEW); 1999, c. 401, Pt. MM, §5(AFF).]C. Be governed by a board, a majority of whose members are individuals who are or will be served by the program and who, as a group, represent the individuals being served in terms of demographic factors such as residing in the community being served, income, race, ethnicity and gender. The board is responsible for: (1) The establishment of the policy in the conduct of the program;(2) Holding regularly scheduled meetings, of which minutes must be kept;(3) Approval of the selection or dismissal of a program director or chief executive officer of the program;(4) Establishing personnel policies and procedures, including selection and dismissal procedures, salary and benefit scales, employee grievance procedures and equal opportunity practices;(5) Adopting policies for financial management practices, including a system to ensure accountability for program resources, approval of the annual program budget, program priorities, eligibility for services, including criteria for partial payment schedules, and long-range financial planning;(6) Evaluating program activities including services utilization patterns, program productivity, patient satisfaction, achievement of program objectives and development of a process for hearing and resolving patient grievances;(7) Ensuring that the program is operated in compliance with applicable federal, state and local laws, rules and regulations; and(8) Adopting health care policies including scope and availability of services, location and hours of services and quality of care audit procedures; [1999, c. 401, Pt. MM, §1(NEW); 1999, c. 401, Pt. MM, §5(AFF).]D. Use any funds provided for the purposes of this chapter to supplement, and not supplant, other funds that are or may be available to the oral health care program; [1999, c. 401, Pt. MM, §1(NEW); 1999, c. 401, Pt. MM, §5(AFF).]E. Implement a patient screening process to determine patient eligibility for Medicaid, the Children's Health Insurance Program under section 3174-T and the sliding fee scale; andF. Employ at least one full-time equivalent dentist practicing general dentistry and be open for business at least 20 hours a week, providing at least 4 hours of coverage during evenings or weekends. [1999, c. 401, Pt. MM, §1(NEW); 1999, c. 401, Pt. MM, §5(AFF).] A program may not receive funds under this chapter to serve more than 3 contiguous dental care analysis areas as defined by the Bureau of Health in the department.
[RR 2021, c. 2, Pt. A, §59(COR).]
3.Discrimination prohibited. An oral health care program receiving funds under this chapter may not discriminate among patients within its service area based upon payment source except as specifically authorized in subsection 2, paragraph B. [1999, c. 401, Pt. MM, §1(NEW); 1999, c. 401, Pt. MM, §5(AFF).]
4. Vouchers for private dental services. An oral health program that receives funds under this chapter may establish a voucher system for the purpose of reimbursing private dental providers providing services to patients of the program in accordance with the provisions of this subsection. A. A voucher may be used only when: (1) A program chooses to provide specialized oral health services to its patients but can not provide these services directly;(2) The patient can not be served by the program with reasonable promptness; or(3) The distance to the program location or transportation problems make access to the program difficult for the patient. [1999, c. 401, Pt. MM, §1(NEW); 1999, c. 401, Pt. MM, §5(AFF).]B. A voucher payment made to a private provider does not exceed the difference between the patient's obligation, if any, under a sliding scale and the rate that Medicaid would reimburse a private provider for that same service. If no fee is established for the particular service in the Medicaid program, the department shall establish a fee. [1999, c. 401, Pt. MM, §1(NEW); 1999, c. 401, Pt. MM, §5(AFF).]C. A voucher payment is made only to a provider enrolled to provide services in the Medicaid program. [1999, c. 401, Pt. MM, §1(NEW); 1999, c. 401, Pt. MM, §5(AFF).] An oral health care program may place reasonable restrictions on a voucher system it establishes if those restrictions are consistent with the purposes of this chapter pursuant to subsection 1.
Even though an oral health care program receives funds under this chapter for the purpose of serving part of its service area through a voucher system, this does not prevent the application of another organization seeking funds under this chapter to provide direct program services to the residents of that area.
[1999, c. 401, Pt. MM, §1(NEW); 1999, c. 401, Pt. MM, §5(AFF).]
5.Encouraging community support. The department shall require any entity seeking funds for the start-up or expansion of oral health programs under this chapter to raise matching funds, including in-kind support, sufficient to demonstrate community support. [1999, c. 401, Pt. MM, §1(NEW); 1999, c. 401, Pt. MM, §5(AFF).]
6.Coordination with Medicaid and the Cub Care program. The department shall coordinate assistance under this chapter with Medicaid and the Children's Health Insurance Program under section 3174-T in a manner most likely to obtain and maximize federal matching funds.6-A.Monitoring of grants. The program director or chief executive officer under subsection 2, paragraph C, subparagraph (3) shall monitor contracts resulting from grant awards established by the department concerning community-based dental clinics affiliated with or operated by a school of dentistry. [2009, c. 645, Pt. E, §1(NEW); 2009, c. 645, Pt. G, §1(AFF).]
7. Rules. The department shall adopt rules, which are routine technical rules, pursuant to Title 5, chapter 375, subchapter II-A, to implement this chapter. [1999, c. 401, Pt. MM, §1(NEW); 1999, c. 401, Pt. MM, §5(AFF).]
Amended by 2024, c. 597,§ 2, eff. 8/9/2024.Amended by 2024, c. 597,§ 1, eff. 8/9/2024.1999, c. 401, §MM1 (NEW) . 1999, c. 401, §MM5 (AFF) . 2009, c. 645, Pt. E, §1 (AMD) . 2009, c. 645, Pt. G, §1 (AFF) .