MA Reimbursement Rate Increase for Dental Services
This bill provides $8,614,045 GPR for fiscal year 2001-02 and $11,628,960 GPR for
fiscal year 2002-03 to increase the MA reimbursement rates for dental services. Under
the bill, the reimbursement rates are increased to the 75th percentile of the fees from the
American Dental Association (ADA) fee survey for the east north central region, which
includes Wisconsin. The bill specifies that for each fiscal year, reimbursement rates shall
be established based on the most recently published ADA fee survey for that year.
MA Reimbursement for Dental Hygienist Services
Under current law, MA reimburses for dental services, limited to basic services
within each of the following categories: diagnostic services, preventive services,
restorative services, endodontic services, periodontic services, oral and maxillofacial
surgery services, emergency treatment of dental pain, removable prosthodontic services,
and fixed prosthodontic services.
The bill provides that MA will reimburse for basic services within the above
categories provided by dental hygienists for services that are within the scope of practice
of a dental hygienist.
MA Reimbursement for Two Dental Cleanings Per Year for Adults
Under current administrative rules of DHFS, MA provides reimbursement for one
dental cleaning per year for adults. The bill appropriates funds to pay for two such
cleanings per year.
AB366, s. 1
20.005 (3) (schedule) of the statutes at the appropriate place, insert 2
the following amounts for the purposes indicated:
- See PDF for table
AB366, s. 2
20.235 (1) (d) of the statutes is amended to read:
(d) Dental education contract.
The amounts in the schedule for 5
support of those Wisconsin residents enrolled as full-time students in the pursuit of 6
a doctor of dental surgery (D.D.S.) degree. An amount of $11,330 in the 1993-94 fiscal
7year and $11,670 in the 1994-95 $15,000 in each
fiscal year and annually thereafter 8
shall be disbursed under s. 39.46 for each Wisconsin resident enrolled as a full-time
student. The maximum number of Wisconsin residents to be funded under this 2
appropriation is 100 160
in the 1993-94 each
fiscal year and thereafter
Note: Increases the per-student tuition assistance for Wisconsin residents
attending the Marquette University School of Dentistry from $11,670 per year to $15,000
per year. Also increases the maximum number of Wisconsin residents who qualify for this
assistance from 100 to 160.
AB366, s. 3
20.435 (4) (b) of the statutes is amended to read:
(b) Medical assistance program benefits.
Biennially, the amounts in 5
the schedule to provide the state share of medical assistance program benefits 6
administered under s. 49.45, to provide medical assistance program benefits 7
administered under s. 49.45 that are not also provided under par. (o), to fund the pilot 8
project under s. 46.27 (9) and (10), to provide the facility payments under 1999
9Wisconsin Act 9
, section 9123
(9m), to fund services provided by resource centers 10
under s. 46.283 and for, to fund
services under the family care benefit under s. 46.284 11
(5), and to provide coverage for topical fluoride varnish under 2001 Wisconsin Act ....
12(this act), section 11
. Notwithstanding s. 20.002 (1), the department may transfer 13
from this appropriation to the appropriation under sub. (7) (kb) funds in the amount 14
of and for the purposes specified in s. 46.485. Notwithstanding ss. 20.001 (3) (b) and 15
20.002 (1), the department may credit or deposit into this appropriation and may 16
transfer between fiscal years funds that it transfers from the appropriation under 17
sub. (7) (kb) for the purposes specified in s. 46.485 (3r). Notwithstanding s. 20.002 18
(1), the department may transfer from this appropriation to the appropriation 19
account under sub. (7) (bd) funds in the amount and for the purposes specified in s. 20
AB366, s. 4
20.435 (5) (h) of the statutes is created to read:
(h) Community water fluoridation.
The amounts in the schedule for 23
community water fluoridation grants under s. 250.13.
AB366, s. 5
49.45 (2) (a) 25. of the statutes is created to read:
(a) 25. Disseminate to health care professionals providing services 3
under the early and periodic screening, diagnosis and treatment program under 42
, and to parents or guardians of children eligible for services under the 5
program, information on the availability of, and coverage for, topical fluoride varnish 6
under that program and on the efficacy of topical fluoride varnish treatments in 7
preventing early childhood caries.
Note: Requires DHFS to disseminate information to health care professionals
providing services under the EPSDT program regarding fluoride varnish.
AB366, s. 6
49.46 (2) (b) 1m. of the statutes is created to read:
(b) 1m. Dental hygienists' services, limited to services that are 10
payable under subd. 1. and that are within the scope of practice of a dental hygienist.
Note: Provides for reimbursement under the MA program, of dental hygienists'
services, limited to those dental services currently payable under the MA program and
that are within the scope of practice of a dental hygienist.
AB366, s. 7
250.13 of the statutes is created to read:
12250.13 Community water fluoridation grants.
From the appropriation 13
under s. 20.435 (5) (h), the department shall award grants each year to applying 14
communities for any of the following purposes:
Purchase of water fluoridation equipment.
Construction of additional building space to house water fluoridation 17
Payment of salaries of employees who operate water fluoridation 19
Note: Sections 1
, 4, and 7 of this bill provide $25,000 GPR in each year of the
2001-03 biennium for a community water fluoridation grant program. The grants may
be used for: (a) purchase of water fluoridation equipment; (b) construction of additional
building space to house water fluoridation equipment; and (c) payment of salaries of
employees who operate water fluoridation equipment.
AB366, s. 8
250.15 (1) of the statutes is renumbered 250.15 (1) (intro.) and 2
amended to read:
250.15 (1) Definitions.
(intro.) In this section, "community: (a) "Community
health center" means a health care entity that provides primary health care, health 5
and social services to low-income individuals.
AB366, s. 9
250.15 (1) (b) of the statutes is created to read:
(b) "Qualified applicant" means an entity that provides, or seeks to 8
provide, dental care services to low-income individuals and that does not receive a 9
federal grant under 42 USC 254b
(c), (g), or (h).
AB366, s. 10
250.15 (2) (d) of the statutes is created to read:
(d) From the appropriation under s. 20.435 (5) (fh), the department 12
shall distribute to qualified applicants grants totaling $1,600,000 in fiscal year 13
2001-02 and $1,600,000 in fiscal year 2002-03 to enable the applicants to provide 14
or expand provision of dental care services. The department shall give preference 15
for grants to qualified applicants that are located in dental health professional 16
shortage areas, as designated under 42 CFR part V, appendix B. Applicants who 17
receive grants under this paragraph shall do all of the following:
1. Make every attempt to collect appropriate reimbursement for its costs in 19
providing dental services to persons who are eligible for and receiving badger care 20
health care, medical assistance, or assistance for medical expenses under any other 21
public assistance program or have coverage under a private insurance program.
2. Prepare and utilize a fee schedule for the provision of its services consistent 23
with locally prevailing charges that is designed to cover its reasonable costs of 24
operation and prepare a corresponding schedule of discounts to be applied to the
payment of such fees. The discounts shall be adjusted on the basis of the patient's 2
ability to pay.
3. Establish a governing board that, except in the case of an applicant that is 4
an Indian tribe or band, is composed of individuals who are representative of persons 5
served by the applicant and a majority of whom are being served by the applicant. 6
The board shall be responsible for the following:
a. Establishing policies surrounding the entity's program operations.
b. Holding regularly scheduled meetings and keeping minutes of the meetings.
c. Approving the selection or dismissal of an entity's director or chief executive 10
d. Establishing personnel policies and procedures, including employee 12
selection and dismissal procedures, salary and benefit scales, employee grievance 13
procedures, and equal opportunity practices.
e. Adopting policies for financial management practices, including a system to 15
ensure accountability for resources, approval of the annual budget, priorities, 16
eligibility for services, including criteria for the fee schedule under subd. 2., and 17
long-range financial planning.
f. Evaluating the entity's activities including service utilization patterns, 19
productivity, patient satisfaction, achievement of objectives, and development of a 20
process for hearing and resolving patient grievances.
g. Ensuring that the entity is operated in compliance with applicable federal, 22
state, and local laws.
h. Adopting health care policies including scope and availability of services, 24
location, hours of services, and quality of care audit procedures.
4. Use any funds provided under this paragraph to supplement, and not 2
supplant, other funds that are or may be available to the entity.
5. Implement a patient screening process to determine patient eligibility for 4
medical assistance, badger care health care, and the payment schedule under subd. 5
6. Provide oral health education in programs operated by and affiliated with 7
the department, including the special supplemental food program for women, 8
infants, and children and head start.
7. Provide dental screening, risk assessments, and preventive dental 10
treatment to pregnant women; infants; preschoolers; persons with diabetes, heart 11
disease, or lung disease; and persons using psychotropic medication.
Note: Sections 8
, 9, and 10 provide $1,600,000 GPR in each fiscal year of the
2001-03 biennium for grants for the provision of dental care services by entities to
provide or expand dental services to low-income individuals. Among other requirements,
the recipients of funds under this program must implement a sliding fee scale for their
patients, and must also be governed by a board representative of persons served by the
AB366, s. 11
Nonstatutory provisions; health and family services.
state fiscal years 2001-02 and 2002-03, from the appropriation under section 20.435 14
(4) (b) of the statutes, as affected by this act, the department of health and family 15
services shall provide medical assistance coverage under the early and periodic 16
screening, diagnosis and treatment program under 42 CFR 441
for topical fluoride 17
varnish, for the purpose of preventing early childhood caries in eligible children 0 to 18
60 months of age, when rendered by health care professionals providing services 19
under the program and acting within their scope of practice and licensure. The 20
department shall promulgate rules relating to coverage of fluoride varnish 21
treatments under the early and periodic screening, diagnosis and treatment 22
program that contain the following provisions:
(1) The department shall provide payment for up to 3 applications per year of 2
topical fluoride varnish per eligible child.
(2) Application of topical fluoride varnish may be, but is not required to be, 4
provided in conjunction with an early and periodic screening, diagnosis and 5
treatment examination that includes a limited oral screening.
(3) Health care professionals providing services under this program shall refer 7
or facilitate referral of children receiving applications of topical fluoride varnish for 8
comprehensive dental care rendered by a dental professional.
AB366, s. 12
Appropriation changes; health and family services.
(1) In the schedule under section 20.005 (3) of the statutes for the appropriation 11
to the department of health and family services under section 20.435 (4) (bm) of the 12
statutes, as affected by the acts of 2001, the dollar amount is increased by $132,000 13
for fiscal year 2001-02 and the dollar amount is increased by $132,000 for fiscal year 14
2002-03 to increase the authorized FTE positions for the department by 5.0 GPR 15
positions on July 1, 2001, for a licensed dental health professional in each of the 5 16
administrative regions of the state, as prescribed by the department.
Note: Provides funding for positions within DHFS for licensed dental health
professionals in each of the five DHFS administrative regions that would be funded
through the MA program to perform dental health outreach services and to provide
dental care primarily to persons eligible for MA.
(2) In the schedule under s. 20.005 (3) of the statutes for the appropriation to 18
the department of health and family services under s. 20.435 (4) (b) of the statutes, 19
as affected by the acts of 2001, the dollar amount is increased by $8,614,045 for fiscal 20
year 2001-02 and the dollar amount is increased by $11,628,960 for fiscal year 21
2002-03 to increase the medical assistance reimbursement rates for dental services 22
to equal the fee at which 75% of dentists in the east north central region charge equal 23
or less amounts, as specified in the annual Survey of Dental Fees of the American
Dental Association. For each fiscal year, reimbursement rates shall be set based on 2
the most recently published American Dental Association fee survey for that year.
Note: Increases the MA reimbursement rate for dental services to the 75th
percentile of the fees from the most recently published ADA fee survey for the east north
In the schedule under section 20.005 (3) of the statutes for the appropriation 4
to the department of health and family services under section 20.435 (4) (b) of the 5
statutes, as affected by the acts of 2001, the dollar amount is increased by $378,466 6
for fiscal year 2001-02 and by $378,466 for fiscal year 2002-03 to provide medical 7
assistance coverage for 2 dental cleanings per year for adults.
Note: Provides funds for two dental cleanings per year for adults under the MA
In the schedule under section 20.005 (3) of the statutes for the appropriation 9
to the department of health and family services under section 20.435 (4) (b) of the 10
statutes, as affected by the acts of 2001, the dollar amount is increased by $162,930 11
for fiscal year 2001-02 and the dollar amount is increased by $325,859 for fiscal year 12
2002-03 to provide coverage of fluoride varnish treatments under Section
of this 13
Note: Provides funds for coverage of topical fluoride varnish through the EPSDT
program under MA.
n the schedule under section 20.005 (3) of the statutes for the appropriation 15
to the department of health and family services under section 20.435 (5) (fh) of the 16
statutes, as affected by the acts of 2001, the dollar amount is increased by $1,600,000 17
for fiscal year 2001-02 and the dollar amount is increased by $1,600,000 for fiscal 18
year 2002-03 for the purposes of funding dental services as specified in section 19
250.15 (2) (d) of the statutes, as created by this act.
Note: Provides funds to entities that provide, or seek to provide, dental services
to low-income individuals.
AB366, s. 13
Appropriation changes; higher educational aids board.
(1) In the schedule under section 20.005 (3) of the statutes for the appropriation 3
to the higher education aids board under section 20.235 (1) (d) of the statutes, as 4
affected by the acts of 2001, the dollar amount is increased by $558,000 for fiscal year 5
2001-02 and the dollar amount is increased by $783,000 for fiscal year 2002-03 for 6
the purpose of increasing the amount of assistance for Wisconsin residents pursuing 7
a doctor of dental surgery degree and the maximum number of students who qualify 8
for this assistance.
Note: Provides funds to increase the per-student tuition assistance for Wisconsin
residents attending the Marquette University School of Dentistry from $11,670 per year
to $15,000. Also provides funds to increase the total number of Wisconsin resident
students eligible for this assistance from 100 to a total of 160.
(1) This act takes effect on the 2nd day after publication of the 2001-03 biennial 11