AB366: Bill Text

LRB-3198/1

DAK:wlj:km

2001 - 2002 LEGISLATURE

2001 Assembly BILL 366

May 1, 2001 - Introduced by Joint Legislative Council. Referred to Committee on Health.

AB366,1,12 An Act to renumber and amend 250.15 (1); to amend 20.235 (1) (d) and 20.435 (4) (b); and to create 20.435 (5) (h), 49.45 (2) (a) 25., 49.46 (2) (b) 1m., 250.13, 250.15 (1) (b) and 250.15 (2) (d) of the statutes; relating to: the state contract for dental education; authorizing licensed dental health professional positions in the department of health and family services; funding for dental services at community health centers; grants for community water fluoridation; increasing the medical assistance reimbursement rates for dental services; making topical fluoride varnish a covered service under the early and periodic screening, diagnosis, and treatment program; creating a fluoride varnish education program; reimbursement for dental hygienist services under medical assistance; medical assistance reimbursement for dental cleanings; requiring the exercise of rule-making authority; and making appropriations.

Analysis by the Legislative Reference Bureau

This bill is explained in the Notes provided by the joint legislative council in the bill.

For further information see the state fiscal estimate, which will be printed as an appendix to this bill.

The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:

Prefatory note: This bill was prepared for the joint legislative council's special committee on dental care access. The bill contains the following provisions:

Tuition Assistance: Marquette University School of Dentistry

Under current law, $1,167,000 is appropriated in each fiscal year to provide tuition assistance of $11,670 per year for up to 100 Wisconsin residents attending Marquette University School of Dentistry.

The bill increases the per student tuition assistance to $15,000 per year and increases the maximum number of Wisconsin residents who qualify to 160. The amount appropriated for this purpose is increased from the current $1,167,000 to $1,725,000 (115 x $15,000) in fiscal year 2001-02 to reflect an additional 15 Wisconsin residents in the fall 2001 incoming class and to $1,950,000 (130 x $15,000) in fiscal year 2002-03 to reflect those 15 students and an additional 15 Wisconsin residents in the fall 2002 incoming class. When fully implemented in the fall of 2004, the amount of the appropriation would be $2,400,000 (160 x $15,000).

Licensed Dental Health Professionals in the Department of Health and Family Services (DHFS)

This bill increases the current appropriation for DHFS under s. 20.435 (4) (bm), stats., for medical assistance (MA) administration by $132,000 in each year of the 2001-03 biennium to increase the authorized general purpose revenue (GPR) positions for DHFS by five GPR positions beginning on July 1, 2001. This funding would provide one licensed dental health professional in each of the five DHFS administrative regions for the division of public health, as prescribed by DHFS. These five licensed dental health professionals would be responsible for performing dental health outreach services and for providing dental care, primarily to persons eligible for MA.

Grants for Community Dental Services

The bill increases DHFS' current appropriation for community health services under s. 20.435 (5) (fh), stats., by $1,600,000 in each year of the 2001-03 biennium. The department must distribute these funds to qualified applicants for the provision or expansion of dental care services. Under the bill, a "qualified applicant" is an entity that provides, or seeks to provide or expand, dental services to low-income individuals and that is not a federally qualified health center. A qualified applicant that receives a grant must ensure that the following criteria are met:

1. The applicant must make every attempt to collect appropriate reimbursement for its costs in providing dental services to persons who are entitled to BadgerCare, MA, or assistance for medical expenses under any other public assistance or private insurance program.

2. The applicant must prepare and utilize a fee schedule for its services consistent with locally prevailing charges for these services that is designed to cover its reasonable costs. The applicant must also have a sliding fee scale for its patients.

3. The applicant must establish a governing board which, except in the case of an applicant that is an Indian tribe or band, is composed of individuals who are representative of persons served by the entity and a majority of whom are served by the entity. The bill sets forth the responsibilities of the governing board.

4. The applicant must use any funds provided under the grant program to supplement, and not supplant, other funds that are or may be available to the entity.

5. The applicant must implement a patient screening process to determine patient eligibility for MA, BadgerCare, and the sliding fee scale.

6. The applicant must ensure that the following services are also provided:

a. Oral health education.

b. Dental screening, risk assessment, and preventive dental treatment to pregnant women, infants, preschoolers, persons with diabetes, heart disease, and lung disease, and persons using psychotropic medication.

Under this program, preference for funding is given to applicants that are located in a dental health professional shortage area.

Grants for Community Water Fluoridation

The bill provides $25,000 GPR in each year of the 2001-03 biennium for a community water fluoridation grant program. Under the program, DHFS must award grants each year to applying communities in Wisconsin for any of the following purposes:

1. Purchase of water fluoridation equipment.

2. Construction of additional building space to house water fluoridation equipment.

3. Payment of salaries of employees who operate water fluoridation equipment.

Coverage of Topical Fluoride Varnish Under Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program

This bill provides $162,930 GPR in fiscal year 2001-02 and $325,859 GPR in fiscal year 2002-03 to provide coverage under the MA program for topical fluoride varnish through the EPSDT program. The bill requires DHFS to promulgate rules regarding coverage of topical fluoride varnish, which specify the following:

a. Coverage is provided through the EPSDT program for children ages 0 to 60 months of age.

b. The fluoride varnish may be applied by any EPSDT health care provider acting within his or her scope of practice and licensure.

c. Payment shall be made for up to three applications per child per year of fluoride varnish.

d. Application of fluoride varnish may be, but is not required to be, provided in conjunction with an EPSDT examination which includes a limited oral screening.

e. Health care professionals providing services under this program shall refer or facilitate referral of children receiving topical fluoride varnish applications to comprehensive dental care rendered by a dental professional.

The bill also requires DHFS to disseminate information to health care professionals providing services under the EPSDT program and to parents or guardians of children eligible for EPSDT services on the availability of, and coverage for, fluoride varnish under EPSDT and the efficacy of fluoride varnish treatments in preventing early childhood caries.

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 Section 1 . 20.005 (3) (schedule) of the statutes at the appropriate place, insert the following amounts for the purposes indicated: - See PDF for table

AB366, s. 2 Section 2. 20.235 (1) (d) of the statutes is amended to read: