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
1Section
1
. 20.005 (3) (schedule) of the statutes at the appropriate place, insert
2the following amounts for the purposes indicated:
-
See PDF for table ![PDF](https://docs.legis.wisconsin.gov/assets/image/file_acrobat.gif)
AB366, s. 2
3Section
2. 20.235 (1) (d) of the statutes is amended to read:
AB366,5,24
20.235
(1) (d)
Dental education contract. The amounts in the schedule for
5support of those Wisconsin residents enrolled as full-time students in the pursuit of
6a 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 8shall be disbursed under s. 39.46 for each Wisconsin resident enrolled as a full-time
1student. The maximum number of Wisconsin residents to be funded under this
2appropriation 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
3Section
3. 20.435 (4) (b) of the statutes is amended to read:
AB366,5,204
20.435
(4) (b)
Medical assistance program benefits. Biennially, the amounts in
5the schedule to provide the state share of medical assistance program benefits
6administered under s. 49.45, to provide medical assistance program benefits
7administered under s. 49.45 that are not also provided under par. (o), to fund the pilot
8project 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
10under 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
13from this appropriation to the appropriation under sub. (7) (kb) funds in the amount
14of and for the purposes specified in s. 46.485. Notwithstanding ss. 20.001 (3) (b) and
1520.002 (1), the department may credit or deposit into this appropriation and may
16transfer between fiscal years funds that it transfers from the appropriation under
17sub. (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
19account under sub. (7) (bd) funds in the amount and for the purposes specified in s.
2049.45 (6v).
AB366, s. 4
21Section
4
. 20.435 (5) (h) of the statutes is created to read:
AB366,5,2322
20.435
(5) (h)
Community water fluoridation. The amounts in the schedule for
23community water fluoridation grants under s. 250.13.
AB366, s. 5
1Section
5. 49.45 (2) (a) 25. of the statutes is created to read:
AB366,6,72
49.45
(2) (a) 25. Disseminate to health care professionals providing services
3under the early and periodic screening, diagnosis and treatment program under
42
4CFR 441, and to parents or guardians of children eligible for services under the
5program, information on the availability of, and coverage for, topical fluoride varnish
6under that program and on the efficacy of topical fluoride varnish treatments in
7preventing 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
8Section
6. 49.46 (2) (b) 1m. of the statutes is created to read:
AB366,6,109
49.46
(2) (b) 1m. Dental hygienists' services, limited to services that are
10payable 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
11Section
7
. 250.13 of the statutes is created to read:
AB366,6,14
12250.13 Community water fluoridation grants. From the appropriation
13under s. 20.435 (5) (h), the department shall award grants each year to applying
14communities for any of the following purposes:
AB366,6,15
15(1) Purchase of water fluoridation equipment.
AB366,6,17
16(2) Construction of additional building space to house water fluoridation
17equipment.
AB366,6,19
18(3) Payment of salaries of employees who operate water fluoridation
19equipment.
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
1Section
8
. 250.15 (1) of the statutes is renumbered 250.15 (1) (intro.) and
2amended to read:
AB366,7,53
250.15
(1) Definitions. (intro.) In this section
, "community: (a) "Community
4health center" means a health care entity that provides primary health care, health
5education
, and social services to low-income individuals.
AB366, s. 9
6Section
9
. 250.15 (1) (b) of the statutes is created to read:
AB366,7,97
250.15
(1) (b) "Qualified applicant" means an entity that provides, or seeks to
8provide, dental care services to low-income individuals and that does not receive a
9federal grant under
42 USC 254b (c), (g), or (h).
AB366, s. 10
10Section
10
. 250.15 (2) (d) of the statutes is created to read:
AB366,7,1711
250.15
(2) (d) From the appropriation under s. 20.435 (5) (fh), the department
12shall distribute to qualified applicants grants totaling $1,600,000 in fiscal year
132001-02 and $1,600,000 in fiscal year 2002-03 to enable the applicants to provide
14or expand provision of dental care services. The department shall give preference
15for grants to qualified applicants that are located in dental health professional
16shortage areas, as designated under 42 CFR part V, appendix B. Applicants who
17receive grants under this paragraph shall do all of the following:
AB366,7,2118
1. Make every attempt to collect appropriate reimbursement for its costs in
19providing dental services to persons who are eligible for and receiving badger care
20health care, medical assistance, or assistance for medical expenses under any other
21public assistance program or have coverage under a private insurance program.
AB366,8,222
2. Prepare and utilize a fee schedule for the provision of its services consistent
23with locally prevailing charges that is designed to cover its reasonable costs of
24operation and prepare a corresponding schedule of discounts to be applied to the
1payment of such fees. The discounts shall be adjusted on the basis of the patient's
2ability to pay.
AB366,8,63
3. Establish a governing board that, except in the case of an applicant that is
4an Indian tribe or band, is composed of individuals who are representative of persons
5served by the applicant and a majority of whom are being served by the applicant.
6The board shall be responsible for the following:
AB366,8,77
a. Establishing policies surrounding the entity's program operations.
AB366,8,88
b. Holding regularly scheduled meetings and keeping minutes of the meetings.
AB366,8,109
c. Approving the selection or dismissal of an entity's director or chief executive
10officer.
AB366,8,1311
d. Establishing personnel policies and procedures, including employee
12selection and dismissal procedures, salary and benefit scales, employee grievance
13procedures, and equal opportunity practices.
AB366,8,1714
e. Adopting policies for financial management practices, including a system to
15ensure accountability for resources, approval of the annual budget, priorities,
16eligibility for services, including criteria for the fee schedule under subd. 2., and
17long-range financial planning.
AB366,8,2018
f. Evaluating the entity's activities including service utilization patterns,
19productivity, patient satisfaction, achievement of objectives, and development of a
20process for hearing and resolving patient grievances.
AB366,8,2221
g. Ensuring that the entity is operated in compliance with applicable federal,
22state, and local laws.
AB366,8,2423
h. Adopting health care policies including scope and availability of services,
24location, hours of services, and quality of care audit procedures.
AB366,9,2
14. Use any funds provided under this paragraph to supplement, and not
2supplant, other funds that are or may be available to the entity.
AB366,9,53
5. Implement a patient screening process to determine patient eligibility for
4medical assistance, badger care health care, and the payment schedule under subd.
52.
AB366,9,86
6. Provide oral health education in programs operated by and affiliated with
7the department, including the special supplemental food program for women,
8infants, and children and head start.
AB366,9,119
7. Provide dental screening, risk assessments, and preventive dental
10treatment to pregnant women; infants; preschoolers; persons with diabetes, heart
11disease, 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
entity.
AB366, s. 11
12Section
11
.
Nonstatutory provisions; health and family services. In
13state 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
15services shall provide medical assistance coverage under the early and periodic
16screening, diagnosis and treatment program under
42 CFR 441 for topical fluoride
17varnish, for the purpose of preventing early childhood caries in eligible children 0 to
1860 months of age, when rendered by health care professionals providing services
19under the program and acting within their scope of practice and licensure. The
20department shall promulgate rules relating to coverage of fluoride varnish
21treatments under the early and periodic screening, diagnosis and treatment
22program that contain the following provisions:
AB366,10,2
1(1) The department shall provide payment for up to 3 applications per year of
2topical fluoride varnish per eligible child.
AB366,10,53
(2) Application of topical fluoride varnish may be, but is not required to be,
4provided in conjunction with an early and periodic screening, diagnosis and
5treatment examination that includes a limited oral screening.
AB366,10,86
(3) Health care professionals providing services under this program shall refer
7or facilitate referral of children receiving applications of topical fluoride varnish for
8comprehensive dental care rendered by a dental professional.