HR0386 100TH GENERAL ASSEMBLY

HR0386 LRB100 12668 MST 26037 r

HOUSE RESOLUTION

WHEREAS, The Illinois State Dental Society (ISDS) has a growing concern with how dental care is being provided and monitored by managed care organizations (MCOs) to their two million Medicaid enrollees; and

WHEREAS, The ISDS has recently submitted several FOIA requests to the Department of Healthcare and Family Services (DHFS) which have uncovered large gaps in basic dental care data that MCOs are supposed to be providing; and

WHEREAS, Care coordination under current MCOs may work with ancillary medical programs such as specialty care and behavioral health, where physicians oversee global medical issues, but dental care is quite different; and

WHEREAS, A true care coordination program established by the MCO with their dental administrator would ensure that pregnant women have access to the additional cleanings and periodontal services; a true care coordination program would have the MCO sharing information with the dental administrator on patients that are diabetic, none of which are occurring; and

WHEREAS, Current MCO contracts with DHFS require systematic monitoring and evaluation for ancillary services, including dental services, and for the MCO to provide a written Quality Assurance Plan to DHFS, along with guidelines for their dental services; additionally, the MCO contract with DHFS requires utilization reporting for dental benefits and ongoing evaluation of continuity of care, access, and utilization, including appropriate linkage between medical and dental coordination none of which is taking place; and

WHEREAS, DHFS has adopted 20 HEDIS (Healthcare Effectiveness Data and Information Set) quality measurements to monitor care provided by the MCOs; none of these metrics look at the quality of dental care provided to Medicaid enrollees; and

WHEREAS, ISDS believes that dental care should not be included under the MCOs, but that dental administrators should be able to directly contract with DHFS; this would allow DHFS to have direct oversight of the programs that provide dental care to the two million Medicaid enrollees in Illinois; and

WHEREAS, There is now a new request for proposal (RFP) that would expand the existing coverage model using medical MCOs for up to 80% of the State's Medicaid population with none of the concerns for dental care being addressed; therefore, be it

RESOLVED, BY THE HOUSE OF REPRESENTATIVES OF THE ONE HUNDREDTH GENERAL ASSEMBLY OF THE STATE OF ILLINOIS, that we strongly recommend and urge Governor Rauner to instruct the Director of the Department of Healthcare and Family Services, Felicia Norwood, to issue an amendment to the current request for proposal separating out dental care for Medicaid eligible recipients into separate stand-alone dental administrators; and be it further

RESOLVED, That this will provide better dental care, increase utilization, control costs, and decrease tooth and gum decay and the suffering prevalent with this population; and be it further

RESOLVED, That adult preventive services should be included and reimbursed at a reasonable level as a key part of this new dental RFP; and be it further

RESOLVED, That suitable copies of this resolution be delivered to the Governor and the Director of Healthcare and Family Services.