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1 | SENATE JOINT RESOLUTION
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2 | WHEREAS, The Illinois State Dental Society (ISDS) has a | ||||||
3 | growing concern with how dental care is
being provided and | ||||||
4 | monitored by managed care organizations (MCOs) to their two | ||||||
5 | million Medicaid
enrollees; and
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6 | WHEREAS, The ISDS has recently submitted several FOIA | ||||||
7 | requests to
the Department of Healthcare and Family Services | ||||||
8 | (DHFS) which have uncovered large gaps in basic dental care | ||||||
9 | data that MCOs are supposed to be providing; and
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10 | WHEREAS, Care coordination under current MCOs may work with | ||||||
11 | ancillary medical
programs such as specialty care and | ||||||
12 | behavioral health, where physicians oversee global medical | ||||||
13 | issues,
but dental care is quite different; and
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14 | WHEREAS, A true care coordination program established by | ||||||
15 | the MCO with their dental
administrator would ensure that | ||||||
16 | pregnant women have access to the additional cleanings and
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17 | periodontal services; a true care coordination program would | ||||||
18 | have the MCO sharing information with
the dental administrator | ||||||
19 | on patients that are diabetic, none of which are occurring; and | ||||||
20 | WHEREAS, Current MCO contracts with DHFS require | ||||||
21 | systematic monitoring and evaluation
for ancillary services, |
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1 | including dental services, and for the MCO to provide a written | ||||||
2 | Quality Assurance
Plan to DHFS, along with guidelines for their | ||||||
3 | dental services; additionally, the MCO contract with DHFS
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4 | requires utilization reporting for dental benefits and ongoing | ||||||
5 | evaluation of continuity of care, access, and
utilization, | ||||||
6 | including appropriate linkage between medical and dental | ||||||
7 | coordination none of which is
taking place; and | ||||||
8 | WHEREAS, DHFS has adopted 20 HEDIS (Healthcare | ||||||
9 | Effectiveness Data and Information Set)
quality measurements | ||||||
10 | to monitor care provided by the MCOs; none of these metrics | ||||||
11 | look at the quality
of dental care provided to Medicaid | ||||||
12 | enrollees; and
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13 | WHEREAS, ISDS believes that dental care should not be | ||||||
14 | included under the MCOs, but that dental
administrators should | ||||||
15 | be able to directly contract with DHFS; this would allow DHFS | ||||||
16 | to have direct
oversight of the programs that provide dental | ||||||
17 | care to the two million Medicaid enrollees in Illinois; and
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18 | WHEREAS, There is now a new request for proposal (RFP) that | ||||||
19 | would expand the existing coverage model using
medical MCOs for | ||||||
20 | up to 80% of the State's Medicaid population with none of the | ||||||
21 | concerns for dental
care being addressed; therefore, be it
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22 | RESOLVED, BY THE SENATE OF THE ONE HUNDREDTH GENERAL |
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1 | ASSEMBLY OF THE STATE OF ILLINOIS, THE HOUSE OF REPRESENTATIVES | ||||||
2 | CONCURRING HEREIN, that we strongly recommend and urge Governor | ||||||
3 | Rauner to instruct the Director of the Department of Healthcare | ||||||
4 | and Family Services, Felicia Norwood, to issue an amendment to | ||||||
5 | the current request for proposal separating out dental care for | ||||||
6 | Medicaid eligible recipients into separate stand-alone dental | ||||||
7 | administrators; and be it further | ||||||
8 | RESOLVED, That this will provide better dental care, | ||||||
9 | increase utilization, control costs, and decrease tooth and gum | ||||||
10 | decay and the suffering prevalent with this population; and be | ||||||
11 | it further | ||||||
12 | RESOLVED, That adult preventive services should be | ||||||
13 | included and reimbursed at a reasonable
level as a key part of | ||||||
14 | this new dental RFP; and be it further
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15 | RESOLVED, That suitable copies of this resolution be | ||||||
16 | delivered to the Governor and the Director
of Healthcare and | ||||||
17 | Family Services.
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