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2005 Testimony

Testimony Before The Senate Human Services Committee

Judy Lee, Chairman

SB 2213 - Medicaid and dental reimbursement

January 18, 2005

Chairman Lee, members of the committee, I am David Zentner, Director of Medical Services for the Department of Human Services. I appear before you to provide information regarding this proposed legislation.

Dental services are one of the optional services that are made available to recipients of the North Dakota Medicaid program. North Dakota has chosen to cover this service for all individuals eligible for the Medicaid program. Payments for dental services are based on a fee for service rate schedule. Fee increases are granted only when the Legislature provides funds for that purpose.

During the 1997 session, the Legislature did provide for a substantial increase in dental fees of about $2 million. At that time the Department established a separate fee schedule for adults and children. Services for children are paid at a higher rate to encourage dentists to provide services to our youngest citizens. The fee increase did result in stabilizing the number of dentists who were willing to remain in the program, but did not result in any substantial increase in the utilization of dental services for Medicaid recipients.

Subsequent to that increase, the Legislature provided inflationary increases of about 2 percent per year until 2002. During the 2001-2003 biennium the Department experienced a budget shortfall that included a deficit of about $13.2 million in general funds. We were unable to grant any fee increases for any providers in the last year of that biennium. In addition, the Legislature did not provide any funds during the current biennium to provide fee increases for any providers except nursing facilities, basic care facilities, in-patient hospital and physician services.

This bill would require the Department to calculate a new fee schedule every two years based on the 75th percentile of billed charges. This method takes the usual and customary charges for each dental service, and calculates at what fee at least 75 percent of all dentists would receive 100% of their billed charges. It would require the Department to recalculate these rates every two years, based on the 75th percentile methodology.

The bill would establish in state law how to pay dentists for services, and would require the Legislature to appropriate adequate funds to support this payment process. At the present time no other provider group has this type of language in state law except for nursing facilities. Most of the professional provider groups and hospitals have payment rates comparable or lower than dentists.

The Department does recognize that there is an access problem for some Medicaid recipients who cannot find a dentist who will treat them. If this bill becomes law I would hope that the dental community would make the commitment, and that dental access would become available for all recipients who seek that service.

The proposed budget for dental services in the 2005-2007 biennium is $13.1 million, of which $4.6 million is general funds. The proposed law indicates that the calculation would occur on September 30th of even numbered years. Based on this language the new fee would go into affect on October 1, 2006, and would be effective for about 10 months of the new biennium. The fiscal note for this bill totals $2.0 million of which about $.7 million is general funds. This bill would increase dental fees within the Medicaid program by about 37% above what other professional providers are scheduled to receive under the proposed appropriation for the next biennium and beyond.

I would be happy to respond to any questions you may have.


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