Amendment #1413 to H5500

Dental Benefits Commission

Ms. Duffy of Holyoke moves to amend the bill by adding the following section:

Section X: (a) There shall be a special commission to study the appropriate level and structure of dental benefits provided under MassHealth and the Health Safety Net. The commission shall evaluate whether such benefits are clinically appropriate, financially sustainable and sufficient to ensure access to medically necessary dental services. The commission shall: (i) assess the current dental benefit structure, including covered services and utilization among adult populations; (ii) evaluate alternative benefit designs, including dollar limits, defined service packages or other models, and their clinical appropriateness; (iii) examine the impact of benefit structures on patient outcomes, including access to preventive, restorative and emergency services, oral health status and unmet need;(iv) assess impacts on providers and other health resources, including participation in MassHealth, financial viability, administrative burden, capacity and emergency care;(v) analyze geographic variation in access to care and identify areas with provider shortages;(vi) evaluate how benefit design influences provider enrollment and participation, including barriers and opportunities;(vii) consider the needs of underserved populations and assess how benefit design affects disparities in access and outcomes;(viii) review best practices from other state Medicaid programs and relevant national standards;(ix) develop recommendations on the appropriate level and structure of benefits, including changes to covered services, limits or reimbursement; and (x) report on other matters deemed relevant to its charge.

(b) The commission shall consist of 15 members, including: the secretary of Executive Office of Health and Human Services, or a designee, who shall serve as chair; the undersecretary of the MassHealth, or a designee; the commissioner of public health, or a designee; 1 member appointed by the senate president; 1 member appointed by the speaker of the house of representatives; 1 member appointed by the minority leader of the senate; 1 member appointed by the minority leader of the house of representatives; 1 member who is a representative of Massachusetts Dental Society; 1 member who is a representative of Health Care For All; 1 member who is a representative of the Massachusetts League of Community Health Centers; 1 member who is a representative of the Massachusetts Hospital Association; 1 member who is a representative of an oral health advocacy organization, appointed by the governor; 3 members who are dental providers that participate in MassHealth, appointed by the governor.

(c) The commission shall file its report and recommendations with the clerks of the senate and house of representatives, the senate and house committees on ways and means, the joint committee on health care financing and the joint committee on public health not later than January 1, 2027.