Full Text of HR0386 100th General Assembly
HR0386 100TH GENERAL ASSEMBLY |
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| 1 | | HOUSE RESOLUTION
| 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
| 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
| 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
| 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
| 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
| 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
| 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
| 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
| 22 | | RESOLVED, BY THE HOUSE OF REPRESENTATIVES OF THE ONE |
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| 1 | | HUNDREDTH GENERAL ASSEMBLY OF THE STATE OF ILLINOIS, that we | 2 | | strongly recommend and urge Governor Rauner to instruct the | 3 | | Director of the Department of Healthcare and Family Services, | 4 | | Felicia Norwood, to issue an amendment to the current request | 5 | | for proposal separating out dental care for Medicaid eligible | 6 | | recipients into separate stand-alone dental administrators; | 7 | | 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
| 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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