Strengthening Medicaid Incentives for Licensees Enrolled in Dental Act or the SMILED Act
This bill requires state Medicaid programs to implement certain measures to improve the participation of dentists and the processing of related claims under Medicaid.
Specifically, states must assure the Centers for Medicare & Medicaid Services that they will address dentist participation by improving eligibility verification and simplifying participation requirements and claims administration. States must also (1) use an electronic, integrated data collection system to credential participating dentists within 90 days of application receipt; and (2) develop procedures for conducting audits that are consistent with practice standards and that allow for improper claims to be rectified through claims adjustments.
[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1422 Introduced in House (IH)]
<DOC>
118th CONGRESS
1st Session
H. R. 1422
To amend title XIX of the Social Security Act to improve oral health
care and dental benefits under the Medicaid program, and for other
purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 7, 2023
Mr. Simpson introduced the following bill; which was referred to the
Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To amend title XIX of the Social Security Act to improve oral health
care and dental benefits under the Medicaid program, and for other
purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Strengthening Medicaid Incentives
for Licensees Enrolled in Dental Act'' or the ``SMILED Act''.
SEC. 2. SUPPORT FOR ENSURING INDIVIDUALS ENROLLED IN MEDICAID HAVE
DENTAL SERVICES ACCESS EQUAL TO THE POPULATION OF THE
STATE.
Section 1903 of the Social Security Act (42 U.S.C. 1396b) is
amended by adding at the end the following new subsection:
``(cc) Equal Access to Oral Health Care Plan.--
``(1) Provider participation and access requirements.--Not
later than 1 year after the date of enactment of this
paragraph, a State shall provide the Secretary with assurances
that administrative barriers to the participation of licensed
dentists under this title will be addressed, by--
``(A) improving eligibility verification;
``(B) ensuring that any such dentist may
participate in a publicly funded plan without also
having to participate in any other plan;
``(C) simplifying claims forms processing; and
``(D) assigning a single plan administrator for the
dental program.
``(2) Study on dentist participation.--Not later than 3
years after the date on which the assurance under paragraph (1)
is submitted, each State shall conduct a study to determine
whether the participation of licensed dentists have increased
following the assurance provided under paragraph (1).''.
SEC. 3. DENTAL AND ORAL HEALTH SERVICES DEFINED; AUDIT REQUIREMENT.
(a) Dental and Oral Health Services Defined.--Section 1905 of the
Social Security Act (42 U.S.C. 1396d) is amended--
(1) in subsection (a)(10), by inserting ``and dental and
oral health services (as defined in subsection (jj))'' after
``dental services''; and
(2) by adding at the end the following new subsection:
``(jj) Dental and Oral Health Services.--
``(1) In general.--For purposes of subsection (a)(10), the
term `dental and oral health services' means dentures and
denture services, implants and implant services, and services
necessary to prevent oral disease and promote oral health,
restore oral structures to health and function, reduce oral
pain, and treat emergency oral conditions, that are furnished
by a provider who--
``(A) is legally authorized to furnish such items
and services under State law (or the State regulatory
mechanism provided by State law);
``(B) is initially credentialed by a State Medicaid
program (or the designated entity of such program)
through an integrated data collection system, as
described in paragraph (3); and
``(C) is, as applicable, re-credentialed through
such integrated data collection system by a State
Medicaid program (or the designated entity of such
program).
``(2) Selection of data collection system.--Not later than
one year after the date of enactment of this subsection, the
State Medicaid Director shall select an integrated data
collection system (as defined in paragraph (3) that--
``(A) minimizes provider paperwork burden; and
``(B) communicates final credentialing decisions to
providers within 90 days of receipt of a completed
application.
``(3) Integrated data collection system defined.--For
purposes of this subsection, the term `integrated data
collection system' means an electronic system maintained by a
State and used for purposes of enrolling, screening, and
credentialing dentists under a State Medicaid program.''.
(b) Dental and Oral Health Services Audit Requirement.--Not later
than 90 days after the date of enactment of this Act, a State Medicaid
program, including a program offered by a sponsor of a Medicaid managed
care plan, that offers dental and oral health services audits a claim
for such dental and oral health services shall--
(1) utilize a licensed health care professional from the
dental specialty area of practice being audited to establish
relevant audit methodology consistent with--
(A) established practice guidelines, standards of
care, and State-issued dental Medicaid provider
handbooks; and
(B) established clinical practice guidelines and
acceptable standards of care established by the dental
professional or specialty organizations responsible for
setting such standards of care;
(2) develop and implement, in consultation with the Centers
for Medicare & Medicaid Services, a procedure in which an
improper payment identified by an audit may be resubmitted as a
claims adjustment, including the resubmission of--
(A) claims denied as a result of an interpretation
of scope of services not previously held by the Centers
for Medicare & Medicaid Services;
(B) documentation when the document provided is
incomplete, illegible, or unclear; and
(C) documentation when clerical errors resulted in
a denial of claims for services actually provided; and
(3) disallow the difference between the payment for the
service that was provided and the payment for the service that
should have been provided if a service was provided and
sufficiently documented, but denied because it was determined
that a different service should have been billed.
<all>
Introduced in House
Introduced in House
Referred to the House Committee on Energy and Commerce.
Referred to the Subcommittee on Health.
Llama 3.2 · runs locally in your browser
Ask anything about this bill. The AI reads the full text to answer.
Enter to send · Shift+Enter for new line