KRS 205.5353: Dental services -- Administrative service organization delivery model --

Legislative findings -- Medicaid dental director -- Procurement --

Administrative regulations -- Dental Services Advisory Panel -- Annual report.

(1) The General Assembly finds and declares that:

(a) Effective management of Medicaid-covered dental services is essential for the

overall health of Medicaid beneficiaries and that specialized administration of

dental services may improve programmatic efficiency, oral health, and overall

health outcomes in the Commonwealth; and

(b) It is the intent of the General Assembly to authorize the Department for

Medicaid Services to administer Medicaid -covered dental services under an

administrative service organization delivery model beginning January 1, 2029,

and for the administrative service organization contracted in accordance with

this section to perform administrative functions necessary to manage or

process claims, prior authorization requests, coordination of care, network

adequacy, and customer service related to Medicaid-covered dental services.

(2) As used in this section:

(a) "Administrative service organization" or "ASO" means the entity contracted

by the department in accordance with subsection (3) of this section to perform

specified administrative functions related to the administration of Medicaid -

covered dental services without assuming a financial or insurance risk; and

(b) "Department" means the Department for Medicaid Services.

(3) The department shall:

(a) Beginning Ju ly 1, 2028, employ a full -time Medicaid dental director who

shall:

1. Be licensed under KRS Chapter 313;

2. Report to the commissioner of the department; and

3. Be responsible for overseeing the administration of Medicaid -covered

dental services;

(b) Consider any recommendations that may be made by the Medicaid Oversight

and Advisory Board, or a subcommittee thereof, regarding the transition of

Medicaid-covered dental services from a managed care delivery model to an

ASO delivery model;

(c) In accordance with KRS Chapter 45A and subsection (5) of this section, select

and contract with a third -party ASO to administer Medicaid -covered dental

services. The contract entered into under this paragraph shall have an effective

date of January 1, 2029;

(d) Promulgate administrative regulations in accordance with KRS Chapter 13A

to implement this section;

(e) Beginning January 1, 2029:

1. Transition all Medicaid beneficiaries from Medicaid managed care

organization coverage into ASO coverage for the administration of all

Medicaid-covered dental services; and

2. Establish a Dental Services Advisory Panel which shall:

a. Include the following members:

i. The Medicaid dental dire ctor employed pursuant to

paragraph (a) of this subsection;

ii. The members of the Technical Advisory Committee on

Dental Care established in KRS 205.590; and

iii. A representative from the ASO contracted with pursuant to

paragraph (c) of this subsection;

b. Be attached to the department for administrative purposes; and

c. Provide ongoing consultation, recommendations, and guidance to

the department to continually improve administration and delivery

of Medicaid-covered dental services; and

(f) On January 1, 2029, begin utilizing an ASO delivery model for the

administration of all Medicaid-covered dental services.

(4) (a) The ASO contracted with pursuant to this section shall operate on an

administrative-services-only basis. The ASO shall not assume any financial or

insurance risk for the cost of dental claims incurred by the Commonwealth,

and the Commonwealth shall remain fully financially responsible for all

Medicaid-covered dental claims.

(b) The duties and responsibilities of the ASO contracted with pursua nt to this

section shall be limited to the following administrative services:

1. Assisting with and facilitating the transitioning of all Medicaid

beneficiaries from Medicaid managed care organization coverage into

ASO coverage for dental services;

2. Processing and paying Medicaid -covered dental services claims in

accordance with the department's established fee schedule and clinical

guidelines;

3. Employing utilization control strategies established by the department

and managing all prior authorization r equests for Medicaid -covered

dental services;

4. Providing coordination of care with a Medicaid beneficiary's Medicaid

managed care organization;

5. Providing customer service and support to Medicaid beneficiaries and

Medicaid-participating dental providers; and

6. Any other administrative duties or responsibilities contractually

assigned to the ASO by the department.

(c) The ASO contracted with pursuant to this section shall not include in any

analysis of network adequacy an inactive Medicaid provider as d efined in

KRS 205.5356;

(5) (a) Notwithstanding any provision of law to the contrary, including subsection

(3)(c) of this section, the department shall not initiate a procurement process

to contract with a third -party ASO to administer Medicaid -covered dental

services prior to January 1, 2028.

(b) Any contract entered into under this section shall be submitted to the

Government Contract Review Committee of the Legislative Research

Commission for comment and review.

(6) On an annual basis, the department, in collaboration with the Dental S ervices

Advisory Panel, shall:

(a) Evaluate the dental ASO's performance based on metrics, including but not

limited to the following:

1. Accuracy and timeliness of claims processing;

2. Efficiency of processing prior authorization requests;

3. Observed network adequacy improvements;

4. Availability of and access to services; and

5. Satisfaction ratings from participating dental service providers and

Medicaid beneficiaries; and

(b) Prepare and submit a report on the evaluation required under this subsection

to the Legislative Research Commission for referral to the Interim Joint

Committees on Appropriations and Revenue and Health Services, and the

Medicaid Oversight and Advisory Board by August 1, 2029, and August 1 of

each year thereafter.