Illinois General Assembly - Full Text of SR0365
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Full Text of SR0365  100th General Assembly

SR0365 100TH GENERAL ASSEMBLY


  

 


 
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1
SENATE RESOLUTION

 
2    WHEREAS, The Illinois State Dental Society (ISDS) has a
3growing concern with how dental care is being provided and
4monitored by managed care organizations (MCOs) to their two
5million Medicaid enrollees; and
 
6    WHEREAS, The ISDS has recently submitted several FOIA
7requests to the Department of Healthcare and Family Services
8(DHFS) which have uncovered large gaps in basic dental care
9data that MCOs are supposed to be providing; and
 
10    WHEREAS, Care coordination under current MCOs may work with
11ancillary medical programs such as specialty care and
12behavioral health, where physicians oversee global medical
13issues, but dental care is quite different; and
 
14    WHEREAS, A true care coordination program established by
15the MCO with their dental administrator would ensure that
16pregnant women have access to the additional cleanings and
17periodontal services; a true care coordination program would
18have the MCO sharing information with the dental administrator
19on patients that are diabetic, none of which are occurring; and
 
20    WHEREAS, Current MCO contracts with DHFS require
21systematic monitoring and evaluation for ancillary services,

 

 

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1including dental services, and for the MCO to provide a written
2Quality Assurance Plan to DHFS, along with guidelines for their
3dental services; additionally, the MCO contract with DHFS
4requires utilization reporting for dental benefits and ongoing
5evaluation of continuity of care, access, and utilization,
6including appropriate linkage between medical and dental
7coordination none of which is taking place; and
 
8    WHEREAS, DHFS has adopted 20 HEDIS (Healthcare
9Effectiveness Data and Information Set) quality measurements
10to monitor care provided by the MCOs; none of these metrics
11look at the quality of dental care provided to Medicaid
12enrollees; and
 
13    WHEREAS, ISDS believes that dental care should not be
14included under the MCOs, but that dental administrators should
15be able to directly contract with DHFS; this would allow DHFS
16to have direct oversight of the programs that provide dental
17care to the two million Medicaid enrollees in Illinois; and
 
18    WHEREAS, There is now a new request for proposal (RFP) that
19would expand the existing coverage model using medical MCOs for
20up to 80% of the State's Medicaid population with none of the
21concerns for dental care being addressed; therefore, be it
 
22    RESOLVED, BY THE SENATE OF THE ONE HUNDREDTH GENERAL

 

 

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1ASSEMBLY OF THE STATE OF ILLINOIS, that we strongly recommend
2and urge Governor Rauner to instruct the Director of the
3Department of Healthcare and Family Services, Felicia Norwood,
4to issue an amendment to the current request for proposal
5separating out dental care for Medicaid eligible recipients
6into separate stand-alone dental administrators; and be it
7further
 
8    RESOLVED, That this will provide better dental care,
9increase utilization, control costs, and decrease tooth and gum
10decay and the suffering prevalent with this population; and be
11it further
 
12    RESOLVED, That adult preventive services should be
13included and reimbursed at a reasonable level as a key part of
14this new dental RFP; and be it further
 
15    RESOLVED, That suitable copies of this resolution be
16delivered to the Governor and the Director of Healthcare and
17Family Services.