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Incorporation of an Adult Dental Benefit into a Value-Based Care Platform

On September 26, 2019, the Governor signed into law HB 4, Sections 224-227, instructing the Department of Health and Human Services to prepare a plan for the incorporation of an adult dental benefit into a value-based care platform.

The Department of Health and Human Services shall develop a plan for the incorporation of an adult dental benefit into a value-based care platform, as follows:

  • In this section, "value-based care" means an oral health care delivery model in which providers are paid based upon making positive health outcomes while reducing costs.
  • No later than 30 days after the effective date of this section, the Department shall convene a working group consisting, at a minimum, of representatives of the following stakeholders:
    • Each managed care plan under contract with the state;
    • The New Hampshire Oral Health Coalition;
    • A public health dentist and a solo private practice dentist recommended by the New Hampshire Dental Society, the New Hampshire Dental Hygienist Association, and the Bi-State Primary Care Association;
    • A representative of a New Hampshire dental insurance carrier designated by the Governor;
    • Two members of the House of Representatives, one of whom shall be from the majority party and one of whom shall be from the minority party, appointed by the Speaker of the House of Representatives;
    • Two members of the Senate, one of whom shall be from the majority party and one of whom shall be from the minority party, appointed by the President of the Senate;
    • A member of the Commission to Evaluate the Effectiveness and Future of the New Hampshire Granite Advantage Health Care Program designated by the Commission; and
    • Two members of the New Hampshire Medical Care Advisory Committee, one of whom shall be a consumer advocate, designated by the Committee.
  • The working group shall be convened by the Commissioner of Health and Human Services and shall be subject to RSA 91-A. The Department, in consultation with the working group, shall prepare a plan for the incorporation of an adult dental benefit into a value-based care platform. The adult dental benefit shall become effective on April 1, 2021.

    Each plan shall include, at a minimum, a detailed description of the following:
    • Eligibility and enrollment covered benefits and scope of services
    • Cost benefit analysis including projected expenditures and anticipated cost savings
    • Transition planning
    • Prior authorization
    • Transportation
    • Pharmacy
    • Case management
    • Network adequacy
    • Credentialing
    • Quality metrics and outcome measurements
    • Patient safety
    • Utilization management
    • Finance and reimbursement
    • Rates and payment
    • Grievance and appeals
    • Office of Ombudsman
    Each plan shall also address how the incorporation of the services into a value-based care platform shall achieve the legislative intent of providing value, quality, efficiency, innovation, and savings.

  • Under no circumstances shall a fee for service model be included in the plan. The plan shall promote the development of an adult value-based dental benefit and/or an alternative payment model.

The Department of Health and Human Services shall present an update on the status of the plan preparation each month to the Fiscal Committee of the General Court and the Oversight Committee on Health and Human Services, established in RSA 126-A:13, until the plan has been implemented. The Department's updates shall also include managed care organization and Department readiness for implementation.

No later than January 1, 2020, the Commissioner shall submit to the Speaker of the House Representatives, the President of the Senate, and the Governor, all proposed changes to state law the Commissioner believes may be necessary for the incorporation of an adult dental benefit into a value-based care platform.

The full text of HB 4 Adobe Acrobat Reader Symbol, relative to state fees, funds, revenues and expenditures, can be viewed at the New Hampshire General Court web site. See Sections 224 – 227 of HB 4.

Adobe Acrobat Reader Symbol Adobe Acrobat Reader format. You can download a free reader from Adobe.

 

 
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New Hampshire Department of Health and Human Services
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