This act requires the Division of Medical Services within the Department of Social Services to establish and implement a process for managing dental benefits for public assistance recipients. Various methodologies, programs, and practices can be used to determine the medical necessity and appropriateness of a recipient's treatment.

The division is allowed to place coverage limits on dental services, excluding state and federally mandated services. The limits must be determined by sound clinical practice guidelines.

The division shall establish a statewide uniform dental program and contract with a single source private entity to provide dental program management service coordination.

The division is prohibited from requiring a dentist to alter a patient's previous course of treatment unless the alteration is warranted by the patient's condition as initiated by the dentist.

Also, a single source private entity which receives the contract to provide dental program management services shall not discriminate against any licensed dentists who are willing to meet the terms and conditions set equally for all dentists for participation established by the single source private entity.

Further, any entity submitting a bid for a program established under the provisions of this act, shall be actuarially sound and provide proof of network and adequacy of network prior to the submission of the bid. No bid shall be accepted by the state of Missouri without meeting the provisions established by this section.

Finally, the Attorney General shall have full prosecutorial authority over any provider or recipient in any program established by this act.

This act is similar to SB 321 (2005).

ADRIANE CROUSE