New Jersey-2024-A897-Introduced

An Act establishing the MOM Project oral health three-year pilot program in the DOH, and making an appropriation.

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

1. As used in this act:

"Community oral health center" or "center" means the following in-State entities: a federally qualified health center, a dental home, or an acute care hospital licensed by the Department of Health that provides dental services to individuals who reside in a medically underserved area.

"Dental home" means a licensed dental practice that administers services in manner that is accessible, culturally-sensitive, and family-centered. A "dental home" does not include a licensed dental practice if less than 75 percent of the dental practice's patients are individuals who are low income and who reside in a medically underserved area

"Department" means the Department of Health.

"Eligible mother" or "mother" means a State resident who is pregnant, low-income, and not enrolled in, eligible for, or determined presumptively eligible for coverage under any Medicaid program.

"Low-income" means a gross annual household income that is less than 300 percent of the federal poverty level.

"Maternal and child health consortium" or "consortium" means a nonprofit organization licensed as a central service facility by the department, and incorporated under Section 501(c)(3) of the United States Internal Revenue Code.

"Medically underserved area" means an area designated by the federal Health Resources and Services Administration as having too few primary care providers, a high rate of infant mortality and poverty, and a disproportionately high share of elderly persons in the population of the area.

"MOM Project" or "program" means the MOM Project program established pursuant to section 3 of this act.

2. The Legislature finds and declares:

a. Maternal periodontal disease is linked to preterm birth and low birthweight.

b. Pregnant women with chronic periodontal disease are seven times more likely to go into labor prematurely.

c. Treatment of periodontal disease during pregnancy has been shown to be safe and effective.

d. The federal Centers for Disease Control and Prevention reports that 47 percent of American adults 30 years of age or older have periodontal disease, and between 60 percent and 75 percent of pregnant women have gingivitis, which can occur due to hormonal changes during pregnancy.

e. According to the American Academy of Pediatric Dentistry, early childhood cavities remain a significant, but preventable public health problem.

f. High levels of cariogenic bacteria in pregnant women can increase the risk of dental cavities in infants or young children.

g. Pregnant women and caregivers can implement preventive measures to decrease a child's risk of developing dental disease.

h. According to an article published in the New England Journal of Medicine:

(1) the cost of dental care in the U.S. has increased 30 percent in the past 20 years;

(2) in 2018, Americans paid $55 billion in out-of-pocket dental expenses, which was more than 25 percent of all health care out-of-pocket spending;

(3) dental and oral disease is particularly burdensome to marginalized and chronically underserved populations; and

(4) groups that have been most affected by COVID-19 in the U.S. appear to be those groups with disproportionately high rates of oral disease;

i. Pregnant women and women who have recently given birth in medically underserved areas and people who earn a low-income tend to lack access to dental care due to:

(1) lack of insurance coverage for dental care services;

(2) the absence or shortage of free or reduced-cost dental care services;

(3) language barriers; and

(4) fear due to immigration status, discrimination, or bias related to racial or socio-economic status;

j. It is in the public interest for the Legislature:

(1) to fund the MOM Project to test and design a sustainable model for access to oral health education and dental care for certain at-risk women who are pregnant or who recently have given birth; and

(2) to collect data regarding the effect of dental health care and education on health.

3. There is established in the Department of Health, the MOM Project three-year pilot program.

a. The department shall administer the program in conjunction with at least one maternal child health consortium. Within 90 days following the effective date of this act, each participating consortium shall begin to provide the following program services:

(1) Each consortium shall implement an outreach plan to identify eligible mothers, who reside in the area served by the consortium, and register the mothers in the program. Upon registration and in a manner that is consistent with federal and State privacy laws, the consortium shall endeavor to collect the following information from eligible mothers: whether the mother has or had access to a dental home during a current or prior pregnancy; the mother's oral hygiene routine, including the use of fluoride toothpaste; the mother's dietary habits; and the results of previous pregnancies.

(2) Each consortium shall establish an oral health education program. Prior to the commencement of the oral health education program, each consortium shall require eligible mothers to complete a pre-education assessment that includes testing the mother's understanding of oral health and oral hygiene.

(3) Each consortium shall provide eligible mothers a minimum of three hours of oral health education that includes the following: oral hygiene routines for mothers, infants, and children; nutritional counseling; education regarding the correlation between cariogenic disease and cardiovascular disease, diabetes, and gastric changes; the impact of tobacco, drugs, and alcohol on a mother's oral health and the unborn child; recommendations and resources for routine oral health care for mothers, infants, and children; and education regarding available educational support. Oral health education program educators shall be compatible with the language and cultural needs of the eligible mothers enrolled in the oral health education program.

(4) Following the eligible mother's completion of the oral health education program, the consortium shall require the eligible mother to complete a post-education assessment that includes testing to assess the mother's understanding of oral health and oral hygiene routines.

b. Within 90 days following the effective date of this act, a community oral health center seeking to participate in the MOM Project shall file an application with the department, in a manner to be determined by the department. The department shall require an eligible community oral health center to enter into an agreement with a consortium to implement the following:

(1) Following an eligible mother's completion of the oral health education program, the center shall develop a customized oral health treatment plan and nutritional recommendations for the mother, infant, and child, as applicable.

(2) Following an eligible mother's completion of the oral health education program, provide the mother, infant, and child, as applicable, oral health treatment for one year. The dental care shall include the following:

(a) a dental visit for cleaning, cavity risk assessment, periodontal charting, and to establish a one-year treatment plan;

(b) comprehensive dental care and restorative treatment as needed;

(c) a cleaning and treatment plan review approximately six months and one year following the date of the initial dental visit;

(d) two dental visits for the child or infant; and

(e) identification of a dental home for the child or infant before the infant receives his or her first tooth.

c. Within 180 days following the effective date of this act, each consortium and health center shall compile and report relevant data to the department, as determined by the department.

d. (1) Within 180 days following the effective date of this act, the department shall contract with a third-party to assist with data analysis and project evaluation activities.

(2) Prior to the expiration of this act, the department and the third-party hired to assist with data analysis and project evaluation activities shall informally convene an advisory panel of interested stakeholders, including, but not limited to, the consortia and centers participating in the MOM Project, Medicaid managed care organizations, and the Department of Human Services to evaluate reported data. This evaluation shall consider, at a minimum, the costs of the MOM Project and comparison costs if similar services were purchased through the Medicaid program on a fee for service basis, the results of the oral health education program based on test results, and maternal and child health outcomes as compared to a similar group of Medicaid beneficiaries who did not participate in the MOM Project. Based on its findings, the advisory panel shall design a model to be potentially included in the Medicaid program.

(3) The department shall prepare and submit a report of its findings to the Governor, and to the Legislature, pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1).

4. a. There is appropriated from the General Fund to the Department of Health such sums as may be necessary to effectuate the purposes of this act, but not to exceed $4,150,000, as shall be determined by the Commissioner of Health.

b. Maternal and child health consortia shall receive the following reimbursement for services: $200,000 in the first year, $400,000 in the second year, and $650,000 in the third year.

c. Community oral health centers shall receive the following reimbursement for services: up to $5,000 per eligible mother and not to exceed 75 mothers in the first year, up to $5,000 per eligible mother and not to exceed 150 mothers in the second year, and up to $5,000 per eligible mother and not to exceed 300 mothers in the third year.

d. The third-party hired by the department to assist with data analysis and project evaluation activities shall receive $275,000 for the provision of services.

5. This act shall take effect 90 days following the date of enactment and shall expire three years thereafter.

STATEMENT

This bill establishes the MOM Project oral health three-year pilot program (program) in the Department of Health (department) and appropriates $4,150,000.

Under the bill, "community oral health center" or "center" means the following in-State entities: a federally qualified health center, a dental home, or an acute care hospital licensed by the department that provides dental services to individuals who reside in a medically underserved area. "Dental home" means a licensed dental practice that administers services in manner that is accessible, culturally-sensitive, and family-centered. A "dental home" does not include a licensed dental practice if less than 75 percent of the dental practice's patients are individuals who are low income and who reside in a medically underserved area. "Eligible mother" or "mother" means a State resident who is pregnant, low-income, and not enrolled in, eligible for, or determined presumptively eligible for coverage under any Medicaid program. "Maternal and child health consortium" or "consortium" means a nonprofit organization licensed as a central service facility by the department, and incorporated under Section 501(c)(3) of the United States Internal Revenue Code.

Under the bill, the department is to administer the program in conjunction with at least one consortium. Within 90 days following the effective date of this bill, each participating consortium is to begin to provide the following program services:

(1) Each consortium is to implement an outreach plan to identify eligible mothers, who reside in the area served by the consortium, and register the mothers in the program. Upon registration and in a manner that is consistent with federal and State privacy laws, the consortium is to endeavor to collect the following information from eligible mothers: whether the mother has or had access to a dental home during a current or prior pregnancy; the mother's oral hygiene routine, including the use of fluoride toothpaste; the mother's dietary habits; and the result of previous pregnancies.

(2) Each consortium is to establish an oral health education program. Prior to the commencement of the oral health education program, each consortium is to require eligible mothers to complete a pre-education assessment that includes testing the mother's understanding of oral health and oral hygiene.

(3) Each consortium is to provide eligible mothers a minimum of three hours of oral health education that includes the following: oral hygiene routines for mothers, infants, and children; nutritional counseling; education regarding the correlation between cariogenic disease and cardiovascular disease, diabetes, and gastric changes; the impact of tobacco, drugs, and alcohol on a mother's oral health and the unborn child; recommendations and resources for routine oral health care for mothers, infants, and children; and education regarding available educational support. Oral health education program educators are to be compatible with the language and cultural needs of the eligible mothers enrolled in the oral health education program.

(4) Following the eligible mother's completion of the oral health education program, the consortium is to require the eligible mother to complete a post-education assessment that includes testing to assess the mother's understanding of oral health and oral hygiene routines.

Under the bill, within 90 days following the effective date of this bill, a community oral health center seeking to participate in the MOM Project is to file an application with the department, in a manner to be determined by the department. The department is to require an eligible community oral health center to enter into an agreement with a consortium to implement the following:

(1) Following an eligible mother's completion of the oral health education program, the center is to develop a customized oral health treatment plan and nutritional recommendations for the mother, infant, and child, as applicable.

(a) a dental visit for cleaning, cavity risk assessment, periodontal charting, and to establish a one-year treatment plan;

(b) comprehensive dental care and restorative treatment as needed;

(c) a cleaning and treatment plan review approximately six months and one year following the date of the initial dental visit;

(d) two dental visits for the infant or child; and

(e) identification of a dental home for the child or infant before the infant receives his or her first tooth.

Under the bill, within 180 days following the effective date of this bill, each consortium and health center is to compile and report relevant data to the department, as determined by the department. The department is to contract with a third-party to assist with data analysis and project evaluation activities. The department and the third-party hired are to informally convene an advisory panel to design an oral health model to be potentially included in the Medicaid program. The department is to prepare and submit a report of its findings to the Governor and to the Legislature.

The bill appropriates $4,150,000 to the department to effectuate the purposes of the bill, as detailed in section 4 of the bill.