CN-680000-FP125.pdf

AHCA CONTRACT NO. FP125

AMENDMENT NO. 1

AHCA Contract No. FP125, Amendment No. 1, Page 1 of 2 April 2020

THIS CONTRACT, entered into between the STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, hereinafter referred to as the "Agency" and DENTAQUEST OF FLORIDA, INC., hereinafter referred to as the "Vendor" or “Dental Plan,” is hereby amended as follows:

1. Standard Contract, Section III., The Vendor and Agency Hereby Mutually Agree, Sub-

Section B., Contract Managers, Item 1 ., is hereby amended to now read as follows:

1. The Agency’s Contract Manager’s contact information is as follows:

Jessica Gramling Agency for Health Care Administration 2727 Mahan Drive, MS #50 Tallahassee, FL 32308

(850) 412-4051 Jessica.Gramling@ahca.myflorida.com

2. Attachment I, Scope of Services, Statewide Medicaid Managed Care Dental Health Program, is hereby deleted in its entirety and replaced with Attachment I, Scope of Services, Statewide Medicaid Managed Care Dental Health Program - Update: February 1, 2025, attached hereto and made a part of this Contract. All references in this Contract to Attachment I, Scope of Services, Statewide Medicaid Managed Care Dental Health Program, shall hereinafter refer to Attachment I, Scope of Services, Statewide Medicaid Managed Care Dental Health Program - Update: February 1, 2025.

3. Attachment II, Scope of Service - Core Provisions, is hereby deleted in its entirety and replaced with Attachment II, Scope of Service - Core Provisions - Update: February 1, 2025, attached hereto and made a part of this Contract. All references in this Contract to Attachment II, Scope of Service - Core Provisions, shall hereinafter refer to Attachment II, Scope of Service - Core Provisions - Update: February 1, 2025.

All provisions not in conflict with this Amendment are still in effect and are to be performed at the level specified in this Contract.

This Amendment and all its attachments are hereby made a part of this Contract.

This Amendment cannot be executed unless all previous Amendments to this Contract have been fully executed.

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

Docusign Envelope ID: 7C2BA43D-B8AA-4758-A17D-CD54CD7DC229 mailto:Jessica.Gramling@ahca.myflorida.com

AHCA CONTRACT NO. FP125

AMENDMENT NO. 1

AHCA Contract No. FP125, Amendment No. 1, Page 2 of 2 April 2020

IN WITNESS WHEREOF, the Parties hereto have caused this two-hundred ninety-five (295) page Amendment to be executed by their officials thereunto duly authorized. This Amendment is not valid until signed and dated by both Parties.

DENTAQUEST OF FLORIDA, INC. STATE OF FLORIDA, AGENCY FOR

HEALTH CARE ADMINISTRATION

SIGNED

BY:

SIGNED

BY:

NAME: NAME:

TITLE: TITLE:

DATE: DATE:

List of Attachments included as part of this Amendment:

Specify Type Number Description Attachment I Scope of Services, Statewide Medicaid Managed

Care Dental Program – Update: February 1, 2025 (32 Pages)

Attachment II Scope of Service-Core Provisions Update: February 1, 2025 (261 Pages)

Brett Bostrack

1/31/2025

SVP Secretary

Jason Weida

2/2/2025

DENTAQUEST OF FLORIDA, INC.

ATTACHMENT I

SCOPE OF SERVICES -- UPDATE: FEBRUARY 1, 2025

STATEWIDE MEDICAID MANAGED CARE DENTAL HEALTH PROGRAM

AHCA Contract No. FP125, Attachment I, Update 02/01/25, Page 1 of 4

I. Services to be Provided

A. Overview of Contract Structure

Part IV of Chapter 409, F.S. established Florida Medicaid’s statewide managed care program, referred to as statewide Medicaid managed care (SMMC). Section 409.973, F.S.

directed the Agency to provide Medicaid recipients with dental benefits separate from SMMC. The dental Contract consists of distinct parts as follows:

(1) Attachment I, Scope of Services, includes contract provisions that are unique to the particular Dental Plan.

(a) Exhibit I-A, Approved Expanded Benefits Coverage and Limitations;

(b) Exhibit I-B, Medicaid Provider Identification Numbers;

(c) Exhibit I-C, Dental Plan Rates – Not for Use Unless Approved by CMS;

(d) Exhibit I-D, Faculty Plans of Florida Dental School Faculty Physician Groups

Rates – Not for Use Unless Approved by CMS;

(e) Exhibit I-E, Dental Provider Incentive Program (DPIP) Summary; and

(f) Exhibit I-F, Plan-Specific Commitments.

(g) Exhibit I-G, Data Transparency Requirements; and

(h) Exhibit I-H, Provider Scorecard Requirements.

(2) Attachment II, Scope of Service – Core Provisions, includes contract provisions that apply to all Dental Plans unless specifically noted otherwise.

B. Authorized Regions

The Dental Plan is authorized to provide services pursuant to this Contract statewide in all nine (9) regions for the SMMC Dental program.

C. Covered Services

The Dental Plan shall ensure the provision of covered dental services in accordance with the provisions of Attachment II, Scope of Service – Core Provisions.

D. Approved Expanded Benefits

The Dental Plan shall provide the following expanded benefits, in accordance with the provisions of Attachment II, Scope of Service – Core Provisions, and the coverage and limitations specified in Exhibit I-A, Approved Expanded Benefits Coverage and Limitations, of this Attachment, denoted by “X” in the Approved Expanded Benefits Table, Table 1, below:

AHCA Contract No. FP125, Attachment I, Update 02/01/25, Page 2 of 4

TABLE 1: APPROVED EXPANDED BENEFITS

Expanded Benefits for All Ages

X Hydroxyapatite (Calcium) Application X Over-The-Counter Products

Expanded Benefits for Ages 20 and Under Nutritional and Tobacco Cessation Counseling

X Surgical Placement and Maintenance of Implant Body, Abutment and Crown Expanded Benefits for Ages 21 and Over

X Adjunctive Dental Services - Treatment of Complications X Amalgam Restorations (Dental Fillings) X Cavity Medicament X Debridement (Removal of Damaged Tissue or Foreign Objects) Diabetes Testing

X Diagnostic X-rays X Oral Hygiene Instruction X Oral Screenings and Evaluation X Periodontal Maintenance X Prophylaxis (Cleaning Treatment) X Periodontal Scaling X Sealants X Topical Fluoride and Fluoride Varnish

Expanded Benefits for Seniors Ages 65 and Older X Crowns - Porcelain Ceramic and Resin Based Crowns - Stainless Steel (Pre-Fabricated)

X Endodontic Therapies, including Root Canals (Anterior, Premolar, Molar) X Therapeutic Parenteral Drugs

Expanded Benefits for Individuals with Developmental Disabilities

X Acclimation Visits X Adjunctive Dental Services - Behavioral Management X Adjunctive Dental Services - Denture Cleaning and Inspections X Crowns - Porcelain Ceramic and Resin-Based Crowns - Stainless Steel (Pre-Fabricated)

X Endodontic Therapies, including Root Canals (Anterior, Premolar, Molar) X Prophylaxis (Extra Cleanings)

Expanded Benefits Pregnant Women X Periodontal Maintenance X Prophylaxis (Extra Cleanings)

AHCA Contract No. FP125, Attachment I, Update 02/01/25, Page 3 of 4

II. Manner of Service Provision

A. Plan Qualification

The Dental Plan is approved to provide contracted services as a qualified entity under s 409.973(5), F.S., as denoted by “X” in the Plan Qualification Table, Table 2, below.

TABLE 2: PLAN QUALIFICATION

Health Maintenance Organization (HMO)

X Prepaid Limited Health Service Organization (PLHSO)

B. Plan Type

The Dental Plan is approved to provide contracted services as a Statewide Medicaid Prepaid Dental Plan.

III. Method of Payment

A. Total Contract Amount

The Agency shall make payment, in a total dollar amount not to exceed $1,372,159,412 to the Dental Plan in accordance with Attachment II, Scope of Service – Core Provisions.

The Agency shall make payments through its fiscal agent using the Medicaid Provider Identification Number(s) specified in Exhibit I-B, Medicaid Provider Identification Numbers.

B. Dental Plan Rates - Not for Use Unless Approved by CMS

The capitation rate payment shall be in accordance with Attachment II, Scope of Service

– Core Provisions. The capitation rates are contained in Exhibit I-C, Dental Plan Rates - Not for Use Unless Approved by CMS, of this Attachment.

C. Faculty Plans of Florida Dental School Faculty Physician Groups Rates - Not for

Use Unless Approved by CMS

The per-member per-month (PMPM) rates for payment of Florida dental school faculty physician groups shall be in accordance with Attachment II and its Exhibits. The PMPM rates are contained in Exhibit I-D, Faculty Plans of Florida Dental School Faculty Physician Groups Rates - Not for Use Unless Approved by CMS, of this Attachment.

D. Dental Provider Incentive Program

The Dental Plan shall reimburse qualified dental providers in accordance with Attachment II and its Exhibits. The Dental Provider Incentive Program Summary is contained in Exhibit I-E of this Attachment.

AHCA Contract No. FP125, Attachment I, Update 02/01/25, Page 4 of 4

IV. Special Provisions

A. Order of Precedence

(1) For all regions, the Dental Plan shall perform its contracted duties in accordance with this Contract, the ITN(s), including all addenda and the Vendor’s response to the ITN(s). In the event of conflict among Contract documents, any identified inconsistency in this Contract shall be resolved by giving precedence in the following order:

a. This Contract, including all attachments;

b. The ITN(s), including all addenda; and

c. The Vendor’s response to the ITN(s), including information provided through negotiations.

B. Plan-Specific Commitments

The Dental Plan shall perform the program enhancements in accordance with Attachment II, Scope of Service – Core Provisions. The Dental Plan’s Plan-Specific Commitments are described in Exhibit I-F, Plan-Specific Commitments, of this Attachment.

C. Special Terms and Conditions

There are no additional special terms and conditions unique to the Vendor.

V. Incentivizing Value and Quality

A. Dental Quality Data Transparency

The Dental plan shall assemble performance measure dashboards and/or report cards to assess important dimensions of the Dental Plan’s performance and include measures that when publicly shared, will also serve to incentivize dental excellence.. The Dental Plan shall fulfill Data Transparency requirements in accordance with Exhibit I-G, Data Transparency Requirements.

B. Provider Scorecard

The Dental Plan shall produce Provider Scorecards that include performance measures and key indicators relative to the care provided to enrollees. The Provider Scorecards shall be publicly available, and include the measures outlined in Exhibit I-H, Provider Scorecard Requirements.

AHCA Contract No. FP125, Attachment I, Exhibit I-A, Update 02/01/25, Page 1 of 7

EXHIBIT I-A

APPROVED EXPANDED BENEFITS COVERAGE AND LIMITATIONS

Category Subcategory Eligible Population Procedure Code Description

Procedure Code Min Age Max Age Expanded Benefit

Coverage (Units)

Acclimation visits N/A Individuals with developmental disabilities

Unspecified diagnostic procedure D0999 0 999 Four (4) per year

Endodontic therapy Root canals

Adults aged 65 and over; Individuals with

Developmental Disabilities

Endodontic therapy, anterior tooth D3310 21 999

Endodontic therapy Root canals

Adults aged 65 and over; Individuals with

Developmental Disabilities

Endodontic therapy, premolar tooth D3320 21 999

Endodontic therapy Root canals

Adults aged 65 and over; Individuals with

Developmental Disabilities

Endodontic therapy, molar tooth D3330 21 999

Endodontic therapy Root canals

Adults aged 65 and over; Individuals with

Developmental Disabilities

Treatment of root canal obstruction D3331 21 999

Endodontic therapy Root canals

Adults aged 65 and over; Individuals with

Developmental Disabilities

Incomplete endodontic therapy D3332 21 999

APPROVED EXPANDED BENEFITS COVERAGE AND LIMITATIONS

Once (1) per year

AHCA Contract No. FP125, Attachment I, Exhibit I-A, Update 02/01/25, Page 2 of 7

Procedure Code Min Age Max Age Expanded Benefit

Coverage (Units)

Preventative Prophylaxis Adults ages 21 and over

Removal of plaque calcium and stains from tooth D1110 21 999

Preventative Prophylaxis Adults ages 21 and over Topical fluoride varnish D1206 21 999

Preventative Prophylaxis Adults ages 21 and over

Topical app. fluoride excluding varnish D1208 21 999

Preventative Prophylaxis Adults ages 21 and over Oral hygiene instruction D1330 21 999

Preventative Prophylaxis Adults ages 21 and over Dental sealant per tooth D1351 21 999 One (1) per tooth per three (3) years

Preventative Prophylaxis Adults ages 21 and over

Interim caries arresting medicament application D1354 21 999 Two (2) per tooth per six ( 6) months

Restorative Dental crowns

Adults ages 65 and over; individuals with developmental disabilities

Resin-based composite D2710 NA 999

Restorative Dental crowns

Adults ages 65 and over; individuals with developmental disabilities

Porcelain ceramic D2740 NA 999

Preventative Prophylaxis

Pregnant women and individuals with developmental disabilities

Removal of plaque calcium and stains from tooth D1110 21 999

Three (3) per year, no limit on timing between services

Once (1) per year or maximum 1 per tooth per lifetime

Two (2) per year

AHCA Contract No. FP125, Attachment I, Exhibit I-A, Update 02/01/25, Page 3 of 7

Procedure Code Min Age Max Age Expanded Benefit

Coverage (Units)

Restorative Amalgam restorations

Adults ages 21 and over

One surface, primary or permanent tooth D2140 21 999

Restorative Amalgam restorations

Adults ages 21 and over

Two surfaces, primary or permanent tooth D2150 21 999

Restorative Amalgam restorations

Adults ages 21 and over

Three surfaces, primary or permanent tooth D2160 21 999

Restorative Amalgam restorations

Adults ages 21 and over Four or more D2161 21 999

Restorative Amalgam restorations

Adults ages 21 and over Resin one surface-anterior D2330 21 999

Restorative Amalgam restorations

Adults ages 21 and over Resin two surfaces-anterior D2331 21 999

Restorative Amalgam restorations

Adults ages 21 and over

Resin three surfaces-anterior D2332 21 999

Restorative Amalgam restorations

Adults ages 21 and over

Resin-based composite -four or more surfaces or with incisal angle D2335 21 999

Restorative Amalgam restorations

Adults ages 21 and over

Anterior resin-based composite crown D2390 21 999

Restorative Amalgam restorations

Adults ages 21 and over

Posterior resin-based composite one surface D2391 21 999

Restorative Amalgam restorations

Adults ages 21 and over

Posterior resin-based composite two surfaces D2392 21 999

Restorative Amalgam restorations

Adults ages 21 and over

Posterior resin-based composite three surfaces D2393 21 999

Once (1) per [tooth + surface(s)] per three

(3) years

AHCA Contract No. FP125, Attachment I, Exhibit I-A, Update 02/01/25, Page 4 of 7

Procedure Code Min Age Max Age Expanded Benefit

Coverage (Units)

Restorative Amalgam restorations

Adults ages 21 and over Protective restoration D2940 21 999 One (1) per tooth per day

OTC

Toothbrushes, tooth paste, mouthwash and dental floss

NA NA D1999 0 999

OTC Pain and inflammation relief NA NA D1999 0 999

OTC

Medicated toothache drops or gel

NA NA D1999 0 999

OTC

Temporary filling and loose cap repair

NA NA D1999 0 999

OTC Denture adhesives NA NA D1999 0 999

OTC

Dry mouth treatment/ lozenges

NA NA D1999 0 999

OTC Mouth guards NA NA D1999 0 999

Periodontics Adults ages 21 and over Periodontal scaling & root D4341 21 999

Periodontics Adults ages 21 and over

Periodontal scaling 1-3 teeth D4342 21 999

Periodontics Adults ages 21 and over Scaling gingiv. inflammation D4346 21 999 Two (2) per year

Periodontics Adults ages 21 and over Full mouth debridement D4355 21 999 One (1) per year

$10 per individual, $30 per family per 90 days

Four (4) units every Twenty-four (24) months

AHCA Contract No. FP125, Attachment I, Exhibit I-A, Update 02/01/25, Page 5 of 7

Procedure Code Min Age Max Age Expanded Benefit

Coverage (Units)

Diagnostic Oral evaluation Adults ages 21 and over

Periodic oral evaluation -established patient D0120 21 999

Diagnostic Pre-diagnostic Adults ages 21 and over Screening of a patient D0190 21 999

Diagnostic Pre-diagnostic Adults ages 21 and over Assessment of a patient D0191 21 999

Diagnostic imaging X-rays Adults ages 21 and over Extraoral 2D project image D0250 21 999

Diagnostic imaging X-rays Adults ages 21 and over Extraoral posterior image D0251 21 999

Diagnostic imaging X-rays Adults ages 21 and over Bitewings single image D0270 21 999

Diagnostic imaging X-rays Adults ages 21 and over Bitewings two images D0272 21 999

Diagnostic imaging X-rays Adults ages 21 and over Bitewings four Images D0274 21 999

Implants Surgical Services, Implant Supported

Prosthetics, Enrollees age 20 and under

Surgical placement of implant body, abutment and crown

D6010 or D6013 or D6040 or

D6050; and D6114 -

6119; and D6060 or

6082 or 6086

12 20

One (1 )tooth per year.

1 per tooth per lifetime.

Only where a maxillary incisor tooth is missing (teeth #: 7, 8, 9, or 10). Only if EPSDT does not cover.

Two (2) per year

Once (1) per thirty (36) months

One (1) per year

AHCA Contract No. FP125, Attachment I, Exhibit I-A, Update 02/01/25, Page 6 of 7

Procedure Code Min Age Max Age Expanded Benefit

Coverage (Units)

Restorative Other Enrollees age 20 and under

Application of hydroxyapatite regeneration medicament D2991 0 20 One (1) per tooth per three (3) years

Periodontics Other Periodontics

Enrollees aged 21 and over Periodontal Maintenance D4910 21 999 Two (2) times (D1110 or D4910) per year

Restorative Other Enrollees age 20 and under

Application of hydroxyapatite regeneration medicament D2991 21 999 One (1) per tooth per three (3) years

Preventive Dental Prophylaxis

Enrollees with chronic illness Prophy D1110 21 999

Three (3) times (D1110 or D4910) per year

Periodontics Other Periodontics

Enrollees with chronic illness Periodontal Maintenance D4910 21 999

Three (3) times (D1110 or D4910) per year

Adjunctive Dental Services

Miscellaneous Services

Enrollees with chronic illness Treatment of complications D9930 21 999 History of a chronic condition

Preventive Dental Prophylaxis

Individuals with developmental disabilities Prophy D1110 0 999

Three (3) times (D1110 or D4910) per year

Periodontics Other Periodontics

Individuals with developmental disabilities Periodontal Maintenance D4910 0 999

Three (3) times (D1110 or D4910) per year

AHCA Contract No. FP125, Attachment I, Exhibit I-A, Update 02/01/25, Page 7 of 7

All expanded benefits are in excess of benefits specified in the Medicaid State Plan.

The Dental Plan may require enrollees to use an established network of providers, approved by the Agency, to obtain expanded benefits under this Contract.

Unless otherwise specified in this Exhibit, expanded benefits are not subject to prior authorization or co-payment charges.

Procedure Code Min Age Max Age Expanded Benefit

Coverage (Units)

Adjunctive Dental Services

Miscellaneous Services

Individuals with developmental disabilities

Cleaning and inspection of dentures D9932-9935 21 999 One (1) per year

Adjunctive Dental Services

Miscellaneous Services

Individuals with developmental disabilities Behavioral Management D9920 21 999 As necessary

Preventive Dental Prophylaxis Pregnant women Prophy D1110 0 1002

Three (3) times (D1110 or D4910) per year

Periodontics Other Periodontics Pregnant women Periodontal Maintenance D4910 0 999

Three (3) times (D1110 or D4910) per year

Adjunctive Dental Services Drugs Adults ages 65 and older Therapeutic parenteral drugs D9610 or

D9612 65 999 Up to four (4) units per year

AHCA Contract No. FP125, Attachment I, Exhibit I-B, Update 02/01/25, Page 1 of 1

EXHIBIT I-B

MEDICAID PROVIDER IDENTIFICATION NUMBERS

MEDICAID PROVIDER IDENTIFICATION NUMBERS

Region Dental

A 123574600-01 B 123574600-03 C 123574600-05 D 123574600-06 E 123574600-07 F 123574600-08 G 123574600-09 H 123574600-10

I 123574600-11

The Agency will provide Medicaid Provider Identification Numbers to the Dental Plan subsequent to the Agency’s completion of a plan-specific readiness review and prior to enrolling recipients in the Dental Plan in each region.

AHCA Contract No. FP125, Attachment I, Exhibit I-C, Update 02/01/25, Page 1 of 1

EXHIBIT I-C – UPDATE: FEBRUARY 1, 2025

DENTAL PLAN RATES - NOT FOR USE UNLESS APPROVED BY CMS

1 Capitation rates are set at a regional level for the Medicaid Only and Dual Eligible rate cells, but set at a statewide level for the Medically Needy rate cells to enhance credibility.

DENTAL PLAN RATES NOT FOR USE UNLESS APPROVED BY CMS

STATEWIDE MEDICAID MANAGED CARE (SMMC) DENTAL HEALTH PROGRAM

FEBRUARY 2025 THROUGH OCTOBER 2025 RATE YEAR (RY 24/25) CAPITATION RATE DEVELOPMENT BY REGION AND RATE CELL

Region Rate Cell A B C D E F G H I

Medicaid Only / Dual Eligible 0-20 $17.74 $10.82 $13.35 $12.59 $11.19 $11.07 $12.80 $12.49 $12.16 Medicaid Only 21+ $6.85 $3.84 $4.36 $4.02 $3.46 $2.69 $2.82 $2.71 $3.39 Dual Eligible 21+ $4.55 $2.85 $3.41 $2.89 $2.94 $2.21 $3.24 $3.06 $2.59 Medically Needy 0-201 $5.77 $5.77 $5.77 $5.77 $5.77 $5.77 $5.77 $5.77 $5.77 Medically Needy 21+1 $2.44 $2.44 $2.44 $2.44 $2.44 $2.44 $2.44 $2.44 $2.44

AHCA Contract No. FP125, Attachment I, Exhibit I-D, Update 02/01/25, Page 1 of 1

EXHIBIT I-D

FACULTY PLANS OF FLORIDA DENTAL SCHOOL FACULTY PHYSICIAN GROUPS RATES- NOT FOR USE UNLESS

APPROVED BY CMS

RY 24/25 Special Payment Rates Pending Finalization

AHCA Contract No. FP125, Attachment I, Exhibit I-E, Update 02/01/25, Page 1 of 1

EXHIBIT I-E

DENTAL PROVIDER INCENTIVE PROGRAM (DPIP) SUMMARY

To qualify for DPIP for the October 1, 2024 – September 30, 2025, contract year, a dental provider must achieve or exceed the benchmarks for each of the following metrics. Dental Quality Alliance (DQA) measures must be calculated using DQA 2024 specifications for CY 2023 services. Child Core Set measures must be calculated using the most recent technical specifications posted at: Child Core Set Reporting Resources | Medicaid.

Metric Measurement Period

Incentive Threshold Rate Metric Description

Preventive Dental Services

10/1/2022- 09/30/2023

65% Percentage of children ages 1 to 20 who are eligible for at least 90 continuous days, are eligible for EPSDT services, and who received at least one preventive dental service during the measurement period.

Child Core Set: Oral Evaluation – Total

1/1/2023- 12/31/2023

65% Percentage of enrolled children under age 21 who received a comprehensive or periodic oral evaluation within the reporting year.

DQA:

Caries Risk Assessment

– Total

1/1/2023- 12/31/2023

70% Percentage of enrolled children under age 21 years who have caries risk documented in the reporting year.

Child Core Set: Sealant Receipt on Permanent 1st Molars – at least one

1/1/2023- 12/31/2023

60% Percentage of enrolled children who have ever received sealants on permanent first molar teeth: (1) at least one sealant

Child Core Set: Topical Fluoride for Children (Total)

1/1/2023- 12/31/2023

65% Percentage of children aged 1-21 years who received at least 2 topical fluoride applications within the reporting year.

https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.medicaid.gov%2Fmedicaid%2Fquality-of-care%2Fperformance-measurement%2Fadult-and-child-health-care-quality-measures%2Fchild-core-set-reporting-resources%2Findex.html&data=05%7C02%7CJamie.Jean-Paul%40ahca.myflorida.com%7C2d77f4007b4148b924ff08dc41fca2fe%7C583c5f193b644cedb59ee8649bdc4aa6%7C0%7C0%7C638457800519667592%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&sdata=m%2F85m%2BNjAa7y7d0IkQPOej2yl8J12jaDfK8pim4fYUw%3D&reserved=0

AHCA Contract No. FP125, Attachment I, Update 02/01/25, Exhibit I-F, Page 1 of 8

EXHIBIT I-F

PLAN-SPECIFIC COMMITMENTS

Region Category Sub-Category Commitment (Description) Important Milestones Target Date(s) for

Completion Statewide Provider

Engagement (investments, models, training, other)

IDD/Special Needs Clinic DentaQuest commits to spearheading a consortium to build a centralized special needs clinic and training center that offers sedation services. Including sedation services, would solve the issue of the lack of outpatient sedation appointment availability. The location is TBD.

Initially in year 1, DentaQuest will organize a planning committee to investigate the feasibility of developing such a center. The Planning Committee will investigate such issues as how the group can be organized, what stakeholders need to be involved, options on locations, how much would such a facility cost to establish, projecting an annual operational budget.

If the Planning Committee determines the concept is feasible, it will move forward with developing an Action Plan in year 2. Once an Action Plan is in place, years 2-5 would consist of implementation.

Throughout the process DentaQuest will dedicate staff to manage the process to keep it moving along.

The location is not known, but we understand stakeholders are looking at central Florida to ensure all dental schools could access the clinic. This is in the early stages of discussion with stakeholders. To be clear, DentaQuest is committed to leading a consortium of stakeholders who have a desire to establish a clinic. DentaQuest would not be establishing a clinic ourselves.

1. Identify consortium stakeholders by 3/1/25.

2. Set meeting cadence, and determine ongoing agenda topics by 7/1/25.

3. Launch consortium by 10/31/25.

End of the first Contract Year.

Statewide Pilots (service delivery, contracting models, other)

Non-Invasive Therapies DentaQuest commits to a pilot for minimally invasive care. We will launch a Healthy Teeth Pilot Program, designed to: replace invasive treatment options like restorations with non-invasive dental therapies for initial, early-stage dental caries, and socialize the benefits of non-invasive treatment options among Providers and Enrollees. Non-invasive care can cost less and work as well or better than traditional drill and fill restorative care.

DQ will contract with Care Quest Innovation Partners and clinical experts will provide specialized in-person and online training to the participating dental providers and their staff. The program will include frequent and ongoing support, including data reporting. The training will focus on two areas - caries lesion (demineralization and decay) assessment and the use of non-invasive therapeutic services. These therapies include traditional preventive agents such as Fluoride varnish and sealants; innovative regenerative products like Curodont Repair Fluoride Plus;

caries arresting agents like silver diamine fluoride (SDF); and remineralizing agents like glass ionomer (GI).

1. Kick-Off workgroup on 11/1/2024.

2. Draft a legal contract by 1/15/2025.

3. Select participating providers offices and contract with them by 2/1/2025.

4. Conduct clinical training by 2/28/25.

5. Launch pilot 3/1/25.

6. Begin bi-weekly office hours with participating providers 3/12/25.

7. Monthly KPI reporting begins 4/1/25.

By 3/1/2025

DentaQuest - Plan-Specific Commitments

AHCA Contract No. FP125, Attachment I, Update 02/01/25, Exhibit I-F, Page 2 of 8

Completion Statewide Provider

Engagement (investments, models, training, other)

PA Waiver for Sedation DentaQuest commits to waiving all prior auth requirements for providers who are rendering care for certain populations under sedation.

Upon execution of this Contract Ongoing - Life of this Contract

Statewide Pathways to Prosperity and Purpose

HRA DentaQuest commits to expanding the health risk assessment process. DentaQuest commits to providing risk assessment for the entire population enrolled in our program.

Within 90 days of contract start:

DentaQuest will make three separate attempts using three different communication channels to conduct the risk assessment for all Enrollees via mail, phone, and text.

During operational phase:

DentaQuest will make three separate attempts using up to three different communication channels to conduct the risk assessment for all Enrollees via mail, phone, and text. Mail will be issued within 5 days of Enrollee joining our plan.

Ongoing - Life of this Contract

Statewide Provider Engagement (investments, models, training, other)

Credentialing Streamlining DentaQuest commits to paying for live scan fingerprinting for any new provider that joins our network (one-time fee at time of enrollment with DentaQuest).

Upon execution of this Contract Ongoing - Life of this Contract

A, B, D, E, F, G

Provider Network (enhanced ratios, other)

Access to Care DentaQuest has identified access to care enhancement opportunities in regions A, B, D/E and F/G. As such, DentaQuest’s affiliate Advantage Dental+ is currently evaluating regional Medicaid market access, cost, and quality challenges along with membership and rate structure opportunities. Upon contact award, DentaQuest and Advantage Dental+ commits to determining next steps in expansion efforts.

1. By 1/1/25, DentaQuest will present proposed locations to AHCA for agreement/approval.

2. Two locations will be opened by 1/1/26

3. Two locations will be opened by 1/1/27.

Two locations will be open and operational by 1/1/26 and two will be open and operational by 1/1/27

AHCA Contract No. FP125, Attachment I, Update 02/01/25, Exhibit I-F, Page 3 of 8

Completion Statewide Technical

(infrastructure investments for telemedicine/teleh ealth, systems upgrades or investments, other)

Provider Portal Upgrades DentaQuest commits to rolling out our next generation Provider portal during the next contract period. Streamlined functionality includes member eligibility search, comprehensive at-a-glance member details, detailed benefits summary and new estimate functionality allow providers to access on demand estimates for services and what would be covered under the plan.

Upon execution of this Contract Ongoing - Life of this Contract

Statewide Technical (infrastructure investments for telemedicine/teleh ealth, systems upgrades or investments, other)

Website Upgrades DentaQuest commits to a new mobile-optimized website, including streamlined navigation, geolocation and improved self-service tools for members:

• Dental Home change feature to allow Members to change their dental home using an online form.

• Dedicated page for Florida AHCA with plan benefits and AHCA specific programs, links and calls to action.

• Improved find a dentist experience that offers results in just one click and includes an interactive map and advanced filter capabilities.

• Digital ID on the website for Florida Medicaid Members on

• On-demand access to view/print/share their member ID.

Upon execution of this Contract Ongoing - Life of this Contract

Statewide Provider Engagement (investments, models, training, other)

Provider Training DentaQuest commits additional training for providers by offering free CE classes.

Upon execution of this Contract Ongoing - Life of this Contract

Statewide Pathways to Prosperity and Purpose

Hope Florida Services DentaQuest commits to working with the Hope Florida initiative to get dental services for adults added to the service offerings. We will ask our Providers to volunteer with the Hope Florida initiative. Additionally, we will also help train, educate and provide resources to the Hope Navigators, the volunteers who help the community to access resources.

1. Upon execution of this Contract, DentaQuest will meet with Hope Florida and its Care Navigators to establish relationships. We will provide education on the different ways we are supporting the mission of Hope Florida.

2. DentaQuest will design and launch a digital toolkit of oral health education for Care Navigators and CBOs by 6/30/25.

Ongoing - Life of this Contract

Statewide Pilots (service delivery, contracting models, other)

HRSA Grants DentaQuest commits to engaging in the grant and proposal processes for alliances such as those that pursue HRSA grants related to pilots to embed dental hygienists into medical practices and settings. We would add expertise and analysis on how properly reimburse and track encounters.

Upon execution of this Contract Ongoing - Life of this Contract

AHCA Contract No. FP125, Attachment I, Update 02/01/25, Exhibit I-F, Page 4 of 8

Completion Statewide Pathways to

Prosperity and Purpose

Hope Florida Services DentaQuest commits to implementing new ways to support low-cost dental programs including:

• Adding information on the Florida Dental Association’s Access to Care Resource Guide in our Member Handbook under a heading about family matters. The first few pages of the access to care guide highlight statewide opportunities including, Remote Access Medical Dental Clinics.

Upon execution of this Contract Ongoing - Life of this Contract

Statewide Pathways to Prosperity and Purpose

Hope Florida Services DentaQuest commits to implementing new ways to support low-cost dental programs including:

• Surveying our Providers to obtain more up-to-date information on whether they offer free or low-cost treatment options for uninsured family members of our Enrollees.

• Working with dental schools and dental hygienist programs Our goal is to develop a listing of Providers that our internal staff can use to refer these family members to for services.

Upon execution of this Contract Ongoing - Life of this Contract

Statewide Pathways to Prosperity and Purpose

Hope Florida Services DentaQuest commits to implementing new ways to support low-cost dental programs including:

• Develop a referral pathway to assist Floridians, who do not qualify for Medicaid or CHIP, to find other acceptable low-cost, high-quality dental plans. Our care/case management team will collaborate with organizations such as:

dentaly.org/us/dental-insurance-usa/florida-fl/;

healthinsurance.org/dental/florida-dental-insurance-guide/; and floridadental.org/public/other-helpful-links to help member navigate other dental plan options.

Upon execution of this Contract Ongoing - Life of this Contract

Statewide Pathways to Prosperity and Purpose

Hope Florida Services DentaQuest commits to implementing new ways to support low-cost dental programs including:

• Supporting Missions of Mercy events, as well as the Special Olympics Fall Games Special Smiles Program for 2024. DentaQuest is providing $30,000 for regional and statewide events. The Special Smiles Program provides screenings and oral health education to the athletes and others attending the events. There will be the Special Smiles area at least one regional event throughout the year, allowing us to have an even greater reach.

AHCA Contract No. FP125, Attachment I, Update 02/01/25, Exhibit I-F, Page 5 of 8

Completion Statewide Pathways to

Prosperity and Purpose

Hope Florida Services DentaQuest commits to implementing new ways to support low-cost dental programs including:

• Sponsoring the Eyes on Smiles Program, which provides training to Dentists to help them become more comfortable in serving individuals with IDD.

At these events, DentaQuest also brings a directory of Providers who see individuals with IDD, allowing us to connect individuals with a dentist after they receive their screening. (Break these out to single commitments where appropriate.)

Upon execution of this Contract Ongoing - Life of this Contract

Statewide Staffing (training, additional/specializ ed FTEs, enhanced ratios, other)

Staffing DentaQuest commits to 89.25 FTEs to service this Contract

Upon execution of this Contract Ongoing - Life of this Contract

Statewide Staffing (training, additional/specializ ed FTEs, enhanced ratios, other)

Staffing DentaQuest commits to having our Florida Dental Director conduct at least 12 on-site fraud visits annually.

N/A - these will be conducted as requested by AHCA as situations arise

Ongoing - Life of this Contract

Statewide Operations Claims Processing Claims Processing DentaQuest commits to paying the following percentages of clean claims within 7 days and 15 days:

• Pay seventy percent (70%) of all clean claims submitted within seven (7) days.

• Pay ninety-five percent (95%) of all clean claims submitted within fifteen (15) days.

AHCA Contract No. FP125, Attachment I, Update 02/01/25, Exhibit I-F, Page 6 of 8

Completion Statewide Quality Quality Continuum Targets Quality Performance Measures

DentaQuest commits to Quality Continuum Targets provided in Tab "Quality Continuum"

Upon execution of this contract, DentaQuest will ensure we are monitoring, tracking and driving commitments to members forward.

Monthly monitoring will occur through our Data Analytics process to push notifications digitally to providers and members to obtain their necessary appointments.

Ongoing - Life of this Contract

Statewide Data Transparency

Report Card Metrics Data Transparency DentaQuest proposes report card metrics to be shared with stakeholders. Metrics include:

1. CMS Child Core Set Measures

2. CMS-416 Any Dental Visit

3. Member Survey CAHPS results

4. Member self-selection rates

5. Value-added benefits and Healthy Behavior incentive

6. Network

Upon execution of this Contract Ongoing - Life of this Contract

Statewide Value-Based Purchasing Programs

Targets for VBP arrangements

Value-Based Purchasing DentaQuest proposes VBP targets for each year for both LAN 2A+ and LAN 3A+. Please see Tab

"VBP"

Upon execution of this Contract Ongoing - Life of this Contract

Statewide Provider Engagement (investments, models, training, other)

Provider Training DentaQuest commits to implementing an attestation process to ensure more precise tracking of completed training.

AHCA Contract No. FP125, Attachment I, Update 02/01/25, Exhibit I-F, Page 7 of 8

Completion

Regions D, E, G, H, I

Recipient Experience

DentaQuest will achieve at least the following targets for having PDP General Dentists required by Table 5, Dental Program Provider Network Standards, in Attachment II, that offer after hours and weekend availability:

Region D: 50% Region E: 50% Region G: 50% Region H: 50% Region I: 50% Achieve Targets Ongoing - Life of this Contract

Regions D, E, G

Recipient Experience

DentaQuest will achieve at least the following targets for having Pediatric Dentists required by Table 5, Dental Program Provider Network Standards, in Attachment II, that offer after hours and weekend appointment availability:

Region D: 45% Region E: 45% Region G: 30%

Achieve Targets Ongoing - Life of this Contract

Statewide Recipient Experience

DentaQuest will achieve at least the following targets for having PDP General Dentists in its network who are accepting new patients:

Region A: 70% Region B: 70% Region C: 75% Region D: 75% Region E: 70% Region F: 70% Region G: 90% Region H: 90% Region I: 90%

Achieve Targets Ongoing - Life of this Contract

Statewide Recipient Experience

DentaQuest will achieve at least the following targets for having Pediatric Dentists in its network who are accepting new patients:

Region A: 70% Region B: 70% Region C: 75% Region D: 75% Region E: 70% Region F: 70% Region G: 90% Region H: 90% Region I: 90%

Achieve Targets Ongoing - Life of this Contract

AHCA Contract No. FP125, Attachment I, Update 02/01/25, Exhibit I-F, Page 8 of 8

Completion

Statewide Recipient Experience

DentaQuest agrees to provide a one hundred-twenty (120) day continuity of care period for new enrollees transitioning into the Dental plan. Ongoing - Life of this Contract

Statewide Provider Experience

DentaQuest agrees to reimburse non-participating providers att he rate they received for dental services rendered to the enrollee immediately prior to the enrollee transitioning into the dental plan for a sixty (60) day period. Ongoing - Life of this Contract

Statewide Provider Experience

Reducing Administrative Burdens

DentaQuest agrees to process standard authorization decisions within five (5) days. Ongoing - Life of this Contract

Statewide Provider Network Provider Network (enhanced ratios, other)

DentaQuest will achieve at least the following geographicaccess standards maximum time and distances for primary and denistry specialists in its network located within urban and rurlal counties required by Table 4, Dental Program Provider Network Standards, in Attachment II:

Ongoing - Life of this Contract

AHCA Contract No. FP125, Attachment I, Exhibit I-G, Update 02/01/25, Page 1 of 6

EXHIBIT I-G

DATA TRANSPARENCY REQUIREMENTS

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SCOPE OF SERVICES – UPDATE: FEBRUARY 1, 2025

AHCA Contract No. FP125, Attachment I, Exhibit I-H, Update 02/01/25, Page 1 of 3

EXHIBIT I-H

PROVIDER SCORECARD REQUIREMENTS

AHCA Contract No. FP125, Attachment I, Exhibit I-H, Update 02/01/25, Page 2 of 3

AHCA Contract No. FP125, Attachment I, Update 02/01/25, Exhibit I-H, Page 3 of 3

ATTACHMENT II

SCOPE OF SERVICE - CORE PROVISIONS – UPDATE: FEBRUARY 1, 2025

DENTAL HEALTH PROGRAM

AHCA Contract No. FP125, Attachment II, Update 02/01/25, Page 1 of 263

Table of Contents

Section I. General Overview

A. Purpose B. Features: Hope Florida Initiative C. Prioritizing Quality and Value D. Prioritizing Provider Recruitment, Retention, and Training E. Prioritizing Florida’s Vulnerable Citizens

Section II. Eligibility and Enrollment A. General Provisions B. Eligibility C. Enrollment D. Disenrollment

Section III. Marketing A. General Provisions B. Prohibited Statements and Claims C. Prohibited Activities D. Marketing of Multiple Lines of Business E. Marketing Agents F. Telephonic Activities and Scripts G. Standards for Marketing Materials H. Use of Superlatives in Marketing Materials I. Nominal Gifts J. Regional Distribution of Marketing Materials K. References to Studies L. Product Endorsements/Testimonials M. Marketing Events N. Individual Marketing Appointments O. Marketing in the Health Care Setting P. Provider-Based Activities Q. Public Events R. Enrollee Educational Events

Section IV. Enrollee Services A. General Provisions B. Enrollee Material C. Enrollee Services

AHCA Contract No. FP125, Attachment II, Update 02/01/25, Page 2 of 263

Section V. Service Administration A. Required Benefits B. Required Dental Benefits C. Expanded Benefits D. Excluded Services E. Coverage Provisions F. Care Coordination/Case Management G. Community Partnerships to Improve Outcomes (CPIO) H. Authorization of Services

Section VI. Grievance and Appeal System A. General Provisions B. Use of Independent Review Organization C. Process for Complaints D. Process for Grievances E. Notice of Adverse Benefit Determination F. Standard Resolution of Plan Appeals G. Extension of Plan Appeal H. Expedited Resolution of Plan Appeals I. Notice of Plan Appeal Resolution J. Process for Medicaid Fair Hearings (for Medicaid Enrollees) K. Appellate Responsibilities

Section VII. Provider Network and Services A. Network Adequacy Standards B. Network Management C. Provider Credentialing and Contracting D. Provider Services E. Claims and Provider Payment

Section VIII. Quality A. Quality Improvement B. Performance Measures C. Performance Improvement Projects D. Satisfaction and Experience Surveys E. Enrollee Record Requirements F. Provider-Specific Performance Monitoring G. Additional Quality Management Requirements H. Continuity of Care in Enrollment

AHCA Contract No. FP125, Attachment II, Update 02/01/25, Page 3 of 263

Section IX. Administration and Management A. General Provisions B. Organizational Governance and Staffing C. Subcontracts D. Information Management and Systems E. Encounter Data Requirements F. Fraud and Abuse Prevention

Section X. Method of Plan Payment A. General Provisions B. Fixed Price Unit Contract C. Payment Provisions

Section XI. Financial Requirements A. Insolvency Protection B. Surplus C. Interest D. Third Party Resources E. Assignment F. Financial Reporting G. Inspection and Audit of Financial Records

Section XII. Sanctions and Corrective Action Plans A. Contract Violations and Non-Compliance B. Corrective Action Plans C. Performance Measure Sanctions D. Additional Sanctions E. Notice of Sanctions F. Dispute of a Corrective Action Plan or Sanction

Section XIII. Liquidated Damages A. Damages B. Issues and Amounts C. Performance Measure Liquidated Damages

Section XIV. Special Terms and Conditions A. Applicable Laws and Regulations B. Coordination of Medical and Dental Services C. Entire Agreement D. Ownership and Management Disclosure E. Conflict of Interest

AHCA Contract No. FP125, Attachment II, Update 02/01/25, Page 4 of 263

F. Readiness G. Withdrawing Services H. Termination Procedures I. Agency Contract Management J. Disputes K. Indemnification L. Public Records Requests M. Communications N. Audits and Monitoring O. Inspection of Records and Work Performed P. Employment Q. Work Authorization Program R. Equal Employment Opportunity (EEO) Compliance S. Discrimination T. Patents, Royalties, Copyrights, Right to Data, and Sponsorship Statement U. Confidentiality of Information V. Legal Action Notification W. Venue X. Performance Bond Y. Fidelity Bond Z. Insurance AA. MyFloridaMarketPlace Vendor Registration and Transaction Fee BB. Agency Goals CC. Transition Enrollment Requirements

Section XV. Accountability A. General Provisions B. Dental Plan Reporting Requirements C. Dental Plan Submission Requirements

Section XVI. Definitions and Acronyms A. Definitions B. Acronyms

Section I. General Overview

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A. Purpose

1. Under the Statewide Medicaid Prepaid Dental Program, the Agency for Health Care Administration (Agency) contracts with Dental Plans, as defined in Section XVI., Definitions and Acronyms, to provide services to recipients.

2. The provisions in this Contract and the terms of the applicable federal waivers apply to all

Dental Plans.

3. The Dental Plan shall comply with all provisions of this Contract and any amendments and shall act in good faith in the performance of these Contract provisions.

B. Features: Hope Florida Initiative

Under the Agency’s mission to improve health care for all Floridians and in tandem with the tenets of the Hope Florida initiative, the Statewide Medicaid Prepaid Dental Program is committed to high quality oral health care for children, seniors, disabled adults, and pregnant women. Preventing and treating cavities and gum disease contributes to better overall health.

Proper dental care, especially for children and pregnant women, is critical for growth and development. For seniors and disabled adults, high quality oral health care is critical for nutrition, communication, dampening systemic inflammation, and quality of life. The following commitments are developed in the context of the Hope Florida initiative tenets of Positive Return on Investment, Accountability for Taxpayers’ Dollars, Freedom First, Strong Florida Families, Building Communities, and Pathway to Prosperity. In the 2025-2030 contract period, the Agency seeks to:

• Improve oral health outcomes by implementing a quality continuum.

• Enable personalized oral health care, particularly for people with special needs.

• Strengthen the network of dental providers.

• Integrate medical and dental care.

C. Prioritizing Quality and Value

The new Dental Program Quality Strategy drives continual improvement in overall program quality using a balance of incentives and penalties. By rewarding high quality performance, the Agency communicates state health care priorities, holds accountable the Dental Plans that fail to improve oral health care quality, and invests in Dental Plans with proven effectiveness.

1. Layered Approach to Drive Continued Improvement

By tying performance incentives and penalties to the Agency’s goals, the Agency will drive Dental Plan performance to the height of quality and best value (Figure 1).

AHCA Contract No. FP125, Attachment II, Update 02/01/25, Page 6 of 263

Figure 1

a. Achieved Savings Rebate One Percent Quality Incentive

The Dental Plan operating at top tier performance levels may retain an additional one percent (1%) of revenue through the Achieved Savings Rebate.

(1) Each year, to be eligible to retain up to an additional one percent (1%) of revenue, the Dental Plan must earn twenty (20) points or more for the Oral Evaluation and have scored at least two (2) points for each reportable performance measure.

(2) The Agency reserves the right during the Contract term to change the

Achieved Savings Rebate One Percent Quality Incentive methodology.

b. Quality Preferred Assignment Incentive

In accordance with Section 409.977(1), F.S., the Agency may adjust enrollment through enhanced auto-assignments to high-performing Dental Plans as a performance incentive.

(1) In addition to the incentive payments available through the Quality Incentive Withhold Arrangement, the Dental Plan may also be eligible for the Quality Preferred Assignment Incentive.

(2) Each year, to earn the Quality Preferred Assignment Incentive, the Dental

Plan must have earned its full one (1%) to one-and-one-half (1.5%) percent withhold and be the top scoring Dental Plan, based on Total Quality Points as a percentage of the Dental Plan’s maximum points as described below, and have scored at least one (1) point for each reportable performance measure rate.

(3) If the Dental Plan earns the Quality Preferred Assignment incentive, the Dental Plan shall receive enrollee assignments at a factor of 1.5 for a six (6) month period.

(4) The Agency reserves the right during the Contract term to change the Quality

Preferred Assignment Incentive methodology.

• Achieved Savings Rebate up to 6%

High Quality + Best Value

• Preferred Assignment

• Quality Withhold and Redistribution • Financial

Consequence

• Liquidated Damages

• Enrollment Freeze

• Corrective Action Plan

AHCA Contract No. FP125, Attachment II, Update 02/01/25, Page 7 of 263

c. Quality Withhold Incentive

The Quality Withhold Incentive creates a financial withhold from the capitation rates paid to the Dental Plan to use as an incentive payment to Dental Plans with high performance on select dental quality measures from the Performance Measures Table, Table 6. The Dental Plan may receive a payment higher or lower than their contribution based on performance. The Quality Withhold Incentive will be used in addition to any other capitation rate withhold or other payment mechanism that may be used to adjust capitation funding based on the Dental Plan’s actual utilization of preventive services as part of the actuarial capitation rate development process.

(1) Each year, the Agency shall withhold 1.5% of the Dental Plan’s capitation rate, with the withhold to be earned based on the Dental Plan’s…