NNOHA strives to share information among safety-net oral health teams so that no one has to “reinvent the wheel” when it comes to operating strong oral health programs with high quality dental services for underserved populations. Do Reimbursement Delays Discourage Medicaid Participation By Physicians? Dentists with any questions about the Alabama Medicaid Dental Program, or for assistance in resolving claims issues or policy questions, should call 334-242-5014. Additional Resources: Cannon Health Building 288 North 1460 West Salt Lake City, UT 84116 In light of ever-changing dynamics within state and federal politics, in light of challenging budgetary realities, this guide is envisioned as an evolving resource, which can be updated on a regular basis. Improving Access through Improved Program Integrity and Provider Education. - Screening: Providing physical, mental, developmental, dental, hearing, vision, and other screening tests to detect potential problems How to Find a Dentist that Takes Medicaid. There are also links to scholarship and loan repayment options that can help alleviate the cost of your dental education, while gaining experience addressing the oral health needs of underserved populations. Improving Access through Effective Managed Care Programs. • How FQHCs insure themselves and their providers: Federal Tort Claims Act Program Integrity: Medicaid Compliance for the Dental Professional (CMS), Medicaid Compliance for the Dental Professional (Video). The American Dental Association has collected a number of resources designed to provide necessary evidence and technical assistance for dental Medicaid advocates. The chapters and links provide flexibility for the user to gain a general overview or delve into specific details. The material contained in this guide is for informational purposes only and is not intended to be viewed as a recommendation to become ADA Policy. The dentists in our networks have agreed to charge lower fees to our members, so choosing in-network dentists saves you money. If you go to a doctor who is not enrolled in Medicaid, Medicaid cannot reimburse for any services from that doctor. Finding a dentist who takes Medicaid can be difficult. - Medicaid Managed Care: A Guide to Reporting Metrics (PDF) - Keep Kids Smiling: Promoting Oral Health Through the Medicaid Benefit for Children & Adolescents Those third-party payers work under the auspices of a contract that they have with the state dental Medicaid program. - Maintaining Your Sanity and Practice Viability as a Medicaid Provider: Embracing Program Integrity. Available at: http://www.nber.org/papers/w19218.pdf?new_window=1. Learn about ADA CERP recognition, look up CERP recognized CE providers and find CE courses. This module provides resources to assist advocates in promoting dental coverage in Medicaid for pregnant mothers. Some waivers directly mention oral health, as part of wellness programs that might be paired with health savings accounts, or by requiring enrollees to pay monthly contributions for dental coverage. They can look after all of your child's dental needs. On average, patients who use Zocdoc can search for a Dentist who takes Medicare insurance, book an appointment, and see the Dentist within 24 hours. Self-Direction of Home-and Community-Based Services: A Training Curriculum for Case Managers. MCNA Dental has a large network of general and specialty dentists throughout Louisiana to make sure you can get the high quality dental care you need. - Dental Care Financing Since the NHSC began, more than 50,000 primary care medical, dental, and mental and behavioral health professionals have served. Ironically, one of the most significant problems in creating an effective dental Medicaid model is also the solution: money. Slides — Recording (27 minutes) An increasing body of evidence shows the value of ensuring pregnant women's oral health not only benefits the mother, but for the baby as well. Dentists push for higher pay from Idaho Medicaid, Florida Medicaid Program Not Providing Children With Federally Guaranteed Rights To Medical and Dental Care, Federal Court Finds, Minnesota dentists say low state payments hurting care for poor, Hail Mary for Healthcare.gov - Challenges of low Medicaid fees under Medicaid Expansion, Florida's Medicaid Failures: Governor and Legislature should heed judge's ruling, Legislative Action Can Improve Dental Care for Iowans, Routine dental care is out of reach for many Missourians, Fixes for dental care shortage? - Topical silver diamine fluoride for managing dental caries in children and adults, Cochrane Reviews July 2017 Completion of this course offers six continuing dental education credits. - Advocating for a Publicly Funded Dental Benefit, - Limited availability of dental providers who accept Medicaid due to: NNOHA was founded in 1991 by a group of Dental Directors from Federally Qualified Community Health Centers who identified a need for peer-to-peer networking, collaboration, research and support in running effective oral health programs. Together. Health Policy Institute Research Brief. Lawmakers considering policies to enhance this aspect of Medicaid oversight should approach with a comprehensive plan that includes appropriate and effective program integrity activities, which can help ensure that providers are not dissuaded from participating in Medicaid. Listing of a service in an administrative regulation is not a guarantee of payment. - Module 4: Operating and Managing Self-Direction in a Managed Care Context Council on Advocacy for Access and Prevention (PDF). If it isn't written down, it does not exist. This module will aid in making the case that dental health care delivery works better when the unique aspects of dental coverage are engrained in to the Medicaid managed care model. - Association of State & Territorial Dental Directors (ASTDD) - Fluorides Committee For additional information on compliance accountability please view the resources below: Improving Access through Improved Program Administration. Safety net programs usually are administered by agencies such as community health centers, dental schools, hospitals, non-profit associations or health departments. - ADA: Nonrestorative Treatments for Carious Lesions Clinical Practice Guideline (2018), Steven P. Geiermann, D.D.S. This line supports inquiries from clinicians only (MD, NP, PA, RN, PharmD or DDS) and is not intended for patient or consumer questions. Choose any combination below then click on the Submit button. In November 2007, the American Dental Association (ADA) sponsored the American Indian and Alaska Native Oral Health Access Summit, which included a presentation on the high prevalence and severity of early childhood caries (ECC) in American Indian and Alaska Native (AI/AN) children. Dentists have a number of considerations to weigh when deciding whether to serve low-income populations through Medicaid. Medicaid funding, residencies, Centers for Medicare & Medicaid Services - Letter to Minnesota Officials Warning of Poor Dental Coverage, Connecticut Health Foundation: Impact of Increased Dental Reimbursement Rates on Husky A-Insured Children 2006-2011, JADA: Impact of fee increases on dental utilization rates for children living in Connecticut and enrolled in Medicaid, The New England Journal of Medicine: Appointment Availability after Increases in Medicaid Payment for Primary Care, The Impact of Medicaid Reform on Children's Dental Care Utilization in Connecticut, Maryland, and Texas, Dentists' participation and children's use of services in the Indiana dental Medicaid program and SCHIP, Medicaid: Good Medicine For State Economies, Office of the Legislative Auditor, State of Minnesota: Medical Assistance Payment Rates for Dental Services, National Dental Expenditures as a Percentage of Overall Medicaid Budget per CMS-64, Key Findings from the Ohio State Medical Association's Primary Care Reimbursement Increase Survey, National Academy for State Health Policy: The Effects of Medicaid Reimbursement Rates on Access to Dental Care, Colorado: CO 2013 S242 Establishes Adult Dental Law, Colorado: Revision of Medical Assistance Rule Concerning Treatment of Oral Medical Conditions for Adult Clients, Massachusetts: MassHealth Dental Bulletin 43 March 2014, Massachusetts: MassHealth All Provider Bulletin 243 March 2014, California: 2017 CA S97 Restores Adult Dental Enacted into law, Hawaii: 2015 HI H863 Adds adult dental Medicaid, Hawaii: 2017 HI H1210 Sugary beverage fee restores adult dental in Medicaid, Maryland: 2017 MD S169 Study's Medicaid ER use and allows state to provide adult dental Medicaid law, Texas: 2017 TX H3295 Relating to the delivery of certain Medicaid services to certain persons, County dentist serves 290 in 2015 Medicaid expansion helps locals, Medicaid's new dental plan will improve overall health, All Bark And No Bite: Politics And Preventive Dental Care In Missouri, States Add Dental Coverage For Adults On Medicaid But Struggle to Meet Demand, Intersection - Dental Care Access in Missouri, Medicaid Adult Dental Benefit Impact on Dental Utilization: A University Clinic Setting, Supporting Efforts to Advance Adult Dental Coverage and Access in Medicaid, New report shows Colorado making strides statewide on dental access, National Bureau of Economic Research: The Economic Value of Teeth, Eliminating Medicaid Adult Dental Coverage In California Led To Increased Dental Emergency Visits And Associated Costs, National Conference of State Legislatures: Dental Benefits for Adults with Medicaid, Court, Dental Programs to Help People with Mental Illnesses, Dental Care Too Late or Elusive for Many Native Adults and Elders in Indian Country, Center for Health Care Strategies - Dental Coverage and Access for Adults in Medicaid: Opportunities for States, Alabama Medicaid Agency Request For Proposals, Louisiana Department of Health and Hospitals Request For Proposals, 2015 Florida H601 Managed Care MLR for Adult Coverage, 2015 Utah S2 MLR for Managed Care Dental Medicaid, 2016 Utah H36 Requires Study of Dental Medicaid Managed Care, 2017 North Carolina S231 Establishes Medicaid Dental MCO, 2017 New York S6247 MLR for Medicaid Dental MCO, 2017 Oregon H2882 CCOs Boards to Include a Dentist, 2017 Utah S2 Requires Report on Managed Care Dental System, 2017 Washington S5604 H1899 Establishing Dental Medicaid MCO, 2017 Texas H335 MCOs Fees Must be Adequate, 'Push! NHSC Students to Service Loan Repayment Program, https://www.medicaid.gov/medicaid/index.html, The Early and Periodic Screening, Diagnostic and Treatment (EPSDT), EPSDT - A Guide for States: Coverage in the Medicaid Benefit for Children and Adolescents, Keep Kids Smiling: Promoting Oral Health Through the Medicaid Benefit for Children & Adolescents, Paving the Road to Good Health: Strategies for Increasing Medicaid Adolescent Well-Care Visits, Making Connections: Strategies for Strengthening Care Coordination in the Medicaid Benefit for Children & Adolescents, Medicaid EPSDT Benefit Keeps Children Healthy, Adult Dental Medicaid Benefits (HPI Research Brief), What is Keeping State Oral Health Leaders Up at Night, Advocating for a Publicly Funded Dental Benefit, Reducing barriers to Medicaid-eligible individuals seeking dental services, Most Important Barriers to Dental Care Are Financial, Not Supply Related, Improving Access to Oral Health Care for Adults in Medicaid: Key Themes from a Policy Roundtable, Phased Strategies for Reducing the Barriers to Dental Care in California, Engaging Stakeholders to Improve Dental Coverage and Access for Medicaid-Enrolled Adults, Benefits for Children: Early and Periodic Screening, Diagnosis and Treatment, EPSDT Periodicity Schedules and Their Relation to Pediatric Oral Health Standards in Head Start and Early Head Start, Journal of the American Dental Association, March 2013. Solving these problems requires various approaches and depends upon, among other things, the state's political will to address the issues. Dental services for children. Operating a safety net dental clinic can be challenging, and this manual was designed to help with this important task. Basic Resources: There are many sources of online Medicaid information, both introductory and more specific. The Academy of Pediatric Dentistry (AAPD) recommends all children see a dentist by 12 months of age. - Module 2: Implementing Self-Direction HPI provides the knowledge to navigate the changing dental landscape. - Early: Assessing and identifying problems early What are Health Professional Shortage Areas (HPSAs)? As has been well established, one is not healthy without good oral health. Solving these problems requires various approaches and depends upon, among other things, the state's political will to address the issues. The manual is a companion manual to the online Safety Net Dental Clinic Manual that covers considerations for fixed dental clinic sites that are not private practices. Apple Health (Medicaid) pays for covered dental services for eligible children, age 20 and younger. The U.S. dental care system is changing rapidly. States are not required, under federal regulations, to provide dental coverage for adult Medicaid enrollees. Dentists who accept medicaid payment programs for childrens dentistry can be found through the use of a family dental practice that provides general dental care patient of all ages or through Pediatric specialists that are listed, in part, in this directory. Thus, cutting adult Medicaid dental benefits is largely a symbolic cost-reduction mechanism for states; which unfortunately, does adversely affect those most in need. Improving Access thorough Improved Adult Dental Programs. Mobile/portable dental systems can serve as dental "safety net" programs for people who lack the resources to acquire those services on their own. To find a dental plan, use a computer and go to www.flmedicaidmanagedcare.com or call 1-877-711-3662 to talk to a Florida Medicaid Choice Counselor. Originally presented on March 1, 2018 - CDA Journal February 2018 Issue; Article: Silver Diamine Fluoride in Elder Care, DentaQuest Tennessee Provider Resource Manual: Available from: http://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_1014_3.ashx. The panel reported there was no evidence that the ECC situation had improved appreciably despite decades of efforts by Indian Health Service (IHS) and tribal dental programs to implement all recommended caries prevention strategies for children. - Medical Necessity Document Example #2, Related Articles: • NHSC Scholarship Program Overview - Silver Diamine Fluoride (SDF) current evidence for the management of dental caries (PDF) MCNA Dental. National Network for Oral Health Access (NNOHA). Dental Manual (Updated .10.1.20) 2020 1099 And W-9 Update Reminder Medicaid Budget Reduction Changes WY COBA Duplicate Claims Issues Postcard Processing CHIP PA Requests for 10.1.2020 DOS Kid Care CHIP is Changing RA Banner Tribal Provider Manual (10.1.20) Dental Fee Schedule (10.2.20) Edits EOBs and Resolutions 4.2.20 Policymakers desire evidence that investing time, energy and money through defined proposals will yield improved care for Medicaid enrollees. This module provides materials meant to help educate policymakers while highlighting potentially adverse policies that could impact provider participation and beneficiaries’ access to care. American Dental Association. - MyView: Medical necessity: friend or foe? In some of the states, adults accumulate money in a health savings account, partly by engaging in specified "healthy behaviors", which they can then use to buy dental benefits. Indian health clinicians often live within the communities they serve and those who proactively immerse themselves within the Indian community enjoy a more holistic and satisfying career experience. Copyright © 2020 American Dental Association. - Compliance in the Era of Accountability (PDF) The Center for Medicaid & CHIP Services developed a set of strategy guides, each on a specific topic, to support states and their partners as they implement the EPSDT benefit. One such requirement is dental coverage for enrolled children under age 21. Access to Dental Care in Medicaid: Spotlight on Nonelderly Adults, Dental Care Utilization and Access to Care. Click here, to find a provider or dental plan. Children’s Medicaid Dental Services Participating Providers/Proveedores Participantes Harris County and Surrounding Area Member Services/Servicios para Miembros 1-877-901-7321, TDD/TTY: 7-1-1 Dental Provider Directory Directorio de dental UnitedHealthcare 10/1/2020_1 CSTX.20.999.20.9.004 Medicaid Managed Care. The manual has six overview areas: essential elements, facilities and staffing, finances, administrative operations, quality management, and clinical operations. 1233 Fee Increase Law, Minnesota: 2015 H1151 Sets fees at 50 percent of 90th percentile, administrative improvements, Mississippi Medicaid Dental Incentive Program, Wisconsin: 2015 S21 Medicaid Enhanced Pay Pilot Law, Access to dental care still a problem for low-income people in Wisconsin, With Half of California's Kids on Medicaid, Advocates Worry About Service. MCNA Dental is the Medicaid dental plan for the entire state of Idaho. Users are referred or linked to information in the Safety Net Manual that applies to basic principles of designing, staffing, operating and financing dental care systems no matter what type of delivery system is used, thus avoiding unnecessary duplication. Public health approaches lend themselves to providing services in settings such as schools, Head Start centers, senior centers or homeless shelters. The manual is not a cookbook, but rather a discussion of important steps and decisions that need to occur. - Key Medicaid Questions Post-Election The Public Practice Readiness site offers exceptional resources for oral health professionals looking to better serve their communities, whether it is from a private practice or public dental safety net venue. Access cutting-edge continuing education courses, Find evidence to support your clinical decisions. Allocation of state Medicaid dollars for dental services averages about 2% of the total Medicaid budget. Advocates may find the resources embedded below, useful in supporting improvements to dental Medicaid programs. Medicaid Financing: How does it work and what are the implications? Medicaid does not cover any type of dental care for adults. December 2014. Advocates may find the resources embedded here and catalogued in this section useful in supporting improvements to dental Medicaid programs. - Silver Diamine Fluoride Webinar Slides by Dr. Brent Martin, Symposium on Early Childhood Caries in American Indian and Alaska Native Children. Illinois Dental Medicaid Program. To find out more information regarding participating dental providers, covered services for children and adults, and information on school-based dental services visit the Illinois Department of Healthcare and Family Services webpage. In order for the state to receive the federal share of Medicaid expenses, it must adhere to a broad set of requirements. Policymakers desire evidence that investments in policy approaches will yield results. In other instances, the state may choose to “carve-out” the dental benefit and have a separate contract directly with a dental benefit administrator. - New Tooth Talk Videos on SDF Show How This Affordable, Safe, Painless Process Stops Growth of Cavities in Baby Teeth (link to videos) Members with Standard Medicaid benefits are eligible for almost all dental and denturist services when they are medically necessary. MCNA Dental has a large network of general and specialty dentists throughout Idaho to make sure you can get the high quality dental care you need. • Health Center Program: Impact and Growth - Phased Strategies for Reducing the Barriers to Dental Care in California Neutralizing many of the barriers requires public policy approaches and the political will to address the issues. Additional Resources: Plus, you can be sure that each dentist or specialist in our network is a qualified dental professional. DentaQuest Partnership for Oral Health Advancement: Safety Net Solutions. The Limitations Facing Medicaid Patients More than 43 million children are on Medicaid and State Children’s Health Insurance Programs (SCHIP), and only about one-third of them actually get dental … • Lunch & Learn Webinars: Previously recorded Safety Net Solutions Lunch & Learn webinars highlighting best practices in safety net dental practice management can be viewed here. Most dentists don't get up in the morning intending to commit billing fraud or perform unnecessary procedures on unsuspecting patients. Each strategy guide identifies specific, doable approaches to improve access, utilization and quality of care for children and adolescents enrolled in Medicaid. Remember it is your responsibility to furnish your MO HealthNet information to the MO HealthNet provider … Along the way, you will be changing lives — not the least of which may be your own. In consultation with the American Academy of Pediatric Dentistry (AAPD), the MPAC offers this Medicaid Provider Reference Guide as an invitation to non-participating dentists to treat Medicaid-eligible individuals and as an encouragement for those who currently participate to continue. - Need for consumer education about the benefits of dental care - A Guide to...Choosing and Adapting Culturally and Linguistically Competent Health Promotion Materials, - Module 1: Introduction to Self-Direction Health & Safety in the Home, Workplace & Outdoors, Clinical Guidelines, Standards & Quality of Care, All Health Care Professionals & Patient Safety, NYS Department of Health disclaimer regarding web site content, Addressing the Opioid Epidemic in New York State, Learn About the Dangers of "Synthetic Marijuana", Help Increasing the Text Size in Your Web Browser. This is less focused on the financing, and more focused on the process. As Medicaid is jointly funded by federal and state dollars, it is reasonable that there be “routine” occasional audits to ensure that taxpayer resources are well-spent and accounted for. - Projecting the Economic Impact of Silver Diamine Fluoride on Caries Treatment Expenditures and Outcomes in Young U.S. Children (Abstract) Our Find a Dentist tool will show you a list of dentists and specialists who provide services covered by your plan. -1115 Waiver Elements Affecting Oral Health: A number of 1115 wavier elements affect access to oral health care. You can search for a dentist by name, gender, location, language, and more. The diagnosis was assumed. The topics include: health center fundamentals, leadership, financials, risk management, workforce and staffing, and quality. The ADA has developed a toolkit to assist state dental associations in working with state Medicaid program administrators to incorporate key elements into state Medicaid managed care RFPs and subsequent contracts. - Diagnostic: Performing diagnostic tests to follow up when a risk is identified, and Health centers deliver care to the Nation’s most vulnerable individuals and families, including people experiencing homelessness, agricultural workers, residents of public housing, and the Nation’s veterans. Slides — Recording (23 minutes) Oral health Medicaid benefits for adults are often viewed as an elective health care option, despite growing evidence that good oral health is integral to overall good health. 3 Buchmueller TC, Orzol S, Shore-Sheppard LD. Decreasing the demand for dental services through more effective prevention programs was the only feasible, long-term solution. • NHSC Students to Service Loan Repayment Program - Dental Care Few resources exist to help people compare various mobile and portable dental systems with enough details for designing, purchasing and operating programs. This section also offers model public policy, advocacy support for these models and studies to further impress the benefits of adequate dental Medicaid investment. Dental service provider coverage for adults is limited but includes oral exams, emergency visits, X-rays, extractions and fillings. Available from: http://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_1214_2.ashx. Dental care is a covered service for eligible Medicaid members who are pregnant, disabled, blind, age 65 or older, or qualify for Early Periodic Screening, Diagnostic and Treatment(EPSDT). - The Compliance Plan (PDF) This section offers some basic actions to consider in preparing for such an occurrence. As Medicaid is the third largest domestic program in the federal budget following Medicare and Social Security, the program plays a unique role in state budgets. Improving Access through Improved Perinatal Care for Enrollees. Dental health is an important part of people's overall health. The online Provider Directory is always current. Streaming: Joint Commission In Dental Settings Push!' This presentation was made by a panel of tribal health representatives, dentists and pediatricians with extensive experience working in AI/AN communities. Contact the HMO Enrollment Specialist at (800) 291-2002 for HMO searches. Only about one in three Georgia dentists accept payment from the Georgia Medicaid program. Hopefully, the information in this section of the Medicaid Provider Reference Guide will help you in your documentation efforts. - Silver Diamine Fluoride Information and Checklist - Policy on the Use of Silver Diamine Fluoride for Pediatric Dental Patients (PDF) Organized dentistry seeks to increase the number of dental providers participating in Medicaid, thus increasing the number of oral health services delivered to Medicaid-eligible individuals. State-level policymakers interested in managing costs often consider the merits of using managed care entities to administer the Medicaid program. - Treatment: Control, correct or reduce health problems found. Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Click on the above link for information on the dental and orthodontia transition to Medicaid Managed Care, including Webinars, Q&A and Dental Vendor Contact Information. - Medicaid Compliance for Dental Professional Resource Guide (PDF) MO HealthNet Fee-For-Service Provider Search. For replay dial: 1-877-919-4059; Passcode: 79521317 - Access to Dental Care in Medicaid: Spotlight on Nonelderly Adults Balancing these competing priorities creates an ever-present tension. Have HMOs fixed the problems with children's Medicaid? - Dental Care Utilization and Access to Care This section provides resources state dental advocates may find useful in promoting the message that proper funding serves to improve patients' lives and reduces long term health care costs in publicly funded programs. This section is designed to assist dental advocates in promoting improvements in dental Medicaid financing. As a result of this joint financing structure, Medicaid acts as both an expenditure and the largest source of federal revenue in state budgets. This manual is designed for all staff—whether experienced clinic directors, new administrators, or somewhere in between. Federally Qualified Health Centers (FQHCs). The Basics of Recordkeeping & Medicaid Fraud, Electronic Health Records: Increasing the Quality of Care, Documenting to Support Medical Necessity for the Pediatric Dental Professional. Any services performed must fall within the scope of practice for the provider. - Use of Silver Diamine Fluoride for Dental Caries Management in Children and Adolescents To find dental providers, see the 'Dental Providers' section below. - Perceived high no-show rates among this population  Medicaid represents $1 out of every $6 spent on health care in the US and is the major source of financing for states to provide coverage to meet the health and long-term needs of their low-income residents. The Medicaid Compliance for the Dental Professional materials review the basic elements of a compliance program and how to facilitate compliance at the practice level. Health Policy Perspectives: Is the number of Medicaid providers really that important? Explore CODA's role and find accredited schools and programs, Learn about the examinations used in licensing dentists and dental hygienists, Learn about recognized dental specialties and certifying boards, The American Dental Association’s Council on Advocacy for Access and Prevention seeks regular guidance and technical assistance from its Medicaid Provider Advisory Committee (MPAC), which has been chaired by Dr. Sidney Whitman since 2011.
2020 medicaid dental providers