W.Va. asks for increase in Medicaid reimbursements

Charleston, W.Va.鈥擳he West Virginia Dental Association says its “serious negotiations” with state officials led to state approval of higher Medicaid reimbursement rates for dentists. West Virginia’s Medicaid office will ask the Obama administration to approve the fee hike. Federal officials have 90 days to approve or disapprove a state plan amendment.

The West Virginia state plan amendment negotiated by WVDA and state Medicaid officials and approved unanimously Jan. 9 by the Medicaid Medical Services Fund Advisory Council will be sent to federal Medicaid officials for approval:

“Dental practitioners who provide covered dental services shall be reimbursed by procedure utilizing the American Dental Association Survey of Dental Fees for the Southern Atlantic Region Norms. The 25 percentile of the Southern Atlantic Regional Survey constitutes the Medicaid cap. Payment shall not exceed the provider’s usual customary charge to the public.”

The proposed amendment was expected to be sent to federal Medicaid officials about the time the new administration takes office in the nation’s capital, and officials will have 90 days to respond.

“We were glad to have the ADA fee survey to demonstrate the significant difference in fees paid by Medicaid and what dentists charge for their services,” said Dr. Craig Wilcox, a Wheeling general dentist and WVDA president through Jan. 17. A state Medicaid advisory council unanimously approved the plan amendment Jan. 9.

“We began serious negotiations with Medicaid officials back in July 2008 not only for an increase in fees but also in relation to some administrative barriers dentists were experiencing,” said Richard Stevens, WVDA executive director.”Medicaid officials saw there was a significant access problem, especially among adults. So ultimately the West Virginia Medicaid agency proposed Jan. 9 to submit a state plan amendment to the federal Centers for Medicare & Medicaid Services to increase fees for dental services up to the 25th percentile of the ADA’s 2007 fee survey.”

It would be the first fee increase in six years, he told the ADA News.

Media reports say the fee increase “will mostly affect” the state’s 152,000 Medicaid children as Medicaid pays only for emergency tooth extractions for adults 19 and older in West Virginia. About 150,000 adults are covered for emergency dental services. “There will be improved access for patients,” said Mr. Stevens, who added that “a greater impact will be on oral surgical services, Oral surgery fees will witness the greatest percentage increase because of their current level.”

He offered as example the surgical removal of an erupted tooth for an adult and said the increased fee will be at least three times higher than the current fee. The costs of dental materials, equipment and overhead costs have increased for dentists during the six years state Medicaid fees were static, and oral surgeons had additional costs associated with surgical procedures, Mr. Stevens said.