CMS presents best practices

Washington鈥擜 16-state Centers for Medicare & Medicaid Services review of dental Medicaid programs identifies best practices and highlights “several overarching issues” such as missed appointments and provider participation, said Dr. A. Conan Davis, CMS chief dental officer.

“In response to concerns regarding access to dental care of Medicaid eligible children, CMS performed 16 state dental reviews this past year,” Dr. Davis said in announcing release of the 2008 national dental summary, which is posted online with each of the state reviews at the CMS Web site.

The ADA urged Congress at hearings and in testimony last year (ADA News Today Sept. 24, 2009, Association pushes for Medicaid improvements) to shore up dental Medicaid for vulnerable low-income children by improving reimbursement rates, addressing administrative barriers and reaching out to the dental community.

CMS said reimbursement rates “were not a specific part” of the state dental reviews. “However, low reimbursement rates were noted by providers and others interviewed as one reason there is low provider participation in Medicaid,” the report said. An appendix to the report discusses financing and reimbursement for dental services.

“Another concern raised in almost every review was the frequency of ‘missed appointments’ by Medicaid beneficiaries,” CMS said.

“While this issue has the potential to negatively impact all providers, dental providers appear to be particularly disadvantaged when it comes to missed appointments. Dentists generally book only as many patients as they and their staff can serve. A provider may decide to bill a patient for a missed appointment. The Medicaid program does not permit a provider to bill a Medicaid beneficiary or the state Medicaid agency for a missed appointment. Therefore, providers are financially disadvantaged when missed appointments occur.”

“The review identified a number of areas of concern and some consistent issues,” CMS said in a national dental summary of reviews conducted February-May 2008. “The dental reviews were conducted to provide information and technical assistance to state Medicaid agencies and are not intended to impose punitive actions against states, but rather provide meaningful guidance to states to improve access to oral health care for Medicaid eligible children.”

CMS made “recommendations” to every state that received an onsite visit and made “findings” in 10 states. A recommendation is “a suggestion that CMS made regarding potential improvements that could be made to provide access to dental services.” A finding “reflects a concern that the state is not adhering to federal law or regulation.”

In addition to the state-specific findings and recommendations, CMS identified “several overarching policy issues that impact access to dental services which will require evaluation by CMS,” the report said. “States, managed care plans and providers, alike, in various forms expressed concern that Medicaid beneficiaries present unique challenges to providing accessible, efficient dental care. CMS understands that issues faced by this population can be unique and that there may be no easy answers to address them.”

CMS also identified a number of areas where states could make improvements by adopting better practices to increase access to dental services.

The report cited several examples of promising or notable practices in the states that were reviewed, including an easing of the “hassle factor” for dentists dealing with the state and using mobile dental vans to expand access to care. One state posted the dental provider manual and relevant provider updates online. One dental provider initiated a practice called “shared medical appointment” with a pediatric practice in the same building. Another instituted a “dental detectives” program offering diplomas to children and the opportunity to “co-teach” their peers.

The states chosen for review had reported dental Medicaid utilization rates of 30 percent or less. They include Arkansas, California, Delaware, the District of Columbia, Florida, Louisiana, Michigan, Missouri, Montana, Nevada, New Jersey, New York, North Dakota, Pennsylvania and Wisconsin. In addition, Georgia was reviewed at the request of the U.S. House of Representatives Committee on Oversight and Government Reform subcommittee on domestic policy. Maryland’s dental program was reviewed by CMS in October 2007 and was not included in the national assessment “because the state is in the process of implementing enhancements in their dental program.”