Patrick W. Finnerty


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Patrick W. Finnerty

  1. 1. Improving Access to Dental Care in Virginia’s Medicaid/SCHIP Program Patrick W. Finnerty, Director Virginia Department of Medical Assistance Services Presentation to: National Association of State Medicaid Directors 2008 Fall Conference November 14, 2008
  2. 2. Virginia Medicaid/SCHIP Dental Benefits <ul><li>Dental benefits for children in Medicaid/SCHIP include: </li></ul><ul><ul><li>Diagnostic, preventive, restorative/surgical procedures and orthodontics </li></ul></ul><ul><li>Dental benefits are not covered for Medicaid adults, except for limited oral surgery (e.g., repair of traumatic wounds, extraction of teeth complicating a medical condition, etc.) </li></ul><ul><li>Prior to July 1, 2005, a large majority of children received dental benefits through a managed care organization (MCO) </li></ul>
  3. 3. Access to/Utilization of Dental Services Needed to Improve <ul><li>In FY 2003, only 23.4% of all </li></ul><ul><li>eligible children actually </li></ul><ul><li>received any dental services </li></ul><ul><li>Low participation of dentists in the Medicaid/SCHIP program was a major problem </li></ul><ul><ul><li>Low reimbursement </li></ul></ul><ul><ul><li>Administrative “hassles” </li></ul></ul><ul><ul><li>Managed care concerns </li></ul></ul><ul><ul><li>Patient no-shows </li></ul></ul>Dentist Participation in Medicaid/SCHIP* * FY 2003
  4. 4. Key Stakeholders Worked Together for Change Advocacy Groups MCOs Organized Dentistry Virginia Medicaid Governor Legislature New Medicaid/ SCHIP Dental Program
  5. 5. New Program Structure and a 30% Increase In Fees <ul><li>General Assembly/Governor authorized an entirely new program structure recommended by Virginia Medicaid </li></ul><ul><li>Also approved a 30% increase in dental fees </li></ul><ul><ul><li>28% on July 1, 2005; additional 2% in May, 2006 </li></ul></ul><ul><li>An “across the board” increase of 23%; the remaining amount was targeted to most critical codes (e.g., oral surgery codes) </li></ul><ul><li>Dental advisory committee participated in process for allocating fee increase </li></ul>
  6. 6. A New Day for Dental! Smiles for Children <ul><li>Effective date: July 1, 2005 </li></ul><ul><li>All children (Medicaid & SCHIP) are enrolled in a single program administered by Doral Dental USA </li></ul><ul><li>Limited medically necessary diagnostic/oral surgery services for adults </li></ul><ul><li>DMAS retains policymaking authority and closely monitors contractor activities along with Dental Advisory Committee </li></ul>
  7. 7. Key Program Reforms Old Program Smiles for Children <ul><li>Different credentialing </li></ul><ul><li>processes </li></ul><ul><li>Streamlined Credentialing </li></ul><ul><li>Complicated Administration </li></ul><ul><li>Easy, Industry-Standard </li></ul><ul><li>Administration </li></ul><ul><li>Limited local representation </li></ul><ul><li>on program decisions </li></ul><ul><li>Va. Based Peer Review </li></ul><ul><li>Committee & Dental </li></ul><ul><li>Advisory Committee </li></ul><ul><li>Single Vendor (Doral) </li></ul><ul><li>Multiple Vendors </li></ul><ul><li>Enrollee transfer between </li></ul><ul><li>plans can disrupt care </li></ul><ul><li>All enrollees in Smiles for </li></ul><ul><li>Children program </li></ul>
  8. 8. Value-Added Benefits for Providers <ul><li>Toll-free phone number for providers </li></ul><ul><li>Call center specialists </li></ul><ul><ul><li>Member Placement </li></ul></ul><ul><ul><li>Eligibility, benefits, authorizations </li></ul></ul><ul><ul><li>Claims issues </li></ul></ul><ul><ul><li>Addressing patient “no-shows” </li></ul></ul><ul><li>Multiple claim submission options……free, electronic filing </li></ul><ul><li>Timely and accurate payments </li></ul><ul><li>Automated, web-integrated or live eligibility verification (24/7) </li></ul>
  9. 9. Program Reforms = Increased Provider Network <ul><li>508 new dentists are participating (82% increase) </li></ul><ul><ul><li>Network continues to expand </li></ul></ul><ul><ul><li>Several localities that had no participating dentists now have access </li></ul></ul><ul><ul><li>Higher percentage of contracted providers are billing for services </li></ul></ul><ul><ul><li>Very high level of provider satisfaction </li></ul></ul>Participating Providers 620 1,128
  10. 10. …..And Increased Access to Care Percentage of Children Receiving Necessary Dental Care Source : Centers for Medicare and Medicaid Services EPSDT 416 Report produced on SFY reporting timeframe. Figures are based on claims received through September 30, 2008. 59% Increase 58% Increase 24% 38% 29% 46%