G ove r n men t Re lat ions
Governor Administration Update
According to the Department of Human Services (DHS),
managed care companies (MCOs) operate under certain federal
waivers that give them the flexibility to directly contract with
PHDHPs practicing in authorized locations. This is restricted to
PHDHPs providing services to MA patients only. DHS released
a bulletin in early August notifying the dental provider
community that MCOs may contract with PHDHPs who enroll
as MA providers. Each MCO will determine which PHDHPs will
join their networks and whether or not to allow them to bill and
be reimbursed directly. They may choose to continue the same
billing and reimbursement process as before, or they may
contract directly with PHDHPs who enroll as MA providers.
For now, MCOs may contract directly with enrolled PHDHPS in
setting approved in statue and regulations. Should the State
Board of Dentistry pass regulations expanding site locations to
physician offices, child care settings, hospice/homebound
patients’ residences, MCOs would then to be allowed to
contract with PHDHPs practicing in those locations, provided
that the patients are enrolled in MA.
Department of Human Services (DHS) Update
In June, PDA met with DHS officials to discuss access to dental
care for Medical Assistance (MA) patients. DHS provided the
following information:
• More than 700,000 adults obtained dental coverage (albeit
limited) when Pennsylvania agreed to Medical Assistance
expansion.
• The Community Health Choices Program is aimed at
providing more home health services to older Pennsylvanians.
The Administration will begin implementing this program in
southwestern Pennsylvania. It will service 400,000 overall.
• Through some of its managed care companies, DHS is
incentivizing physicians to make more patient referrals to
dentists and to apply fluoride varnish on children. DHS is also
incentivizing dentists to provide more preventative services
to children.
• DHS is making concerted efforts to build collaboration
between the medical and dental community with a broad-
based referral system.
DHS cites federal MA regulations at 42 CFR Section 438.602(b)
and 438.608 (b) as the reasons why it is necessary to enroll
qualified PDHPS in the MA program. DHS claims that it will
enroll PHDHPs to provide services within their scope of practice.
They must refer patients to dentists for exams, interpretation
of radiographs and diagnoses, and for all other services outside
their scope of practice.
Access to Dental Care Initiatives
Take 5
PDA’s Take 5 initi ative encourages all dentists to become
Medical Assistance (MA) providers and to welcome five families
into their practices. PDA is working with MCOs and the
Department of Human Services to streamline the credentialing
process to make participating and treating patients as seamless
as possible. Members of the Access to Oral Health Advisory
Group have volunteered to serve as liaisons to help dentists
through the enrollment and credentialing process.
Log on to PDA’s website at www.padental.org to find more
information about PDA’s Take 5 program.
N OVEM BER/DECEM BER 2017 | P EN N SYLVAN IA DEN TAL JOURNAL
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