Pennsylvania Medical Assistance : Evaluation of Children ’ s Access to Dental Services
We used the DPW data for the number of dentists who accepted any Medical Assistance payment in 2009 , as our estimate of the number of dentists participating in Medical Assistance . We did not use the DOH estimate because it underestimates the number of dentists who accept Medical Assistance , particularly in counties where managed care is mandatory . For example , according to the DOH data , 127 dentists accept Medical Assistance in Allegheny County . 23 However , directors of two large Medical Assistance managed care plans in Allegheny County indicated that their plans had contracts with 220 and 205 unique dentists , respectively . 24
Using our estimates of the number of practicing dentists ( 6,659 ) and DPW data on the number of dentists who accepted Medical Assistance ( 1,723 ), we estimate that about 26 percent of the practicing dentists in Pennsylvania accepted Medical Assistance in 2009 . 25 There are no recent data on the proportion of dentists nationally who treat Medicaid patients . In 1999 , the United States General Accounting Office surveyed state Medicaid programs . 26 Of 39 states that provided information about dentists ’ participation in Medicaid , 23 reported that fewer than half of the states ’ dentists saw at least one Medicaid patient during 1999 . 27 These , and other findings , indicate that dentist participation in Medicaid , across all states , is low .
Pennsylvania Dentists Accepting New Medical Assistance Patients There is considerable turnover ( leaving the program and then reenrolling ) among the Medical Assistance population , particularly children . Therefore , it is important to know whether Pennsylvania dentists are accepting new Medical Assistance patients . Using DOH data , we estimate that approximately 94 percent of dentists who treated Medical Assistance patients in 2009 are accepting new Medical Assistance patients . 28 This is a rough estimate given , that the DOH data do not include all Pennsylvania dentists who treat Medical Assistance patients .
Medical Assistance Program Improvements
Between 2005 and 2010 , Pennsylvania undertook a number of initiatives to improve the dental portion of the Medical Assistance program . Most of these changes were directly applicable to Medical Assistance dentists who worked in FFS , although some were targeted to Medical Assistance MCOs .
• DPW required Medical Assistance managed care plans to report on three dental variables .
• To reduce the administrative complexity of the program , the number of procedures that required prior approval by DPW was decreased . In addition , DPW changed the coding system to create uniformity in coding for both private insurance and Medical Assistance patients . And , finally Medical Assistance dentists are now able to file for payment electronically .
• DPW increased reimbursement levels for dental services , as shown in Table 3 . Between 2005 -2008, fees were increased as much as 76 percent for certain procedures . 29
Table 3 : Medical Assistance Dental Services With Increased Fees
Year
2005
Service
Sedation / anesthesia Behavior management services ( these are services such as that make it easier for dentists to manage complex patients )
2006 Behavior management services ; Orthodontic services
2007
2008
Prophylaxis , fluoride treatments , endodontics , crowns and extractions
Fluoride varnish , endodontics , dentures , extractions and orthodontics
Source : US Department of Health and Human Services : Centers for Medicare & Medicaid Services , Region III ( Pennsylvania EPSDT Review Report- Dental Services . April 2008 Site visit ) Final Report . December 31 , 2008 .
• DPW expanded the Access transportation system to help ensure that Medical Assistance children make their dental appointments . 30
• In 2008 , an ACCESS Plus Dental Care / Disease Management Program was implemented to encourage greater access to care and to establish dental homes for individuals less than 21 years of age . 31
• DPW added language to the contract that contains provisions for expanded activities related to the management of dental services and provider network development for ACCESS Plus .
September / October 2010 • Pennsylvania Dental Journal
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