Medicaid and SCHIP Promising Practices

Name of Practice: Virginia Dental Program (VA0801)

Category: Dental

Abstract:

A 2004 survey found that nearly all dentists in the State of Virginia considered Medicaid fees low in comparison with private insurance rates, and claims data from the following year indicated that only about 3 in 10 Medicaid-eligible children above the age of 3 received dental services. Building on a statewide study and the formation of various committees and coalitions charged with developing strategies for improving access to dental care, the Virginia General Assembly in 2004 approved a 30 percent increase in dental reimbursement and a "carve-out" of dental services from managed care in both the Medicaid program and SCHIP. The new Smiles for Children program has significantly expanded the network of Medicaid and SCHIP, the percentage of network providers submitting claims for rendered services, and the percent of children receiving dental services.

The Problem:

In 1995, Virginia's Medicaid and SCHIP programs began providing dental services to managed care plan enrollees either through the managed care organization's (MCO) own network of dentists or through the MCO's subcontract with a dental vendor. Under these arrangements, dentists were generally reimbursed on a fee-for-service basis. A 2004 survey indicated that only about three percent of dentists in the State viewed Medicaid fees for a sample of pediatric dental procedures favorably in comparison to reimbursement from private insurance. In fiscal year (FY) 2005, only 29 percent of children ages 3-20 received dental services.

Discussion of Approach:

In 1997, a study conducted for the Virginia General Assembly analyzed the reasons for dentists' reluctance to participate in the Medicaid program. Over the next three years, the State Medicaid agency convened a Dental Advisory Committee and a coalition, called Virginians for Improved Access to Dental Care (VIADC), was formed to obtain input from stakeholders on dental access concerns. Members of the VIADC coalition included the Virginia Department of Medical Assistance Services (DMAS), the Virginia Dental Association, Virginia Association of Free Clinics, Virginia Primary Care Association, Virginia Commonwealth University's School of Dentistry, and the Division of Dental Health of the Virginia Department of Health (VDH). Several members of the coalition worked in coordination with the National Governors Association Oral Health Policy Academy and an Oral Health Purchasing Institute convened by the Center for Health Care Strategies to develop an oral health action plan for the State of Virginia.
In 2004, the Virginia General Assembly acted to stimulate greater participation of dentists in the State's Medicaid program by approving a 30 percent increase in dental reimbursement, as well as a "carve-out" of dental services from managed care in both the Medicaid program and SCHIP. In July 2005, the State awarded a contract for a statewide, fee-for-service dental program, "Smiles for Children," serving both Medicaid and SCHIP populations. Incentives designed to increase provider participation included the establishment of a dedicated call center, new billing options and quicker payment, streamlined prior authorization, simplified provider credentialing, and creation of a patient "broken appointment log" for provider use. Dental fees were increased by 28 percent overall. Effective May 2006, reimbursement for some endodontic, oral surgery and conscious sedation services were increased an additional two percent.

Results:

In the first year of the Smiles for Children program the network of Medicaid and SCHIP dentists increased by 30 percent, or an additional 190 dentists. The percentage of network providers submitting claims for rendered services increased by 34 percent to 78 percent.
With significant administrative, reimbursement, and outreach changes in the Medicaid dental program, the percentage of children ages 0-20 receiving dental services has increased by 21 percent to 29 percent. Utilization of dental services increased for children ages 3-20 by 24 percent to 36 percent.

Further Information:

Contact:

Sandra Brown
Dental Program Manager
Virginia Department of Medical Assistance Services
600 East Broad Street
Suite 1300
Richmond, Virginia 23219
(804) 786-156
e-mail: Sandra.Brown@dmas.virginia.gov

This Profile has been posted to the CMS Medicaid/SCHIP Quality website for informational purposes only and does not convey CMS endorsement of the practice itself. The descriptive information supplied and the results reported in this Profile have been supplied by sources familiar with the practice but have not been independently validated by CMS.

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