12/9/2013. MassHealth Dental Program Train the Trainer Presentation Agenda. Dental Disease MassHealth Dental Benefits Find a MassHealth Dentist

Transcription

1 MassHealth Dental Program Train the Trainer Presentation 2013 Agenda Dental Disease MassHealth Dental Benefits Find a MassHealth Dentist 1

2 State of Oral Health in America Employees lose more than 164 million hours of work a year due to dental issues. (over 82,000 work years) 1 More than 51 million school hours are lost each year to dental illness. (Over 45,000 school years) One out of every two people over age 30 suffer from periodontal disease. 2 Tooth decay affects nearly 20% of 2-4 year-olds, more than 50% of 8 year-olds, and more than 75% of 17 year-olds. 3 1.U.S. Dept. of Health and Human Services, Oral Health in America: A Report of the Surgeon General, National Institutes of Health, Centers for Disease Control and Prevention, Journal of Dental Research, August Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Oral Health: Preventing Cavities, Gum Disease and Mouth and Throat Cancer, There are Two Major Types of Dental Disease: 1. Caries (Cavities/Decay) 2. Periodontal (Gum) Disease Both Are Caused By Bacteria Both Are Preventable 2

3 HEALTHY TEETH* PLAQUE ON TEETH WHITE SPOT LESION AND EARLY TOOTH DECAY* TEETH WITH DECAY SEVERE TOOTH DECAY WITH DENTAL ABSCESS* TEETH WITH RESTORATIONS * Photo courtesy of Dr. Joanne Douglass BDS, DDS Plaque + Sugar = Acid Acid + Tooth = Decay 3

4 How Do We Get This Harmful Bacteria? Children exposed to bacteria early in life have a higher h incidence of tooth decay. Primary transmission of cavity causing bacteria is from mother to child Transmission includes kissing and tasting the infant s food before feeding them. PREGNANT WOMEN Remember that good dental health is very important to pregnant women and their unborn children. The health of a mother s gums can affect her unborn baby s health. Research shows that a pregnant woman with gum disease has a better risk of having a baby too small. Pregnant women should see a dentist at least one time during pregnancy. Necessary treatment can be provided throughout pregnancy. 1Offenbacher, Steven, Periodontal Infection as a Possible Risk Factor for Preterm Low Birth Weight Journal of Periodontology 1996 October; 67 (10 Suppl): pp

5 Periodontal Gum Disease Gum disease doesn t hurt, so you might not know you have it. If your gums bleed when you brush, you may have gum disease. The best way to ease chances of gum disease is to brush your teeth at least once a day, but twice a day is better. If you think you might have gum disease, see your dentist. Early gum disease is easy to treat. 1Offenbacher, Steven, Periodontal Infection as a Possible Risk Factor for Preterm Low Birth Weight Journal of Periodontology 1996 October; 67 (10 Suppl):pp Important Messages Children should see their dentists by the age of one. Brush your teeth twice a day for two minutes Flossing should begin for any teeth that touch one another. Visit the dentist for a checkup every six months. Never allow your children to fall asleep with a bottle of milk, formula, fruit juice, or sweetened drinks in their mouth. Replace toothbrush when bristles appear worn. Change your toothbrush every 3 months Assist children with tooth brushing until age 7 or 8. 5

6 MassHealth Dental Program Goals Improve oral health and wellness for more than 1 million MassHealth members Improve member access to dental care Streamline program administration Increase provider participation in the MassHealth Dental Program Create and sustain stain a partnership between een MassHealth and the large public health community. Overview of Dental Benefits Effective July 1, 2010, certain dental services are no longer covered for MassHealth Members aged 21 and older who are not Department of Developmental Services (DDS) clients. Eligible MassHealth adult members who are not DDS clients can still maintain full coverage for these services under the Heath Safety Net program which is only available through Community Health Centers. For information on the Health Safety Net, go to 6

7 Overview of Dental Benefits The following dental services are covered only for Adults aged 21 and older who qualify as Department of Developmental l Services (DDS) clients (if medically necessary): Diagnostic services (exams & x-rays) Preventive services (cleanings) Restorative (fillings) Periodontics (deep scaling) Crowns Extractions (removing teeth) Root canal treatments Dentures Emergency and urgent care Overview of Dental Benefits The following dental services are covered for Children under age 21 (if medically necessary): Diagnostic services (exams & x-rays) Preventive services (cleanings, fluoride & some sealants) Crowns Restorative (fillings) Oral Surgery -Extractions (removing teeth) Root canal treatments Root canal treatments Orthodontic (if medically necessary) Emergency and urgent care 7

8 Overview of Dental Benefits The following dental services are covered for all Adults aged 21 and older (including DDS clients) when medically necessary: Diagnostic services (exams & x-rays) Preventive services (cleanings) Extractions (removing teeth) Anesthesia Certain oral surgeries such as biopsies and soft tissue surgery Emergency and urgent care House/facility call Behavior management Treatment of complications related to surgery Member Resources For more information on the MassHealth Dental Program please visit or call Member Services at If members have concerns about finding a dentist or the quality of care received, or if the member feels he or she has been treated unfairly, please contact DentaQuest at , or send a letter to: DentaQuest MassHealth Dental Program Attn: Complaints and Grievances North Corporate Parkway Mequon, WI Members may also contact the State Enrollee Help Line at with other concerns. 8

9 MassHealth ID Cards Cards can be used immediately by MassHealth members. Members can receive a new card at no cost. To get a replacement ID Card, or to report an address change, members can contact Customer Service: , or providersupport@mahealth.net Please remember that a MassHealth card does not guarantee eligibility for services. You must continue to verify eligibility on the date of service. Fluoride Map 9

10 The Dental Home How to Find Your Dental Home on the Internet -Go to -Click on General Public 10

11 Click -Find Provider How to Find Your Dental Home on the Internet Dentists t closest to the member will show on the screen.. Members can select a dentist that meets their needs. 11

12 How to Find Dental Information and Educational Materials -Go to -Click on General Public 12

13 Click -Documents Dental Information and Educational Materials 13

14 DentaQuest Boston Contact Information Tracy Chase Executive Director Phone: Megan Mackin Outreach Coordinator Phone: Arielis De La Rosa Intervention Specialist Phone: Felicia Moses Intervention Specialist Phone: DentaQuest Provider Relations Contact Information Daniel Archambault Provider Relations Representative (West) Phone: Keishia Lopez Provider Relations Representative (East) Phone:

15 Thank you! Developing collaborative relationships with entities in Massachusetts interested in improving oral health is key to the success of the program. We look forward to working with all of you! Questions? 15