MHS Mobile Dental: Memorandum of Understanding

Transcription

1 MHS Mobile Dental: Memorandum of Understanding A Memorandum of Understanding (MOU) between: Oral (Dental) Healthcare Provider: MHS Mobile Dental School/School District/Organization: The purpose of this MOU is to define and outline the responsibilities of the healthcare provider, MHS Mobile Dental and the School District or Organization listed above when MHS Mobile Dental comes on-site to provide dental care services. This agreement provides authorization from the Organization or School District to allow MHS Mobile Dental to provide dental care and follow-up screenings at the agreed upon and scheduled times during the Fall or Spring semesters covering the entire school year. The School/Organization agrees to provide the following support to the MHS Mobile Dental staff while at this site: FACILITIES: *Available space for setup of dental services equipment & access to water/sink & toilet facilities EQUIPMENT & SUPPLIES: *At least one telephone for contacting the dental personnel (Front office, Nurse office, etc.) PROGRAMMATIC COMPONENTS: Assistance with: *Obtaining parental consent forms *Accommodating parental presence (if requested) during dental procedures *Assist in distribution of communication materials relating to the school-based dental program MHS Mobile Dental will provide the following: THROUGH ON-SITE SERVICES: (for enrolled students only with parental consent ONLY) *All necessary computer and dental equipment or supplies needed to provide service *Primary & preventive dental health services & follow-up screenings according to Dental Health Guidelines. *Referral and follow-up for needed dental care SIGNATURES: MHS Mobile Dental Representative Date: School/School District/ Organization Representative Date: Business Office: 1904 Lakeland Dr., Ste C, Jackson, MS / PO Box 12605, Jackson, MS Office Ph: * Operations Director: * Fax: * mhsmobiledental@gmail.com

2 MHS DENTAL * DENTAL SCREENING CONSENT FORM Office Address: 1904 Lakeland Dr., Suite C, Jackson, MS Office: * Operations Director: * Fax: * Web: PLEASE COMPLETE & RETURN THIS FORM ON THE NEXT DAY OF SCHOOL It is very important that children see a dentist on a regular basis to stay healthy and avoid toothaches, cavities, and other problems so that they are better prepared to learn. Your child will now have the opportunity to receive a dental exam, cleaning, fluoride, sealants, and other dental services through this school-based mobile dental outreach program. The mobile clinic will be setup at your child s school for 1 week during the school year. The consent form is effective for the entire school year. After your child s visit, he/she will receive a walk-out statement to bring home that lists services performed and any additional information. If you have questions, please call one of the numbers listed above or visit mhsdental.com. *A separate form is needed for each of your children. * PATIENT INFORMATION CHILD S NAME CHILD S BIRTH DATE GRADE GENDER M F PHONE TEACHER SCHOOL ADDRESS CITY ZIP * INSURANCE INFORMATION (CHECK ONE) MEDICAID / MS CHIP / MS CAN (*ID Number ) PRIVATE DENTAL INSURANCE (*Policy/ID Number ) & (*Group Number ) Name of Insurance: Subscriber Name: Subscriber D.O.B.: Subscriber SSN: UNINSURED * HEALTH HISTORY/INFORMATION Has your child ever had any serious health problems listed below: (Please check all that apply) Diabetes Asthma Behavior Problems Anemia Sickle Cell Other (Explain) Is your child allergic to any food or medication? If so, please list Is your child currently taking any medications? If so, please list Is your child allergic to? Latex Acrylic/Plastic Does your child have any dental pain? Yes No If Yes, how long If your child is currently seeing a dentist, list their name: Date of last dental visit: PARENT or LEGAL GUARDIAN MUST SIGN & CHECK YES BEFORE CHILD CAN PARTICIPATE By signing below, the parent or legal guardian is saying YES, I authorize a MS state licensed dentist with MHS Dental to provide my child a dental exam, x-rays, cleaning, fluoride, sealants at their school without my presence unless I withdraw consent. Dental care service is provided for children with Medicaid, CHIP, Private Insurance, or those with no insurance coverage. Services are no out of-pocket costs and are charged directly to Medicaid, MS CHIP, MS Can, or private insurance provider. If your child already sees a dentist on a regular basis, the parent or guardian should continue to arrange dental care through that provider. The treatment of your child through this mobile dental clinic may affect insurance benefits (as with any dental office) as treatment services will be billed to your dental insurance provider. Three to Six months following this initial visit, MHS Dental in partnership with North Sunflower Medical Center may provide a basic follow-up screening. PLEASE SIGN HERE: DATE: PRINT NAME: RELATION TO CHILD:

3 MHS Mobile Dental School-Based Preventative Oral Healthcare Program [About] The goal of this outreach program is to provide quality preventative dental care to individuals living in Mississippi who may otherwise not have access to dental care on a regular basis. Many Mississippians, especially in the inner city and rural areas, are underserved when we look at oral health care. Not only are these individuals underserved by the lack of providers, but also by the lack of providers accepting state and federal funded programs such as Medicaid and the MS Children s Health Insurance Program (CHIP). Mobile Health Solutions, Inc. has been providing on-site dental care in classrooms since Statistics show that oral health significantly affects our children and for this reason, the program is focusing on the elementary schools, Head Start programs, youth summer programs and other organizations in our communities. Since there is such an obvious need, the MHS Dental program (Approved by the Mississippi State Board of Dental Examiners) will be coming directly to your community to offer free dental care for the participants in your program. A full range of dental services will be offered and provided by a board certified dentist, a dental hygienist, and their staff. The program will fill an oral health care void in the areas that are underserved. If a child has dental coverage through any program (Medicaid, CHIPS, Magnolia, private insurance) or has no coverage at all, then that child has the opportunity to be seen by a Board Certified Dentist while under the supervision of their schools, Head Start program, boys & girls club, or other programs. MHS intends to work with local health departments, MS Department of Health, or any organization that will partner with us to help bring quality oral health care to the schools, Head Start and other community programs. Our goal is to bring quality and convenient dental care to areas in Mississippi that are underserved by dental health care professionals. What We Do. The MHS Mobile Dental is a group of committed dentists, dental hygienists and dental assistants who promote excellence in oral health and provide dental services to patients in non-traditional settings. Using portable equipment, MHS provides high quality dental services in schools, other childcare facilities or Head Start Programs. Our Dentists Can Provide: - Examinations - Sealants - Radiographs - Teeth Cleanings - Fluoride - Free Toothbrushes - Referrals to a Dental Home Why We Do It. Dentistry in the 21st century is changing. Although many individuals are still able to make regular visits to the dentist, there are many, for various reasons that cannot access a traditional dental office. Lack of transportation, lack of child care, lack of time off for the working parent, lack of local dentists accepting Medicaid, and limited traditional dental office hours are among the multitude of reasons that make mobile dentistry so popular. How We Do It. MHS Mobile Dental converts a classroom or any pre-determined area in a school or facility into a dental office for the day. Compressors, chairs, portable x-ray machines, sterilizers, high and low volume suction, air water syringe and focused lights are among the various pieces of equipment that are employed. New or disposable supplies are utilized for each patient. A referral base is always available to the patients and their families if further dental work is required.

4 Program Info for School Districts & Local Dentists: We are approved and regularly inspected by the MS State Board of Dental Examiners. We have been approved through MSBDE under Regulation 61 (Mobile/Portable Dental) since We strictly follow all guidelines put forth by the dental governing & regulatory body of Mississippi. Every single consent form, walk-out form, or any other form that MHS Dental distributes HAS been approved by the MSBDE. The purpose of this program is not to become a dental home of the patient, but to catch those under-served patients who are not seeing a dentist on a regular basis. Since 2009, our stats show that we only receive signed consent forms from approximately 25% of a total student body of most schools we go to. For High Schools that number is less than 10%. Of the approximate 25% of a student body that returns consent forms, our numbers show that roughly 35-40% of that 25% have NO insurance coverage at all. We provide those patients with a FREE comp exam, cleaning, fluoride, and sealants. We provide well over $150 in free dental care to each uninsured child we see. Reference our website and you will see we provide in-kind/free care in the amount of well over $500,000 per year to those uninsured. We only get approximately less than 5% returned consent forms from children with private insurance. We don t discriminate who can sign up for the program. Any parent that signs their child up will be seen regardless of insurance status. Our goal once a child sees us is to refer them to a local dentist that has signed up to be a referral for the area. Our hope is that the dentist will use his limited exam code, the two bite wings that we didn t take and treat the cavity or other issue that we referred them for. Then we hope that the local dentist would discuss with the parent that the child does have dental coverage and that it would be best to continue coming to that, clinic or any other local clinic of their choosing, every 6 months for regular visits and not at the school. Many of our referrals have done that and are now seeing entire new families because of children we have referred through the program. Any digital x-ray that we have taken can also be ed to a dentist office upon request.

5 MHS Mobile Dental Program [Frequently Asked Questions] Why should we have a Mobile Dentist at our location? The U.S. Surgeon General and the Centers for Disease Control recommend in-school dental prevention and sealant programs for low-income children. Do you know that four out of five low-income children never see a dentist in a year? It has also been determined that 85% of all decay in children occurs in this group of low-income children. Dental disease can be serious and lead to severe infections that can have serious health and learning consequences. Dental decay is highly preventable and the goal of our program is to serve the most vulnerable children who don t see a dentist for simple and highly effective prevention measures. Do we have to pay MHS Mobile Dental to come to our location? No. There s no cost to the school or any other program where we provide service. Does the MHS Mobile Dental school-based program charge a fee to the families of the children? Most dental insurances, including Medicaid and CHIP, cover 100% of the preventive services that we provide. Also, MHS sees any child that has NO insurance coverage if his parents return a signed consent form. MHS Mobile Dental gives away between $500,000 $1,000,000 in free dental care annually to the uninsured. How many people actually come to our location? Our teams generally include a dentist and three to five dental assistants. One of the dental assistants will be working the check-in and checkout process with the computer. Another dental assistant will be assisting with the x-rays and the other assistants will be helping the school or program in getting the children to the dentist and back to class or other activities. How long will our students be out of the classroom? On average, the children are with our team for about 20 minutes, but the actual length of time depends on three things: the number of services the child requires, the age of the child and of course how many teeth need to be sealed. What happens if a child requires a referral for additional dental work? We have a referral list of dentists and dental public health facilities that accept patients for follow-up work. Every child that visits us in the school-based program will get a form listing a dentist that has agreed to take referrals from this program for any additional or emergency care. Also, if we take x-rays on a child, we will send those upon written request to the dentist providing follow-up care. Do you see every child in the school or program that you visit? No. By law, we can ONLY see children who have provided us a consent form that has been signed by a parent or guardian. Our forms have to be approved by the Mississippi State Board of Dental Examiners (MSBDE). What do we need to prepare for a visit? We ask you to do only two things before our visit: 1) Hand out the consent forms and health history forms (provided by us) to the children and/or parents and collect them as the children or patients return them. 2) Identify a space about 12x12-feet where we can set up our dental office that is in close proximity of bathroom and running water and has adequate electrical outlets.

6 DELIVERING BRIGHT SMILES TO BRIGHT MINDS MHS Mobile Dental Program [Notable Oral Health Statistics in Children] Please look at the following children s oral health stats. They provide proof that the frequency of oral disease occurrence directly correlates to disparities in dental care access. One of the primary indicators of dental decay for children is low socioeconomic status. Approximately one in five Mississippians lives in poverty, and of this 20 percent, over one-third (38%) are children ages 17 and younger (U.S. Census Bureau, 2000). Therefore, a high percentage of the Mississippi school-age population is in a high-risk group for dental decay. In the 2003 "Keep America Smiling: Oral Health in America" report by Oral Health America, Mississippi received an overall mark of "D+" compared to the national overall mark of "C." While Mississippi has begun to address the oral health needs of its children, many opportunities remain in the areas of prevention and access to dental care. The statistics below are some of the reasons that the SDDC-MHS Dental Program was developed. The following children s oral health stats provide proof that the frequency of oral disease occurrence directly correlates to disparities in dental care access. Tooth decay (dental caries) is the single most common chronic childhood disease. Approximately 1 in 5 preschoolers, half of second graders, and four in five 17- year-olds have at least one cavity or filling. A child suffering from dental pain may have difficulty with school attendance, which compromises their mental and social well-being. Children living in poverty suffer 2 times the tooth decay and pain, but are only one-half as likely to obtain a dental visit as their affluent peers. One in four children living in poverty has not seen a dentist before entering kindergarten. African American children have a much higher proportion (67.4%) of untreated dental caries than White children. (37.3%) Research results of 5,227 third graders, representing 74 public schools in Mississippi included: Almost three in four children (70%) exhibited caries experience. Fifteen percent (15%) were in urgent need of dental care. African American Only children about one had in one-half five children the number of sealants For as every White child children. without medical Children without enrolled sealants in Medicaid had 3 times received the need a single for urgent care coverage, than children there are with 2.6 sealants. children Children with more dental than visit one in a sealant year. had less need for dental without care. dental coverage. (Silberman, Mosca, Eklund & Stilley 2001)

7 MHS Mobile Dental [Delivering Bright Smiles to Bright Minds.] As the most widespread, chronic, and preventable childhood disease, dental caries is costly to children, families, and the state. In addition, poor oral health in young children, if untreated, sets the stage for a lifetime of negative health outcomes. Clearly, continued support for efforts to increase dental care access and caries prevention in Mississippi will be necessary to improve the oral health of our children and to positively affect both the health and educational outcomes of Mississippi's youth. The program, including the equipment, our procedures, and documentation, is regularly inspected by the MSBDE (MS State Board of Dental Examiners). This program is designed to not cost the school nor any patient (Medicaid, CHIP, Private Insurance or non-covered) any out of pocket expenses. The purpose of our outreach dental program is to provide a service of quality and convenient oral health care to anyone that has a need. We hope that if you see a need for increased oral health care in the community, you will consider partnering with MHS Mobile Dental to offer our free dental service in your school district or Head Start/Youth program. Our goal for this partnership is to improve the oral health and dental care access to our children by delivering bright smiles to the bright minds of Mississippi s future. A Memorandum of Understanding will be provided to be signed by MHS Mobile Dental and your school district or program should we agree to establish a partnership and offer this free dental care service at your schools, Boys/girls club or Head Start program locations. MHS Dental Dental Director Richard Williams, D.M.D. J. Felda Jones, Jr., D.M.D. Tasia Poyadou Lamb, D.M.D. Executive Director Mike Murphy Corporate Office Address & Phone Office: 1904 Lakeland Dr., Ste C, Jackson, MS Mailing Address: PO Box 12605, Jackson, MS Office Phone: * Fax: Mobile Dental Billing Director: Clara Martin Mobile Dental Operations Director: Chris Martin mhsmobiledental@gmail.com Website:

8 Mail PO Box 12605, Jackson, MS Office 1904 Lakeland Dr., Ste C, Jackson, MS Tel Fax Web Jackson County School Board & Administrators, Thank you for your consideration of allowing MHS Dental to provide preventative dental services for the students in the Jackson County School District. After speaking with Mr. Todd Knight and Dr. Van Winkle, as well as all the nurses in the district, we received positive feedback about our program and have provided the following information for the purpose of obtaining approval from the Jackson County School District Board of Directors to provide our preventative services to students in this district. MHS Mobile Dental is the first full-time dedicated mobile/portable dental company based in the state of Mississippi. MHS Mobile Dental has been providing preventative oral healthcare services on-site in schools, head start centers, boys and girls clubs, and other youth programs throughout Mississippi since MHS Mobile Dental is approved by the Mississippi State Board of Dental Examiners through Regulation 61 to provide on-site dental care. MHS Mobile Dental has 9 state licensed dentists approved to work for our program. We have provided preventative oral healthcare to well over 30 districts throughout Mississippi since In most of the school districts that we serve, we have provided services for more than 5 years. We serve several districts on the Mississippi Gulf Coast including Pascagoula, Moss Point, Harrison County, Gulfport, Long Beach, Bay St. Louis/Waveland, and Hancock County. We also serve several districts in the Pine Belt and Central MS as well. MHS Mobile Dental is able to come to each school in your district once per year. We will distribute parental consent forms for parents to sign if they would like their child to be seen by a dentist. Once on-site, the preventative services provided by MHS Mobile Dental include a digital x-ray, a comprehensive exam by a state licensed dentist, teeth cleaning, fluoride treatment and sealants when necessary. Once service is completed, we provide a walk-out form for each child as required by law the details what services were performed and any necessary additional dental care that may be needed. We are required by regulation 61 to provide the name(s) of referral dentists in the area who have agreed to see patients that we refer from this program. This program was designed to provide access to quality dental care for children of families that may be under-served or lack access to a traditional dental office. By no means is this program designed to become a child s dental home. Our numbers over the past 7-years show that we only get participation from 20-25% of a schools entire student body. Of that 20-25%, typically 35% have no insurance coverage and receive our services for free. We give back well over half a million dollars in free dental care each and every year. And the majority of the remaining students of that 20-25% are typically covered through a federal program like Medicaid or MS Chip. Only approximately 1-2% of the returned forms are from children with private insurance. MHS can provide more information as needed. We ask that your board of directors give consideration to signing the attached MOU for approval of our mobile dental services starting in the spring semester of the school year. Please refer to our website at to find additional information as well as studies, statistics, and copies of all of our forms that are approved by the Mississippi State Board of Dental Examiners. We have provided some additional information below for your review. Thanks for your consideration, Mike Murphy Executive Director, MHS Mobile Dental

9 The MHS Mobile Dental program offers the following: Quality preventative services to all students who return a signed consent form. No charge to any student without dental insurance or out-of-pocket cost for any student. No cost to the school or school district. Referral to dental home. Educational material for nurses / school clinic. Detailed participation reports with statistics for administrators and district office. Dedicated staff to answer oral healthcare questions or concerns that arise during the school year. The first and longest running full-time mobile dental company in MS. (Approved by MSBDE in 2009) Experience Matters (MHS Mobile Dental Sept Nov. 2016) Initially approved the MSBDE and subsequently provided care under the name RDC Mobile Dental in 2009, then changing our name and becoming MHS Mobile Dental in 2010; we are the first and longest running full time schoolbased mobile dental clinic in Mississippi. MHS currently provides preventative oral healthcare services in 175+ individual locations from Central MS to the Gulf Coast. These locations include schools, head start centers, youth summer programs, and boys & girls clubs. Since Sep 2010 (through Nov 2016) we have provided approximately 60,500 individual dental visits o That equates to an average of over 8,000 visits per year Of that 60,500 total visits, 19,800 were uninsured. o That is (32.7%) or one third of all children that we see that are given care in-kind o On average, we provide each uninsured patient with $ in free dental services As far as what MHS Dental is collecting per billed patient: o On average since Sept our avg. collection per billed patient is $ o That is $18.41 LESS than the average that we are giving away to uninsured patients o This debunks statement like running up benefits people/dentists/etc. may say about programs like this Free dental care/services we have given away since Sept (through Nov 2016) o Including uninsured patients and uncollected write-offs, the total is $5,240,358 o On avg. we give back $750,000 annually o On avg. we give back 0ver $3,500 every day we work We don t see the vast majority of children with private insurance o These kids are typically not under-served o Typically from middle class homes o Typically visit a dentist annually o Of all our patients, 32.7% are UNINSURED o Of the remaining 67.3% of the patients, 97.8% have gov t healthcare (i.e. Medicaid/Chip/MSCan) MHS Mobile Dental Has 9 MS state licensed dentist approved through regulation 61 MHS Mobile Dental has two full time units staffed with a dentist daily Both MHS Mobile Dental units have full-time contract labor staff (i.e. dental assistants, billing, hygienists) MHS Mobile Dental guarantees every district that we will provide service to every grade K-12 every year