State of Alabama FY 2009

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1 State/Federal Collaborative Workshop On Oral Health Improvement Initiatives 2010 NASHP Meeting New Orleans, Louisiana Oral Health Session November 7, 2010 Mary G. McIntyre, M.D., M.P.H. Medical Director and Deputy Commissioner, Clinical Standards and Quality Alabama Medicaid Agency State of Alabama FY 2009 Total Population in Alabama ~ 4.8 million Medicaid eligible population 964,171 (20.1%) Total child population 1,353,472 Medicaid eligible children 547,581 (40.5%) Total payments $4,667.9 million 1

2 Alabama Medicaid Dental Program Vision Statement Dental Program To ensure every child in Alabama enjoys optimal health by providing equal and timely access to quality, comprehensive oral health care, where prevention is emphasized promoting the total well-being of the child 2

3 Smile Alabama! Initiative Public/Private Partnership Robert Wood Johnson Foundation s 21 st Century Challenge Fund supported matching grants program Dental Outreach Initiative-Official Start, February 2001 Two Primary Goals Increase the number of dental providers participating in the Medicaid program by 15% during the 3-year grant period Increase the number of children receiving dental care by at least 5% (CMS Annual Dental Visit Rate) 3

4 Where We Started Identification of Key Individuals who could make the difference... Dentists (ALDA) AL Medicaid Agency AL Department of Public Health Governor Legislature Dental School We Listened Formation of Dental Task Force Non-Medicaid and Medicaid dentists Alabama Dept of PH and UAB School of Dentistry Dental Task Force discussed Medicaid issues Dental Surveys done #1 Issue - Low Reimbursement #2 and #3 Claims Processing 4

5 Timeline Formed Dental Task Force Jan 1998 Targeted Rate Increase Jan 1999 Coordinate with State Dental Association Survey of state dentists 1999 and 2000 Develop educational materials for dentists Provider enrollment User friendly billing manual Aug/Sept 1999 Timeline Streamline claims payment Oct 1999 ADA approved claim forms Scanning technology Free software for electronic claims submission (Windows Based) Proclamation April 2000 Educate legislature Enlist Governor s Support Spring 2000 Governor s Letter to Dentists Oct

6 Timeline Establish Multidisciplinary Workgroup Evaluate state needs for all March 2000 Outreach program Provider visits July/Aug 1999 Visit all participating dentists March 2000 Attend state and regional meetings Ongoing Speak to dental students yearly Ongoing Dental Outreach Specialists June Timeline Grant applications RWJ April & Nov 2000 NGA Oct 2000 Targeted Case Management (TCM) Increase in Fees Oct 2000 March 2000 Developed patient education materials May 2001-Ongoing Public education campaign Nov 2001, April 2003 Video and Public Service Announcements (TV & Radio) 6

7 Working Together Establishment of Additional Teams Dental Initiative Workgroup evolved into current Oral Health Coalition of Alabama (OHCA)-Initial focus on AL Medicaid oral health strategies, now work to implement strategies for AL OH Strategic Plan AL NGA Policy Academy Team now AL Oral Health Strategic Team (AOHST) Oral Health Policy Team (NGA) Alabama Dental Association Alabama Department of Public Health Alabama Medicaid Agency Alabama Primary Health Care Association Child Health Insurance Program CMS Regional Office Governor s Office Legislator Office of Primary Care & Rural Health Private dentist UAB Dental School 7

8 Oral Health Coalition of Alabama (OHCA) Alabama Office of the Governor Alabama Legislature Alabama Extension Service Alabama Medicaid Agency Alabama Department of Public Health Department of Rehabilitation Services Department of Children s Affairs Department of Education Department of Human Resources Department of Mental Health UAB School of Dentistry Oral Health Coalition of Alabama (OHCA) Alabama Academy of Family Physicians Alabama Academy of Pediatrics Alabama Arise Alabama Association of School Nurses Alabama Hygienists Association Alabama Dental Association Alabama Dental Society Alabama Hospital Association Alabama Pediatric Dental Association Alabama Primary Health Care Association 8

9 OHCA (Continued) Alabama State Medical Association Alabama Power Business Council of Alabama Blue Cross and Blue Shield of Alabama Consumer Representatives Faith Based Organization FOCAL Head Start Medical Association of the State of Alabama Medicaid Dental Task Force VOICES Target Populations Identified Medicaid children and caregivers Practicing dentists Stakeholder or partner associations and groups 9

10 Interventions Claims Processing Simplification Dental Rate Increase Provider Outreach and Education Consumer and Patient Education Strategies Implemented Healthy teeth, healthy mouth, healthy you! Head Start OH Lesson Plans (Initially) Office of School Readiness (Pre-K programs) Take a 1 st Look Primary Care Physician (focus on OH risk assessment and referral by age 3) Initial Program Revised 1 st Look and re-implemented effective Jan 2009, added fluoride varnishing reimbursement for 1 st Look certified physicians and requirement for referral to care coordinator for establishment of dental home for all high risk children assessed through 1 st Look, ages 6 through 35 months of age) Obstetrical Early Intervention Pregnant women (Taking Care of Baby s Teeth) 10

11 I ll have water, please! Going to bed with a bottle of milk or juice can cause a problem called baby bottle tooth decay. A tooth with decay can cause great pain and can cost a lot of money to fix. To prevent this problem Put water in nap or bedtime bottles. Don t let baby carry around a bottle or sippy cup filled with a sweet drink. Don t dip pacifiers in anything sweet. By the first birthday,teach your baby to drink from a cup. Clean baby s mouth with a clean, damp cloth after each feeding and before bed. Your Rights and Duties As a Dental Patient Read this and find out what you need to know! Having healthy teeth is an important part of your good health. Medicaid s dental program is set up to help you get good dental care. In order for you to get good dental care, there should be respect and trust between you and your dentist. When you signed up for Medicaid, you agreed to be a part of Medicaid and to follow Medicaid s rules. This also means you have the following rights and duties when you go for dental care on the Medicaid program: You have the right: To be told what your dental problem is, if you have one, and what the dentist thinks is the best way to treat it; To decide about your dental care and to give your permission before the start of any treatment; To have the personal information in your dental records kept private; To report to Medicaid any complaint or grievance about your doctor or your medical care; and To be treated with respect, dignity and privacy. 11

12 To be signed by the patient: You need to know... Your dentist has the right to ask you to follow the rules for the office or clinic. This also applies to any visitors or relatives who come with you or your child. If you or others with you do not follow the rules, your doctor has the right to ask that your child go to another dentist. Serious problems, such as refusing to keep appointments, or acting in a rude, mean or threatening way to the dentist or to a person who works for the dentist, may result in your losing your Medicaid. This includes fighting, using profanity or other abusive words, carrying a weapon or being under the influence of drugs or alcohol while at the office or clinic. I have been told about my rights and duties as a Medicaid dental patient. I have been told what the rules are for my dentist s office or clinic. I have been given the chance to ask questions about any rules I do not understand. I have been told that if I miss appointments, do not follow the dentist s directions or do not follow the rules for Medicaid, my dentist can ask that my child go to another dentist. I understand that if I or someone who comes with me acts in a rude, mean or threatening way to the dentist, employees of the office or clinic and/or other patients and visitors, I can lose my Medicaid. I have been told that I have a right to complain to Medicaid and get an answer to my complaint. Signed: Date: Baseline Data In FY 1999, 82,585 of 317,214 Medicaid eligible children received dental services (26%) 436 Medicaid enrolled dentists Of these, 328 were participating (75.2%) Total dental expenditure of $ counties had 1 or no Medicaid participating dentist 12

13 FY1998-FY2010 RESULTS Figure 1. Alabama Dental Medicaid Utilization,

14 Figure 2. Enrolled and Performing Dentists, Alabama Dental Medicaid, Figure 3. Performing Dentists, Alabama Dental Medicaid,

15 Figure 4. Percent Medicaid Eligibles Receiving Any Dental Service, by age category, U.S. and Alabama, FY 2006 Where We Are Now FY 2008, 204,163 of 501,058 Medicaid eligible children received dental services (40.8%) *661 Medicaid enrolled dentists for FY 08 Of these, 595 participating (90%) Total dental expenditures of $60 million 11 counties with 1 or no Medicaid participating dentists 15

16 Where We Are Now FY 2009, 233,983 of 531,296 Medicaid eligible children received dental services (44.4%) 696 Medicaid enrolled dentists for FY 08 Of these, 597 participating (86%) Total dental expenditures of $73 million 11 counties with 1 or no Medicaid participating dentists Where We Are Now FY 2010, 243,257 Medicaid eligible children have received dental services as of data run date 8/23/2010 Utilization percentage pending 2010 eligibility numbers 764 Medicaid enrolled dentists for FY 09 Of these, 654 participating (86%) Total dental expenditures of $82 million 12 counties with 1 or no Medicaid participating dentist as of September 27,

17 HEDIS 2009 Annual Dental Visit Rate HEDIS 2009 Annual Dental Visit Rate Age Groups Denominator Numerator Percentage Age Group ,881 16,414 45% Age Group ,816 35,001 70% Age Group ,012 39,019 71% Age Group ,212 32,258 64% Age Group ,974 25,080 56% Age Group ,636 2,606 19% Total 250, ,378 60% What Can You Do? Identify key stakeholders and work collaboratively to achieve goals Use multiple strategies Continuously review program strategies and make changes and modifications as needed Remember that this is a process and it should be ongoing! 17

18 Contact Information Mary G. McIntyre, M.D., M.P.H. Medical Director and Deputy Commissioner, Clinical Standards and Quality (334) Carol Akin, Dental Program Manager (334)

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