Promoting Oral Health Through the Medicaid Benefit for Children and Adolescents

Transcription

1 Promoting Oral Health Through the Medicaid Benefit for Children and Adolescents Wednesday, June 18, :00 3:00 pm ET For audio, please listen through your speakers or call: Follow NASHP on Supported by the Centers for Medicare & Medicaid Services under a contract to NORC at the University of Chicago Agenda 2:00 2:05 pm 2:05 2:15 pm Welcome and Introductions Neva Kaye, Interim Executive Director, NASHP Federal Perspective on Oral Health Services under the Medicaid Benefit for Children and Adolescents Laurie Norris, JD, Senior Policy Advisor and Coordinator of the CMS Oral Health Initiative 2:15 2:40 pm 2:40 2:55 pm 2:55 3:00 pm Insights from States Susan Tucker, MPH, MBA, Executive Director, Office of Health Services, Maryland Department of Health & Mental Hygiene Michelle Harper, MPA, Deputy Director, Office of Policy, Medicaid/CHIP Division, Texas Health and Human Services Commission Question and Answer Facilitator: Neva Kaye Wrap-up 1 1 1

2 Resources for States NASHP has launched a Resources to Improve Medicaid for Children and Adolescents map: The map offers: State-specific resources on several topics, including data collection, care coordination, and behavioral health Strategies that state policymakers and Medicaid officials are using to deliver the Medicaid benefit for children and adolescents Additional national resources 2 A Federal Perspective on the Medicaid Benefit for Children and Adolescents Laurie Norris, JD Senior Policy Advisor and Coordinator of the CMS Oral Health Initiative 3 2

3 CMS Oral Health Initiative Goal #1 Increase by 10 percentage points the proportion of Medicaid and CHIP children ages 1 to 20 (enrolled for at least 90 days) who receive a preventive dental service. Baseline year is FFY National baseline is 42%. Goal year is FFY National goal is 52%. Every state has its own baseline and goal. Goal #2 Increase by 10 percentage points the proportion of Medicaid and CHIP children ages 6 to 9 (enrolled for at least 90 days) who receive a sealant on a permanent molar tooth. CMS is working to operationalize this goal. 4 States Meeting or Exceeding 1 st Year Interim Goal Preventive Dental Services Source: FFY FFY 2012 CMS 416 reports, lines 1b, 12b. State baseline percentages were computed using FFY 2011 data reported to CMS as of May 28, State progress was computed using FFY 2012 data reported to CMS as of April 10, * Ohio data were unavailable in FFY 2011 and the state was therefore excluded from FFY 2012 computakons. FFY 2012 data for ConnecKcut were not available so FFY 2011 data for ConnecKcut is subsktuted in FFY 2012 for the comparakve analysis. 5 3

4 CMS Learning Labs Developing State Oral Health Action Plans Using State Data Successful Beneficiary Outreach Strategies Quality Improvement Processes: An Introduction for Medicaid and CHIP Dental Programs Engaging More General Dentists to Care for Young Children: Access to Keep Kids Smiling: Promoting Oral Baby and Child Dentistry (ABCD) in Health Through the Medicaid Benefit Washington and South Dakota for Children & Adolescents Dental Sealants: An Effective State State Medicaid and CHIP Program Strategy to Prevent Dental Caries in Support of Sustainable Oral Health Children Care Delivery Models in Schools and Community-Based Settings 6 Improving Oral Health Care Delivery in Medicaid and CHIP: A Toolkit for States hlp:// CHIP- Program- InformaKon/By- Topics/Benefits/ Downloads/Oral- Health- Quality- Improvement- Toolkit- for- States.pdf Provides a step-by-step, datadriven quality-improvement process that can be tailored to each state s needs and priorities Guides states to use available data to identify and address gaps and variations in use of dental and oral health services Walks through a six-step process to identify QI goals, target areas of improvement, plan and implement interventions, and evaluate progress. 7 4

5 Keep Kids Smiling: Promoting Oral Health Through the Medicaid Benefit for Children & Adolescents One of a series of strategy guides to help states improve child health services delivered through Medicaid and CHIP Keep Kids Smiling provides: An overview of the children s dental benefit in Medicaid, Support for evidence-based policies at the state level, and Details of successful strategies with state examples. ANETTE ROMANENKO DREAMSTIME.COM hlp:// CHIP- Program- InformaKon/By- Topics/Benefits/ Downloads/Keep- Kids- Smiling.pdf 8 Keep Kids Smiling: 4 Overarching Strategies Improve performance through policy changes Maximize provider participation Directly address children and families Partner with oral health stakeholders 9 5

6 Think Teeth! Three free materials: For parents of babies and toddlers up to age 3 For parents of children of all ages For pregnant women English/Spanish Can be bulk-ordered free from CMS professionals/dental/ index.html 10 Insure Kids Now: Medicaid/CHIP Dentist Locator Tool Download the Widget: hlp://datawarehouse.hrsa.gov/tools/widgets.aspx To use the Dental Provider Locator Tool: Go here hlp:// then click on your state 11 6

7 Texas Maryland Michelle Harper, Deputy Director, Office of Policy, Medicaid/CHIP Division, Texas Health and Human Services Commission Susan Tucker, Executive Director Office of Health Services Maryland Department of Health & Mental Hygiene Insights from States 12 Maryland Maryland has had great success in improving children s access to both preventive and restorative dental services. What has been your state s approach and how have you achieved these increases? Maryland Children Receiving Dental Services -./0%!1+&2%345677/8%965%:;%</:0;%"+&%=:>0%?4%@/8?A:?8% % Receiving Service!"#$%!!#&%!$#"% '"#(% )&#'% )"#$% ))#)% )*#(% +&&'% +&&)% +&&*% +&&(% +&&$% +&,&% +&,,% +&,+% Calendar Year 13 Source: The Hilltop Institute 7

8 Medicaid Oral Health Strategies and Stakeholder Input Pre-Intervention History Until 2007, 7 Managed Care Organizations (MCOs) provided dental coverage Dental Action Committee (DAC) convened in June 2007 by former Maryland Health Secretary, with encouragement from Maryland Governor s Office, providers, and community stakeholders Met seven times between June and August 2007, to create recommendations to increase access to oral health care for Medicaid populations Committee issued seven recommendations in September 2007, based on assessments 14 Medicaid Oral Health Strategies and Stakeholder Input Addressing Utilization Gaps Financing Increase dentist participation in Medicaid Streamline program navigation for members Public Health Create access points to care statewide Strengthen oral health safety net Education Public information campaign targeting children and adults Community education on effective oral health preventive care Scope of Practice Fill gaps in service areas needing more dentists Strengthen the oral health delivery system 15 8

9 Medicaid Oral Health Strategies and Stakeholder Input Post-Intervention Results Increased rates for 12 targeted dental procedure codes by an average of 94% in July 2008 Implemented statewide dental ASO DentaQuest (formerly Doral Dental) in July 2009 that streamlined credentialing, revamped customer service for providers and members, increased the dental provider network, and created a provider portal and missed appointment tracker Created a public health dental hygienist position in July 2009 to broaden access to routine care without the need of dentist supervision Developed a fluoride varnish program for children ages 0-3 using EPSDT well child care providers in July 2009 Created new safety-net provider sites throughout the state over a three-year period (in partnership with dental schools and clinics) Unveiled a unified oral health educational program in February 2012, located at DentaQuest assigned Medicaid children statewide to a dental home as of September Medicaid Oral Health Strategies - Lessons Learned Making reforms simultaneously can present a challenge; but comprehensive changes should attract dentists to the Medicaid network Increasing rate reimbursement is important; but so are cutting administrative burdens, educating the public about the importance of regular dental care, and rebranding the Medicaid oral health program for providers and recipients State Medicaid agencies need stakeholder champions to carry out comprehensive dental improvement plans (In Maryland, our champion is the Maryland Dental Action Coalition formerly known as the DAC) Lessons will continue to be learned as Maryland implements its Oral Health Plan through 2015 and conducts program evaluation 17 9

10 Maryland One of the results of this approach has been a stronger partnership with the Department of Public Health. Can you describe how this partnership came about and the ways in which you work together to provide oral health services? 18 Medicaid Oral Health Strategies Maryland Medicaid & Public Health Maryland Oral Health Plan: Improve access to care, especially for vulnerable populations Decrease oral disease and injury through education, prevention, and improved care Increase awareness of how to achieve good oral health and find care 19 10

11 Medicaid Oral Health Strategies Maryland Medicaid & Public Health Dental Safety Net Clinics/Programs New program: Worcester County health department program began April 2011 Grants to Maryland counties to expand oral health services - examples Funds for Head Start programs to TLC FQHC (Somerset County) Funds for WIC clinics to Choptank FQHC (Caroline, Dorchester, Talbot counties) Funds for school-based sealants programs to Chase Brexton FQHC (Howard County) Continued grant support for established clinical and non-clinical dental programs for every local health department Maryland Dent-Care Loan Assistance Repayment Program Continuing provision of training for dental and medical providers to increase access to care for children enrolled in Medicaid Public Health s continued partnership with Medicaid and DentaQuest 20 Medicaid Oral Health Strategies Maryland Medicaid & Public Health Healthy Teeth, Healthy Kids oral health literacy campaign for targeted low-income families of children 0-6 and pregnant women ( Maryland Mouths Matter Medicaid medical FV/training program ( Medicaid reimbursement for fluoride varnish Provide oral health risk assessment Educate caregivers on proper oral health practices Refer high risk children to a dentist Train general dentists in principles of pediatric dentistry 21 11

12 Fluoride Varnish Program Summary ü ü ü ü EPSDT-certified pediatrician, family physician or nurse practitioner Participate in the Maryland Medicaid Program Successfully complete the Fluoride Varnish and Oral Health Screening online training program 448 Medical Providers enrolled as of Feb 2014! ü Fluoride varnish applications provided to children enrolled in the Maryland Medicaid Program ü Applications provided to children 9 months to 36 months in tandem with the Medicaid schedule of approved well-child visits. ü Over 100,000 fluoride varnish applications as of Feb 2014! 22 Medicaid Oral Health Strategies Maryland Medicaid & Public Health Increased dentist participation in Maryland Healthy Smiles Dental Program August 2013: 1,244 individual providers enrolled Dentist-to-child enrollee ratio of approximately 1:519 Increased number of dental hygienists working in public health settings 23 12

13 Medicaid Oral Health Strategies Maryland Medicaid & Public Health Key to Success: Partnerships Galvanizing event coalesced network but plans already in place Recognize and acknowledge sense of urgency Develop a sense of commitment to a common goal Overcome rivalries and develop trust Information exchange Pool political capital Catalyze efforts through many networks in multiple sectors across Maryland 24 Visit Maryland s page on NASHP s new resource compendium to learn more: You will find materials including links to: Information on the Maryland Healthy Smiles Dental Program Resources on Healthy Kids Program Nurse Consultants helping providers understand and deliver EPSDT benefits Information on partnerships between Medicaid and local public health departments to support outreach to families and much more! 25 13

14 Texas Texas has been working to improve access to and delivery of preventive oral health services through the First Dental Home. Can you tell us about that initiative and how it works? 26 First Dental Home Builds the foundation for oral health A package of preventive dental services aimed at improving the oral health of children 6-35 months of age Goals Establish a dental home no later than 12 months of age Referrals to dental specialists when appropriate Reduce severe early childhood caries (tooth decay) among children The American Academy of Pediatric Dentistry defines a dental home as: The ongoing relationship between dentist and patient, inclusive of all aspects of oral health care delivered in a comprehensive, continuously accessible, coordinated, and family-centered way. Page 27 14

15 Evolution of First Dental Home In 2007, the Texas Legislature appropriated funds for implementing strategic medical and dental initiatives to improve children s access to preventive services Texas implemented First Dental Home in 2008 Materials for First Dental Home were collaboratively developed by pediatric and general dentists Page 28 Elements of First Dental Home First Dental Home visits include: Completion of oral health questionnaires Review of health history Review of dental history Comprehensive oral evaluation Caries risk assessment Toothbrush dental prophylaxis Oral hygiene instructions with primary caregiver Application of topical fluoride varnish Dental anticipatory guidance Establishment of recall schedule Billing a First Dental Home visit D0145 all inclusive bundled code-reimbursement of $ Page 29 15

16 First Dental Home Results Increased collaboration with Medicaid and public health programs First Dental Home was adopted by the public health Title V/ Maternal Child Health and Children With Special Health Care Needs programs Page 30 First Dental Home Results March 2008 through August 2011: 571,634 children under 36 months received First Dental Home Dentists billing D0145 under First Dental Home 2,430 general dentists 593 pediatric dentists September 2011 through February 2013: 440,191 children under 36 months received First Dental Home Dentists billing D0145 under First Dental Home 3,791 general dentists 695 pediatric dentists Page 31 16

17 Texas How did the recent move of Texas Medicaid to managed care help or hinder this work and make you re-think the model? 32 First Dental Home Move To Managed Care Main dental home model resembles Primary Care Physician model and encourages a one-on-one relationship with a single dentist to promote an ongoing, comprehensive relationship First Dental Home requirements were written into contracts with the Dental Maintenance Organizations (DMOs) DMOs are required to administer the First Dental Home benefit to members ages 6-35 months DMOs are required to include First Dental Home utilization in their dental utilization review process Page 33 17

18 Challenges/Opportunities Under Managed Care Challenges: Teach members that they must receive services through their main dental home Opportunities: Promote quality initiatives through DMO contracts HHSC can place DMO performance measures at risk - DMO may forfeit a percentage of their capitation if approved benchmark is not met DMOs have contractual requirements regarding network adequacy to ensure a robust network of available dental providers Page 34 Resources for First Dental Home Complete online provider training and certification process Download questionnaires, First Dental Home documentation to use during visit THStepsCatalog.shtm Order laminated anticipatory guidance and parent/caregiver education materials Page 35 18

19 Visit Texas s page on NASHP s new resource compendium to learn more: You will find materials including links to: Resources on the First Dental Home in Texas Online training modules for Medicaid primary care providers on creating and maintaining medical homes for children and adolescents Pediatric medical check-up forms and developmental screening tools used for Medicaid-enrolled children and much more! 36 Susan Tucker, MPH, MBA Executive Director Office of Health Services Maryland Department of Health and Mental Hygiene susan.tucker@maryland.gov Michelle Harper, MPA Deputy Director for Policy Development for Medicaid and CHIP Texas Health and Human Services Commission Michelle.Harper@hhsc.state.tx.us Laurie Norris, JD Senior Policy Advisor and Coordinator of the CMS Oral Health Initiative Centers for Medicare & Medicaid Services Laurie.Norris@cms.hhs.gov Neva Kaye Interim Executive Director and Managing Director for Health System Performance National Academy for State Health Policy nkaye@nashp.org 37 19

20 Questions and Answers Questions for the presenters? Please type them into the chat box now! 38 Thank You! Please fill out your evaluations! For additional resources, Visit epsdt/resourcesimprove-medicaidchildren-andadolescents 39 20