The Bridge Issue 7 2016 | Page 7

appropriateness of care through receipt of services based on risk assessment .
• CMS should foster the development of a measure that evaluates whether children are receiving a risk-based oral health assessment , as recommended by the HHS and American Academy of Pediatrics ( AAP ). Such a measure , along with other DQA pediatric dental measures , should be considered for inclusion in the child core set . Moreover , reporting on the child core set should become a mandatory requirement for states .
Options for Congress
• Congress should direct HHS to conduct a review of the Essential Health Benefits ( EHB ) in 2016 with specific attention to pediatric services and professional guidelines on pediatric oral health care .
• Congress should instruct HHS to release detailed enrollment data for pediatric dental coverage , including enrollment in stand-alone dental plans and QHPs that embed pediatric dental coverage , by age , state , plan , race and income .
Options for States
• States should adopt a dental periodicity schedule for their Medicaid / CHIP programs that requires caries risk assessment and treatment plans that reflect a child ’ s risk for dental disease . Furthermore , states should align their payment policies and contracting arrangements with these guidelines .
• States should refine Medicaid / CHIP policies to encourage and incentivize the use of oral health risk assessments and fluoride varnish by pediatricians . Moreover , states should adopt the American Dental Association ’ s dental billing codes for caries risk ( CDT codes D0601 , D0602 , and D0603 ) and reimburse these services .
• States should work to report accurately on the new dental sealant Core Set measure and consider adopting additional Dental Quality Alliance measures for performance indicators in oral health moving forward .
The Comprehensive Dental Reform Act of 2015 was introduced into the Senate by Bernard Sanders ( I-VT ) in February 2015 to improve access to oral health care for vulnerable and underserved populations . It was subsequently assigned to a congressional committee ( the Committee on Health , Education , Labor , and Pensions ) for consideration before possibly sending it on to the House or Senate as a whole . The bill would expand dental coverage through Medicare ,
Medicaid , the Affordable Care Act and the Department of Veterans Affairs , helping to fill the gap for the more than 1 in 4 Americans who lack dental insurance . Here ’ s how :
• Amends titles XVIII ( Medicare ) and XIX ( Medicaid ) of the Social Security Act to cover oral health services .
• Increases the federal medical assistance percentage for oral health services , thereby increasing payments to states under Medicaid .
• Directs the Centers for Medicare & Medicaid Services to maintain a database of dental benefits available to adult Medicaid enrollees in each state .
• Amends the Public Health Service Act to establish , revise , and extend funding for grant programs for : educating nondental professionals about oral health care ; providing dental services in hospital emergency rooms or in community settings ; providing scholarships and education loans for oral health professional students ; providing oral health services to low-income and underserved individuals ; building , operating , or expanding dental clinics in schools ; and providing mobile , comprehensive dental services at locations that serve individuals who qualify for benefits under specified programs .
• Authorizes community based dental residencies .
• Authorizes specified agencies to conduct research on oral health issues through FY2019 .
• Amends the Patient Protection and Affordable Care Act to make oral health services an essential health benefit .
• Removes restrictions on the authority of the Department of Veterans Affairs ( VA ) to provide dental care to veterans ( thereby requiring dental care on the same basis as other VA-provided medical care and services ).
• Authorizes the VA , Department of Defense , Bureau of Prisons , and Indian Health Service to carry out demonstration programs to train and employ alternative dental health care providers in order to increase access to dental services .
• Directs the Department of Health and Human Services to conduct a cost-benefit analysis of the expansion of dental service coverage pursuant to this Act .
• Directs the Government Accountability Office to evaluate the implementation and utilization of expanded dental service coverage under this Act and the demonstration programs authorized by this Act . •••
Issue 7 , Journal 1 ; November 2016
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