Virginia’s Smiles for Children

Dental Program

Presentation for the:

National Academy for State Health Policy

Patrick W. Finnerty, DirectorDepartment of Medical Assistance Services

August 1, 2007

2

Access to/Utilization of Dental Services Needed to Improve

87%

13%

Not ParticipatingParticipating

Low participation of dentists in the Medicaid/SCHIP program was a major problem– Low reimbursement– Administrative “hassles”– MCO concerns– Patient no-shows

Dentist Participation in Medicaid/SCHIP*

* FY 2003

In FY 2003, only 23.4% of all eligible children actually received any dental services

3

Key Stakeholders Worked Together for Change

Advocacy Groups

MCOs

Organized

Dentistry

Virginia Medicaid

Governor

Legislature

New Medicaid/ SCHIP Dental

Program

4

New Program Structure and a 30% Increase In Fees

General Assembly/Governor authorized an entirely new program structure recommended by Virginia Medicaid

Also approved a 30% increase in dental fees– 28% on July 1, 2005; additional 2% in May, 2006

An “across the board” increase of 23%; the remaining amount was targeted to most critical codes (e.g., oral surgery codes)

Dental advisory committee participated in process for allocating fee increase

5

A New Day for Dental! Smiles for Children

Effective date: July 1, 2005

All children (Medicaid & SCHIP) are enrolled in a single program administered by Doral Dental USA

Limited medically necessary diagnostic/oral surgery services for adults

DMAS retains policymaking authority and closely monitors contractor activities along with Dental Advisory Committee

6

Key Program Enhancements

Old Program Smiles for Children

Different credentialing processes

Complicated Administration

Limited local representation on program decisions

Enrollee transfer between plans can disrupt care

Single Vendor (Doral)

Streamlined Credentialing

Easy, Industry-Standard Administration

Va. Based Peer Review Committee & Dental Advisory Committee

Multiple Vendors

All enrollees in Smiles for Children program

7

Value-Added Benefits for Providers

Toll-free phone number for providers

Call center specialists– Member Placement– Eligibility, benefits, authorizations– Claims issues– Addressing patient “no-shows”

Multiple claim submission options……free, electronic filing

Timely and accurate payments

Automated, web-integrated or live eligibility verification (24/7)

8

Program Changes = Increased Provider Network

351 new dentists are participating (57% increase)– Network continues to expand– 6 localities that previously

had no participating dentists now have access

– Percentage of contracted providers who are billing for services has increased from 50% to 80%

Very high level of provider satisfaction

620

971

0100200300400500600700800900

1000

Jul-05 Jun-07

Participating Providers

9

…..And Increased Access to Care

0.0%5.0%

10.0%15.0%20.0%25.0%30.0%35.0%40.0%45.0%

Ages 0-20 Ages 3-20

FFY 2005 FFY 2006

Percentage of Children Receiving Necessary Dental Care

30% Increase

33% Increase

24% 32% 30% 39%

Source: CMS 416 Report for Virginia

10

Smiles for Children Has Received National Attention

14th Annual Medicaid Managed Care Congress

2006 & 2007