Dental Services for Medicaid Adults in Long-Term Care Facilities in Texas Healthy Aging Webinar October 13, 2009 Linda M. Altenhoff, DDS

Background Incurred medical expense (IME) funds can be used to pay for dental services Private pay arrangement between the patient and the dentist outside of Medicaid No standardized dental fee schedule Regional nurses reviewed/approved all non- routine dental services Disconnect regarding “routine” dental services Dental provider concerns State program concerns

Legislative Direction Senate Bill (SB)1188 passed during 2005 legislative session SB 1188 required the state to: Use fee schedules for reimbursable IME dental services Form a Dental IME workgroup to assist in development of the dental fee schedule

Dental IME Workgroup Began meeting in 2006 Members included: Private practice dentists Nursing facility representatives Long-term care advocates State staff

Dental IME Workgroup Goals Establish a statewide dental fee schedule Review and streamline the dental IME approval process Include dentists in review process Expand routine dental services

Outcomes Achieved Established the use of the American Dental Association Survey of Fees Cost of living index adjustment Defined routine dental services that do not require prior approval Defined non-routine dental services that do require prior authorization Utilize state dentists to review treatment plans for non-routine dental services

Contact Information Linda M. Altenhoff, DDS State Dental Director/Oral Health Program Manager Texas Department of State Health Services (512) ext 3001