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DENTAL CARVE OUT IN MISSOURI

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					DENTAL CARVE OUT IN MISSOURI
 Cutting the red tape & Increasing services
The MDA has long advocated for the estab-             Fee For Service                                     Kansas, have implemented a dental carve out.
lishment of a “Dental Carve Out” in Missouri.         There are 61 counties that participate in a typi-   Every state that has implemented a dental
Although we have lobbied for several years            cal fee-for-service arrangement. In these coun-     carve out has seen an increase in provider
on the issue, several misconceptions remain           ties, the Department of Social Services directly    participation and utilization. (In Kansas, for
about how the system would work and why it            reimburses the dentist provider for procedures      example, after establishing a dental carve out
is needed.                                            performed on qualified patients.                    in 1998, the number of eligible children receiv-
                                                                                                          ing an annual Medicaid dental visit went from
Opponents of dental carve out have used these                       MO HealthNet                          24,855 to 54,362 by 2003.)
misconceptions to defeat the proposal. But we
believe this year could be different.                              Dental Providers                       In this arrangement, money for dental Medic-
                                                                     Patient Services                     aid services is ‘carved out’ of the Medicaid bud-
With the many challenges facing the state                                                                 get. This money is directly provided to a single
budget, it is more important than ever for            Managed Care                                        dental managed care company that develops
state programs to run efficiently. It is vital that   In 53 counties and the City of St. Louis, Medic-    a network of dentists to provide services to
money provided to the Medicaid system is used         aid is provided through Managed Care. In these      patients in all 114 counties in the state.
for patient services, rather than bureaucracy         arrangements the state contracts with several
and red tape.                                         Managed Care companies and pays a flat rate           Dental Managed Care Company
                                                      to those companies based on the number of
We feel a state dental carve out would stream-                                                                       Dental Providers
                                                      patients they cover. However, these companies
line the current operations of the MO Health-                                                                          Patient Services
                                                      do not directly provide dental benefits. Instead,
Net program to create a better system for
                                                      they subcontract the dental services to a sec-
providers and—more importantly—for patients.                                                              This not only streamlines the current program
                                                      ond Managed Care company with a dental net-
                                                      work. These companies then develop a provider       (by removing layers of bureaucracy) but also
WHY IS IT NEEDED                                                                                          creates a single set of rules that apply to all
                                                      network and reimburse dentists for procedures
The two most common complaints with the               performed on their network patients.                patients and providers (easier administration).
Medicaid system are: the reimbursements are
well below my usual fees (even below my over-                                                             LEGISLATIVE ACTION
                                                                     MO HealthNet
head), and the system is too complicated.                                                                 The MDA currently is asking the legislature
                                                               Managed Care Company
                                                                                                          to establish a dental carve out during the
While we have had some success in improving                      Dental Subcontractor                     2010 legislative session; however, it is our
fees, the complexity of the system remains a
                                                                    Dental Providers                      understanding that some companies currently
problem—complexity that discourages dentists
                                                                     Patient Services                     involved in the Managed Care system will op-
from signing up as Medicaid providers, leaving
                                                                                                          pose our efforts.
some qualifying patients without a local Med-
icaid provider. A dental carve out will:              As you can see, this layered system is compli-      We are confident that our efforts to establish
  • End the complicated system that currently         cated even more by the fact that each dental        a dental carve out will increase the number of
    exists                                            subcontractor can establish rules specific to       children receiving preventive care, increase the
  • Ensure that more tax dollars go to care           their network. Therefore, a procedure that          number of dentist providers and make the most
    and less go to administration costs               would be directly reimbursed by the state in a      of tax payer dollars.
                                                      fee-for-service area may require pre-authori-
  • Streamline the Medicaid billing operations                                                            The success of this item, as well as the rest of
                                                      zation with one dental subcontractor and may
    in your office                                                                                        the MDA legislative agenda, will depend on the
                                                      only be offered to a specific population by an-
  • Expand the number of dental providers in                                                              support of our members. We look forward to
                                                      other subcontractor. This arrangement creates
    the state.                                                                                            your help.
                                                      confusion for the patient and the provider.
Ultimately, it improves the system and expands
                                                      CARVE OUT                                           LEARN MORE
‘access to care’—a goal shared by many—with-
out adding to the state budget.                       With so many levels of bureaucracy, it’s no         For question about dental carve out or other
                                                      wonder providers and patients find the system       MDA legislative priorities, contact Aaron Wash-
                                                      confusing and complex and choose not to             burn at aaron@modental.org. Learn about MO
MO HEALTHNET TODAY
                                                      participate.                                        HealthNet managed care regions at www.dss.
Currently the state’s Medicaid system is admin-
                                                                                                                                                              FOCUS | ISSUE 1 | 2010




                                                                                                          mo.gov/mhd/mc/index.html.
istered in two different ways: Fee-For-Service
                                                      To streamline the system and make it more
or Managed Care.
                                                      efficient, 16 states, including Tennessee and

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posted:10/19/2011
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