Proposal To Charge Ohio’s Medicaid Enrollees Faces Critics, Negotiation– ideastream – 5/9/16
Last week we delivered a Lawmaker Letter which provided state lawmakers with details about the safety, quality care, education, and training of the dental therapist just days before the professional dental lobby group held its “day at the statehouse.” We wanted to let legislators know that they do not speak for all dentists or the many community-based and statewide organizations, including the Ohio Dental Hygienist Association, who support expanding the dental care team.
Following are excerpts from the Lawmaker Letter.
“It is no longer a question as to whether adding new providers to the dental team will expand access to quality care. Numerous evaluations prove that dental therapists will. The question that remains is when will Ohio take this critical step to improve access to care?”
We knew that lawmakers would hear concerns from organized dentistry but wanted to make sure they knew that the evidence supporting dental therapists includes the following:
Regarding SAFE, QUALITY CARE
Studies show conclusively that dental therapists deliver safe, quality care. In addition, they allow dentists to grow their practices and increase revenues while treating more patients.
The American Dental Association’s own journal acknowledged “a variety of studies indicate that appropriately trained mid-level providers are capable of providing high quality service.” There have been more than a thousand studies on the quality of care provided by dental mid-levels, and none has ever shown it to be unsafe.
A 2012 literature review of more than 1,100 studies across multiple nations demonstrates the quality of care provided by dental therapists. We have also seen it in practice here in the U.S. In Alaska, dental therapists have been able to provide quality care since 2005 to 35,000 people who previously had no opportunity for dental care. In Minnesota, one practice has been able to save $1,200 a week by adding a dental therapist to the team. That therapist cared for 1,000 people in the first year alone. A further Minnesota study shows that dental therapists are expanding access to care to low-income, uninsured, and underinsured patients. Clinics reported improved quality and high patient satisfaction in addition to reduced travel and wait times for some patients.
Regarding EDUCATION AND TRAINING
“They’ll [dental therapists] get actually more practice than a dentist does by the time they graduate. The dental therapist has a very small scope of practice. The dentist has to do multiple procedures.” –Dr. Mary Williard, the Director of the Dental Health Aide Therapist Training Program in Alaska, graduate of The Ohio State University College of Dentistry, 1994.
In February 2015, the Commission on Dental Accreditation (CODA) approved national training standards for dental therapy education programs. CODA is the same accreditation body for the education of dentists and dental hygienists. CODA adopted standards that ensure training institutions will have national and streamlined standards to shape their dental therapy programs.
The CODA approval signaled that organized dentistry’s accrediting body thought it was in the best interest of the dental profession and the public to develop national standards for the program. More importantly, the vote was recognition that dental therapy as a profession is here to stay.
Acknowledging the need for national standards and establishing them is another important step in dentistry’s path toward adopting team based providers—a step the medical community took decades ago when it expanded the medical team to include physician assistants and nurse practitioners.
Public health dentists across the country and the world promote this evidence-based approach to expanding access to dental providers. Team-based dental care that includes dental therapists can increase access to quality care in a way that is proven and cost-effective. With the number of dental health professional shortage areas in Ohio on the rise, we need to modernize our dental practice laws to expand the dental care team to include dental therapists who can treat dental disease.
On March 29, 2016 the Centers for Medicare and Medicaid Services (CMS) finalized the long-awaited rule applying mental health and substance use disorders parity to Medicaid and the Children’s Health Insurance Program (CHIP).
Mental health and substance abuse parity means that a health plan pays for treatment as it would if the patient was being treated for any physical disorder. When a plan has parity, it means that if you are provided unlimited doctor visits for a chronic condition like diabetes, the health plan must offer unlimited visits for a mental health condition such as depression.
Community Catalyst’s Health Policy Hub blog post on April 7, 2016 highlights the important features of the rule.
These provisions of the rule were finalized as proposed:
All mental health and substance use disorders benefits offered through Medicaid managed care organizations (MCOs) have to follow the new rules.
Medicaid programs can’t avoid the rules just because it costs more.
Managed Care Organizations must disclose how they decide if a treatment is medically necessary for substance use disorders or mental illness, and the MCOs must provide explanations when they deny coverage. States must also publicly post documentation of compliance with parity rules.
Learn more about the rules by reading the full Community Catalyst blog.
Although states have 18 months to come into compliance with the parity regulations, there are three things advocates can start to do now:
Get in touch with state health department and Medicaid officials. Advocates can highlight stories of Medicaid and CHIP consumers who aren’t getting the mental health and/or substance use disorders care they need and urge officials not to wait 18 months to bring the Medicaid program into compliance with parity rules. Consumers should not have to wait any longer for good care.
Continue advocacy for fuller implementation of Early, Periodic Screening, Diagnosis and Treatment (EPSDT). Given the establishment of the EPSDT benefit as a compliance standard for parity in CHIP and concerns about how EPSDT is implemented, advocates can continue to encourage state regulators to monitor EPSDT services. Advocates can also proactively engage providers about the importance of including age-appropriate substance use disorders and mental health screenings as a critical component of the EPSDT benefit.
Push for more data, reporting, and enforcement. Laws and regulations do not guarantee robust enforcement. Advocates can urge state officials to improve data collection and reporting systems about consumer experiences, including better tracking of parity complaints with state agencies. Most importantly, advocates can press state and federal officials to enforce parity in all Medicaid and CHIP programs.
Many thanks to Community Catalyst for the content of this article.
