Dental Role Of Government - Incomplete

Front 1

ADA has Division of Gov’t Affairs b/c dentists are… (7)

Back 1

1) Provider of clinical service, 2) User/transmitter of personal info., 3) Participant in care financing agreements, 4) Employer of personnel, 5) Small business, 6) Commercial polluter – disinfectants, mercury, biohazards, 6) Use research findings of research funded by gov’t, 7) Advocate if health promoting policies

Front 2

Role of Federal Public Health Agencies (5)

Back 2

1) Develop new knowledge, 2) Develop consensus standards by bringing experts together (ex: Level of fluoride, care for pregnant women, etc.), 3) Reallocate resources (PH programs and individual care), 4) Make commerce more efficient (safe products, consumer protection), 5) Expertise for technical/specialized assistance (ex: migrant workers)

Front 3

Major timeline events of evolving role of government (8)

Back 3

1) 1798 Marine Hospital Service – gov’t paid for soldiers dental care overseas, 2) 1912 Children’s Bureau allocated funds back to state level, 3) 1931 – NIH Dental Hygiene Unit which became NIDCR in 1948, 4) 1965 – Medicare and Medicaid (more medical), 5) 1990 – Americans with Disabilities Act established laws that offices must be handicap accessible, 6) 1996 - HIPAA confidentiality rights, 7) 1997/2009 – State Children’s Health Insurance Program (SCHIP) gives state funding for working poor children, incl. dental, 8) 2010 – Patient Protection and Affordability Care Act

Front 4

What are 5 major federal investments in dentistry?

Back 4

1) Grants to support residencies in pedodontics, general dentistry, and dental public health, 2) Monitoring dental disease (CDC) and care utilization (by Agency for health care research equality), 3) Research to expand knowledge base, 4) Grants to private Community Health Centers, 5) Grants and technical assistance to public health agencies for community preventive interventions (i.e. CWF; water fluoridation and school sealant programs)

Front 5

Legislative vs Regulatory Role

Back 5

LEGISLATIVE – Authorize programs and appropriate funds for them; REGULATORY – Regulation and control

Front 6

Legislative role of federal vs state

Back 6

STATE – Financing care, public health, and prevention; FEDERAL – Research, education, care provision, financing, and disease surveillance

Front 7

Regulatory role of federal vs state

Back 7

FEDERAL – drugs, public water, commerce (trade); STATE – Practice of dentistry

Front 8

State Dental Practice Act (2 components)

Back 8

who can practice, what they can do, and under what obligations

Front 9

Commission vs Omission

Back 9

1) Commission – people doing things the wrong way because underqualified; 2) Omission – not having enough trained people to get the job done

Front 10

Dental hygienist controversy

Back 10

Only some states allow dental hygienists to place sealants without dentists examining first but allowing them to do so ensures efficiency of school-based programs; 29 states don’t require the exam and 10 do and 10 require direct supervision while placing them; - ISSUES OF EXCESS COMMISSION OR OMISSION

Front 11

Who is the main source of authority on regulating dental practice

Back 11

THE STATE; Agency’s only derive their authority when legislation is passed to give them that power

Front 12

Social Security Act of 1935

Back 12

Provides income maintenance for the elderly based on employee-employer contributions; amended 30 years later to include financing physician/hospital services

Front 13

Medicare

Back 13

1965 Amendment to Social Security Act - compulsory hospital insurance plan for the aged (65+) and voluntary medical plan payed for by payroll deductions

Front 14

Medicaid

Back 14

Amendment to Social Security Act that gives comprehensive care (incl. dental care) to people on public assistance or medically needy – the blind/disabled, children, and the aged; Must give dental to kids under 18 (Early Periodic Screening Diagnostic and Treatment – EPSDT)

Front 15

How is Medicaid managed and financed?

Back 15

Managed by the state under federal guidelines (Can exceed minimum guidelines to give adult dental if they want to); Jointly financed by federal and state governments

Front 16

How does MD handle insurance claims for Medicaid?

Back 16

DentaQuest handles it

Front 17

Why is dentist participation low with Medicaid (6)?

Back 17

1) REIMBURSEMENT RATE - Many states provide less than 60% normal cost of procedure which is actually equal to overhead (MD gives 71%) – MORE DOCTORS THAN DENTISTS SEE MEDICAID PATIENTS, 2) Burdensome Credentialing, 3) Unresponsive or Excessive preauthorization requirements, 4) No-shows/broken appts, 5) Low “dental literacy” of patients/caregivers, 6) Audits are punative (ex: scam where ortho treatment paid by Medicaid w/o pre-authorization)

Front 18

How many children did not get dental care because of financial barriers?

Back 18

4.6 million

Front 19

What is the trend in dental Medicaid utilization?

Back 19

20-25% in 1990 and 40-50% in 26 states by 2007 due to Pew’s benchmark (MD exceeds benchmark but is still not the best)

Front 20

What states have dental Medicaid utilization at more than half?

Back 20

AL, TX, VT (But still doesn’t beat 58% utilization by kids with private insurance)

Front 21

How do doctors contribute to oral health?

Back 21

In many states (incl. Maryland), Medicaid pays medical staff for early preventive dental care

Front 22

Occupational Health Safety Act (OHSA)

Back 22

Promotes safe and healthy working conditions

Front 23

Health Care Quality Improvement Act

Back 23

established the National Practitioner Data Bank, and information clearing house, to collect and release certain information related to the professional competence and conduct of physicians, dentists, and in some cases, other health care practitioners (Ex: medical malpractice and adverse actions)

Front 24

Americans with Disabilities Act

Back 24

against discriminating against ppl with disabilities (incl. students or patients with HIV); Dental offices must be disability accessible

Front 25

State Children’s Health Insurance Program (SCHIP)

Back 25

States able to initiate and expand health insurance coverage for uninsured children at or below 200% of the Federal Poverty Level

Front 26

Health Insurance and Portability Act (HIPAA)

Back 26

Providers must have procedures and mechanisms to keep protected health information confidential

Front 27

Patient Protection and Affordable Care Act (ACA)

Back 27

Gives insurance to 95% of Americans while reducing costs and budget deficit; CHIP will be phased out and more share taken by federal gov’t (Parents paid via subsidy)

Front 28

Impact of ACA on children’s dental coverage

Back 28

All Insurance must include dental coverage for children; No change for adult coverage – It Is up to the state (MD covers emergency and pregnant women)

Front 29

How many ADDITIONAL children will have coverage in 2014 due to ACA?

Back 29

5.4 million

Front 30

What is an unintended consequence and why significant?

Back 30

Since employers must provide medical insurance up to age 26 for kids, they may go ahead and also offer dental insurance through that age; Good because young adults currently have lowest % dental utilization (behind old ppl)

Front 31

What are the Oral Health Provisions of ACA and why are they a hollow victory?

Back 31

1) Oral Health Promotion – community health prevention, family level disease management, Individual Disease management, 2) Access to Dental Care – Coverage and Financing, Workforce & Training, Delivery Systems ; HOWEVER NO FUNDING IS GIVEN FOR THESE PLANS/PROVISIONS!