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31 Cards in this Set
- Front
- Back
ADA has Division of Gov’t Affairs b/c dentists are… (7) |
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
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Role of Federal Public Health Agencies (5)
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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)
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Major timeline events of evolving role of government (8)
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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
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What are 5 major federal investments in dentistry?
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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)
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Legislative vs Regulatory Role
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LEGISLATIVE – Authorize programs and appropriate funds for them; REGULATORY – Regulation and control
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Legislative role of federal vs state
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STATE – Financing care, public health, and prevention; FEDERAL – Research, education, care provision, financing, and disease surveillance
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Regulatory role of federal vs state
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FEDERAL – drugs, public water, commerce (trade); STATE – Practice of dentistry
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State Dental Practice Act (2 components)
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who can practice, what they can do, and under what obligations
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Commission vs Omission
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1) Commission – people doing things the wrong way because underqualified; 2) Omission – not having enough trained people to get the job done
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Dental hygienist controversy
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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
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Who is the main source of authority on regulating dental practice
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THE STATE; Agency’s only derive their authority when legislation is passed to give them that power
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Social Security Act of 1935
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Provides income maintenance for the elderly based on employee-employer contributions; amended 30 years later to include financing physician/hospital services
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Medicare
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1965 Amendment to Social Security Act - compulsory hospital insurance plan for the aged (65+) and voluntary medical plan payed for by payroll deductions
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Medicaid
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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)
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How is Medicaid managed and financed?
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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
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How does MD handle insurance claims for Medicaid?
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DentaQuest handles it
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Why is dentist participation low with Medicaid (6)?
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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)
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How many children did not get dental care because of financial barriers?
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4.6 million
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What is the trend in dental Medicaid utilization?
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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)
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What states have dental Medicaid utilization at more than half?
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AL, TX, VT (But still doesn’t beat 58% utilization by kids with private insurance)
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How do doctors contribute to oral health?
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In many states (incl. Maryland), Medicaid pays medical staff for early preventive dental care
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Occupational Health Safety Act (OHSA)
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Promotes safe and healthy working conditions
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Health Care Quality Improvement Act
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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)
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Americans with Disabilities Act
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against discriminating against ppl with disabilities (incl. students or patients with HIV); Dental offices must be disability accessible
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State Children’s Health Insurance Program (SCHIP)
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States able to initiate and expand health insurance coverage for uninsured children at or below 200% of the Federal Poverty Level
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Health Insurance and Portability Act (HIPAA)
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Providers must have procedures and mechanisms to keep protected health information confidential
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Patient Protection and Affordable Care Act (ACA)
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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)
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Impact of ACA on children’s dental coverage
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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)
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How many ADDITIONAL children will have coverage in 2014 due to ACA?
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5.4 million
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What is an unintended consequence and why significant?
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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)
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What are the Oral Health Provisions of ACA and why are they a hollow victory? |
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! |