Necessary reform to pediatric dental care under Medicaid

hearing before the Subcommittee on Domestic Policy of the Committee on Oversight and Government Reform, House of Representatives, One Hundred Tenth Congress, second session, September 23, 2008.
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U.S. G.P.O., For sale by the Supt. of Docs., U.S. G.P.O. , Washington
Poor children -- Dental care -- United States -- Finance, Med
Classifications
LC ClassificationsKF27 .O942 2008k
The Physical Object
Paginationiii, 210 p. :
ID Numbers
Open LibraryOL23923680M
ISBN 100160843146
ISBN 139780160843143
LC Control Number2009438827

Get this from a library. Necessary reform to pediatric dental care under Medicaid: hearing before the Subcommittee on Domestic Policy of the Committee on Oversight and Government Reform, House of Representatives, One Hundred Tenth Congress, second session, Septem [United States.

Congress. House. Committee on Oversight and Government Reform. Necessary reform to pediatric dental care under Medicaid hearing before the Subcommittee on Domestic Policy of the Committee on Oversight and Government Reform, House of Representatives, One Hundred Tenth Congress, second session, Septem Similar Items.

Necessary reform to pediatric dental care under Medicaid hearing before the Subcommittee on Domestic Policy of the Committee on Oversight and Government Reform, House of Representatives, One Hundred Tenth Congress, second session, Septem   The Centers for Medicare & Medicaid Services does not further define what specific dental services must be provided, however, EPSDT requires that all services coverable under the Medicaid program must be provided to EPSDT recipients if determined to be medically necessary.

Under the Medicaid Necessary reform to pediatric dental care under Medicaid book, the state determines medical necessity. Learn from Dental Caries experts like Marlow Doyle and Stephanie Ridd.

Read Dental Caries books like Cavities and Cure Tooth Decay. HOUSE HEARING, TH CONGRESS - EVALUATING PEDIATRIC DENTAL CARE UNDER MEDICAID. Author Scribd tmp2A Author Frontiers. HOUSE HEARING, TH CONGRESS - NECESSARY REFORM TO PEDIATRIC DENTAL CARE UNDER.

Guide to Children's Dental Care in Medicaid (PDF, KB) Policy Issues in the Delivery of Dental Services (PDF, KB) Eight-State Medicaid Dental Review Summary Report (PDF, KB) Individual State Reports (ZIP, KB) National Dental Summary Report (PDF, KB) Individual State Reports (ZIP, MB).

Medicaid has always provided unlimited federal matching payments to states based on whatever they spend providing care to the poor. Some of what the program covers is mandatory — emergency and.

The services must be medically necessary. The initial medical diagnosis and institution of a plan of therapy or referral may also be covered. Nebraska Medicaid also covers the services of certified pediatric nurse practitioners and certified family nurse practitioners, as required by federal law.

Dental services for children. Apple Health (Medicaid) pays for covered dental services for eligible children, age 20 and younger. The Academy of Pediatric Dentistry (AAPD) recommends all children see a dentist by 12 months of age.

The Children's Health Insurance Program (CHIP) provides comprehensive benefits to children. States have flexibility to design their own program within federal guidelines, so benefits vary by state and by the type of CHIP program.

States may choose between a Medicaid expansion program, a separate CHIP, or a combination of both types of programs. Coverage for children’s preventive health services. All Marketplace health plans and many other plans must cover the following list of preventive services for children without charging you a copayment or is true even if you haven’t met your yearly deductible.

Alcohol, tobacco, and drug use assessments for adolescents; Autism screening for children at 18 and 24 months. Get this from a library.

Download Necessary reform to pediatric dental care under Medicaid FB2

Evaluating pediatric dental care under Medicaid: hearing before the Subcommittee on Domestic Policy of the Committee on Oversight and Government Reform, House of Representatives, One Hundred Tenth Congress, first session, May 2, [United States.

Congress. House. Committee on Oversight and Government Reform. Under the ACA, a small-group employer is allowed to purchase EHB-compliant pediatric dental from a stand-alone dental carrier like Delta Dental. Medical carriers are not required to sell pediatric dental coverage to a small-group employer so long as the carrier is reasonably assured that EHB-compliant pediatric dental coverage has been obtained.

This coverage qualifies as an Essential Health Benefit (EHB) under the Affordable Care Act (ACA) and meets the ACA pediatric dental requirement, effective January 1, When you renew your Neighborhood Health Plan coverage, you’ll receive a Delta Dental member ID card.

Notably, Medicaid and CHIP must provide youth enrollees with dental services.6 In addition, under the ACA, qualified health plans, Basic Health Program plans, and Medicaid benchmark coverage must cover pediatric dental care.7 Still, advocates should monitor their state?s Medicaid and CHIP programs and their state?s health care reform implementation process to ensure youth.

A scale similar to the one used by the Texas Medicaid and Healthcare Partnership (TMHP) to determine eligibility for treatment under general anesthesia was developed to evaluate the need for GA versus CS for dental care of uncooperative pediatric patients ().The scale was designed such that a higher score would indicate the need for GA versus CS.

Under new health reform laws that take effect Jan. 1, pediatric dental care must be part of your health insurance plan — whether or not you have kids — if you have an individual or small group policy and if that policy is an “off-exchange plan” — meaning bought outside of Oklahoma's new federally-administered online marketplace.

ple, defines medically necessary as: “Services or supplies that are needed for the diagnosis or treatment of your medical condition and meet ac-cepted standards of medical practice.” MNC is also the benchmark for coverage of dental services under Medicaid.

Documenting to Support Medical Necessity for the Pediatric Dental Professional. All plans must offer the same dental benefits for children. Starting inall health plans sold to individuals must offer 10 essential health benefits (EHBs), one of which is pediatric dental care, including: • Coverage for diagnostic and preventive care, as well as medically necessary orthodontia; • Coverage under age 19.

made by the State’s contracted managed care organizations to its dental providers, 3) dental subcapitation payments made by managed care organizations. Amounts shown include all payments made through 3/31/ for services provided in the time period shown.

Details Necessary reform to pediatric dental care under Medicaid PDF

Additional service claims may have been received after this date. Medicaid coverage has provided the foundation on which a comprehensive pediatric health care program is based. Without Medicaid, low-income children would not have full access to well-child visits, immunizations, lead screenings, vision and hearing services, dental care, developmental screening, adolescent counseling services, mental health.

How will access to dental care change under health reform. The Affordable Care Act created a concept called essential health benefits, and that requires certain categories of health care. Hospice care is an optional benefit in state Medicaid and CHIP programs.

44 Oklahoma is the only state that does not currently offer a Medicaid hospice benefit unless children are covered by the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program. 2,45 EPSDT is federally mandated under Title XIX of the Social Security Act and. Utah opted to require its pediatric dental plans to cover only preventive care, as the benchmark plan on which Utah’s exchange plans are based does not cover restorative dental care.

But the rest of the states have more comprehensive pediatric dental plans, and most include at least some degree of coverage for medically necessary orthodontia.

When modern dental teams are financially rewarded for pediatric oral health outcomes rather than procedures provided, they can be expected to triage groups of children by disease risk and intervene selectively using approaches like the American Academy of Pediatric Dentistry’s ‘care paths’; turn their attention to behavioral, social, and.

Medicaid pays for emergency and medically necessary dental work across the country. Medicaid also pays for comprehensive dental care in more than 30 states. However, others may only cover certain categories of treatments. Medicaid does cover dental services for all child enrollees as part of the Early and Periodic Screening, Diagnostic and.

CareSource® covers dental services for our Ohio Medicaid members. Our dental providers can access the following tools to help them provide efficient and quality care. Provider Manual The CareSource Dental Provider Manual provides information on topics such as covered services, claims submissions and prior authorization requirements and processes.

Resources View the Updates. Results. The identified potential determinants of oral health and dental use among children living in foster care included: (1) linguistic and cultural barriers; (2) lack of dentists willing to accept children's Medicaid dental insurance; (3) lack of resources available to case workers (i.e.

large caseload burden) (4) lack of federal funding for specialized dental care; (5) lack of systematic.

INTRODUCTION. The U.S. Institute of Medicine Report Improving Access to Oral Health Care for Vulnerable and Underserved Populations indicated adolescents have difficulties accessing dental care. 1 Three times as many adolescents have unmet dental care needs as adolescents with unmet medical needs ( percent and percent, respectively).

2 Dental care is the most common unmet need for.

Description Necessary reform to pediatric dental care under Medicaid PDF

Medically Necessary: The health care services provided for the purpose of preventing, evaluating, CDT Dental Procedure Code Book. American Academy of Pediatric Dentistry Guideline on Dental Management of Pediatric Patients Receiving Chemotherapy, Hematopoietic Cell Transplantation, and/or Radiation Therapy.

Offering coverage for medically necessary orthodontics is another key element of the Pediatric Dental Essential Health Benefit required under the new health care reform law. This unique benefit provides orthodontic services for children with serious orthodontic impairment resulting from congenital abnormalities that affect their daily ability to function, like eating and speaking.Introduction.

Not since the s has there been such interest in restructuring the health care system. Building on the foundation of Medicare and Medicaid, enacted infour successive presidents—Lyndon Johnson, Richard Nixon, Gerald Ford, and Jimmy Carter—paid such significant attention to national health care issues that many believed broad-scale reform was imminent.

Dental care is currently included in the list of services that managed care plans must provide to Medicaid patients. The Legislature inthough, passed a bill over strong objections from the managed-care industry to carve dental services out of the statewide managed-care program.