Special Needs Dental Patients Work Group Learns about DHS Dental Initiatives, Mulls Hospital Reimbursement

January 16, 2020

The potential to re-establish a post-graduate residency in hospital dentistry in Wisconsin is closer to reality due to a new Oral Health Workforce grant recently awarded to the Department of Health Services (DHS) by the Health Resources and Services Administration. At its Jan. 8 meeting, WHA’s Work Group on Special Needs Dental Patients heard from Marisa Voelker, oral health workforce coordinator at DHS, about the grant. The grant’s objective is to develop a plan to introduce a postgraduate program (known as a general practice residency program) in Wisconsin. Wisconsin has been without such a program since the closure of the Max Pohle Clinic at UnityPoint Health Meriter hospital in 2015.

A general practice residency is a key opportunity for dentists to obtain advanced training in hospital-based dentistry, including treatment of patients with special needs who may need to receive their dental care in a hospital operating room under general anesthesia. DHS will convene a task force this spring which will include a variety of stakeholders, including a WHA representative, to develop recommendations for implementing the general practice residency program. The goal is to have at least one hospital identified in Wisconsin by 2023 to serve as sponsor for the residency program.

Pam Fraser, director of oral health services at Children’s Wisconsin, described the Milwaukee County Oral Health Task Force’s efforts to design a system in Milwaukee County to improve access to oral health care for patients with special needs. A key part of that effort is accurately identifying the number and location of patients who need access to general anesthesia dental care so the system can be scaled to their needs. DHS assisted in identifying these patients by running data on the number of dental care episodes provided in a year to Supplemental Security Income recipients on Medicaid. Nicholas Di Meo, DHS’ Southeast Wisconsin Medicaid policy advisor, asked the work group for feedback on the preliminary data and whether it reflects what they are seeing in their facilities.

The work group also heard from State Dental Director Dr. Russ Dunkel on DHS efforts with the federal Center for Medicare & Medicaid Services (CMS) to gain approval for Medicaid reimbursement increases targeted to dental patients with special needs. DHS has encountered some obstacles in gaining this approval due to restrictions in targeting Medicaid funding based on patient characteristics rather than the amount, scope and duration of services. The work group discussed other possible ways to code dental procedures so that reimbursement reaches the facilities providing care to special needs patients while at the same time addressing CMS’ concerns. WHA will continue to explore ways to improve Medicaid reimbursement to hospitals providing access for this dental care in a way that conforms with CMS requirements. The work group also heard from State Dental Director Dr. Russ Dunkel on DHS efforts with the federal Center for Medicare & Medicaid Services (CMS) to gain approval for Medicaid reimbursement increases targeted to dental patients with special needs. WHA will continue to work closely with DHS on implementation of this important reimbursement improvement that will expand access to these services.

For further information on WHA’s efforts to improve dental access for underserved patients in Wisconsin, contact WHA Vice President for Policy Development Laura Rose.
 

This story originally appeared in the January 16, 2020 edition of WHA Newsletter