Special Care North Carolina Style Special Care Dental Association Meeting Chicago, April 11, 2014 Bill Milner, D.D.S., M.P.H. Betsy White, R.D.H.

In The Beginning: 1985 North Carolina Dental Society Coalition on Aging 1989 Apple Tree Model (clinical, education, advocacy, research) Advantages of Non-profit Model - $1.5 million for trucks/equipment Support of 30 different disability groups

Really Mobile Dentistry All in the trunk of the Taurus. Friday Long-Term Care Dentistry 6 Facilities Hygienist, Assistant Autoclave at Health Department Saturday Morning Billing

Dr. Ford Grant arriving from Louisville to take over established geriatric program. Carolinas Health Care had the financial resources. Sponsored by NCDS 1997 Carolinas Mobile Dentistry, Carolinas Health Care, Charlotte

2000 Access Dental Care Rolled private practice into stand alone non-profit (not associated with hospital) Covers NC Piedmont (Concord – Raleigh, 1.5 hour radius drive) 60 Facilities 2 Teams

Access Dental Care Service Areas Skilled Nursing Facilities Continuing Care Retirement Centers VA Nursing Facility Group Home Day Centers Local Arc (Assoc. of Retarded Citizens) Adult Day Health Care Center PACE (Programs of All-Inclusive Care for the Elderly) Central Carolina Health Network (HIV/AIDS) Home Health Operating Room for Extreme Behaviors

Staff Involved 3 Office Staff 3 Certified Assistants 2 Hygienists 1 Full-Time Dentists 2 Part-Time Dentists (Except for 1 DDS, No one with less than 5 years at ADC.) Operating budget – 85K/month

North Carolina Safety Net Providers Description of existing special care and community providers (addition of each is a slide overlay) Pediatrician Infant Topical Fluoride Programs Private Practitioners (Office and On-site) Public Health Preventive Programs – Preschool/School Based Health Department Dental Clinics Non-Profit Community Care Clinics UNC School of Dentistry Intellectual/Physical Disability State Centers Hospital Residency Programs

North Carolina Medicaid Program Comprehensive Dental Medicaid (Child and Adult) 45% of UCR Advocate for Facility Visit Fee Advocate for Mobile Special Care Credentialing Established Close Relations ADC Study of Long-Term Care Practitioners

Started With: Skilled Nursing Group Home Day Centers CCRCs (Independent, Assisted Living, Skilled, Memory) Arc of High Point Hospital OR Support

Added: VA State Nursing Facility Home Health Adult Day Care

Finally: PACE (Program of All-Inclusive Care for the Elderly) HIV/AIDS (Central Carolina Health Network )

During This Time: Expanded Slowly Without Compromising Quality of Care Community Based Approached – 5 NC Programs Never in Debt Foundation Based Capital Funding Service Based Operating Funding

Finances Questions North Carolina Medicaid Fee-for-Service Private Pay Retainer Fee (20 year old model) Capitated Fee (PACE) - credit Berkey Per-Day-Fee (Health Network) Proposed Capitated Insurance Policy

Future Financial Picture North Carolina Medicaid Reform Loss of Adult Medicaid Insurance Policy Loop-hole Skimming Prevention – NC/SCDA action Disability Advocacy

Programming - Looking For A Niche Recent providers wanting to start programs Assisted Living Corporate Hygiene/Limited Care More DDS/RDH resumes Disability Accessible Offices Special Care Fixed Office Expertise

Rules of the Road: Always available for emergencies. Facility liaison a must. Minimum of 12 patients on schedule. Everyone drives the truck, loads and unloads. Clinical care a team effort.

Treatment Considerations: Total Comprehensive Care Initial Permission Permission for treatment after exams, prophy and x-rays. Orders for premeds – ABX and Sedation Worked with malpractice insurance provider on form language. No excuse for not getting care.

Access Dental Care Bill Milner, DDS Betsy White, RDH