Virginia’s Smiles for Children Dental Program Presentation for the: National Academy for State Health Policy Patrick W. Finnerty, Director Department of Medical Assistance Services August 1, 2007

2 Access to/Utilization of Dental Services Needed to Improve n Low participation of dentists in the Medicaid/SCHIP program was a major problem –Low reimbursement –Administrative “hassles” –MCO concerns –Patient no-shows Dentist Participation in Medicaid/SCHIP* * FY 2003 In FY 2003, only 23.4% of all eligible children actually received any dental services

3 Key Stakeholders Worked Together for Change Advocacy Groups MCOs Organized Dentistry Virginia Medicaid Governor Legislature New Medicaid/ SCHIP Dental Program

4 New Program Structure and a 30% Increase In Fees n General Assembly/Governor authorized an entirely new program structure recommended by Virginia Medicaid n Also approved a 30% increase in dental fees –28% on July 1, 2005; additional 2% in May, 2006 n An “across the board” increase of 23%; the remaining amount was targeted to most critical codes (e.g., oral surgery codes) n Dental advisory committee participated in process for allocating fee increase

5 A New Day for Dental! Smiles for Children n Effective date: July 1, 2005 n All children (Medicaid & SCHIP) are enrolled in a single program administered by Doral Dental USA n Limited medically necessary diagnostic/oral surgery services for adults n DMAS retains policymaking authority and closely monitors contractor activities along with Dental Advisory Committee

6 Key Program Enhancements Old Program Smiles for Children n Different credentialing processes n Complicated Administration n Limited local representation on program decisions n Enrollee transfer between plans can disrupt care n Single Vendor (Doral) n Streamlined Credentialing n Easy, Industry-Standard Administration n Va. Based Peer Review Committee & Dental Advisory Committee n Multiple Vendors n All enrollees in Smiles for Children program

7 Value-Added Benefits for Providers n Toll-free phone number for providers n Call center specialists –Member Placement –Eligibility, benefits, authorizations –Claims issues –Addressing patient “no-shows” n Multiple claim submission options……free, electronic filing n Timely and accurate payments n Automated, web-integrated or live eligibility verification (24/7)

8 Program Changes = Increased Provider Network n 351 new dentists are participating (57% increase) –Network continues to expand –6 localities that previously had no participating dentists now have access –Percentage of contracted providers who are billing for services has increased from 50% to 80% n Very high level of provider satisfaction Participating Providers

9 …..And Increased Access to Care Percentage of Children Receiving Necessary Dental Care 30% Increase 33% Increase 24%32%30%39% Source: CMS 416 Report for Virginia

10 Smiles for Children Has Received National Attention 14th Annual Medicaid Managed Care Congress 2006 & 2007