1. UF ASDA Dental Discussion Series Florida’s Action for Dental Health – A multi-year, multi-faceted plan to improve the oral health and resulting overall health of all Floridians through promotion, collaboration, and expansion of the existing dental team and stakeholders. Saturday, February 7, 2015 Jolene Paramore, DMD Florida Dental Association Secretary Florida’s Action for Dental Health – A multi-year, multi-faceted plan to improve the oral health and resulting overall health of all Floridians through promotion, collaboration, and expansion of the existing dental team and stakeholders. Saturday, February 7, 2015 Jolene Paramore, DMD Florida Dental Association Secretary

2. Dental Care: Who is responsible? A tough question we all struggle to answer. Is it the dentist? Is it the patient? Is it the parent or caregiver? Is it “society”? Is it the government? All of the above? Is it the dentist? Is it the patient? Is it the parent or caregiver? Is it “society”? Is it the government? All of the above? Is dental care a right? Is free dental care a right for those in poverty/the working poor? Is it acceptable to have a tiered system of care? Why are current caregivers underutilized? Is dental care a right? Is free dental care a right for those in poverty/the working poor? Is it acceptable to have a tiered system of care? Why are current caregivers underutilized?

3. Access to care, care to access, or access to funding? There ARE significant obstacles to dental care for some patients. Many do not know how to navigate the system to get care available. Some do not want care even if it is free, offered, and available. Need does not equal demand. The level of dental disease is often greater in the underserved and uninsured which may require extensive treatment. There ARE significant obstacles to dental care for some patients. Many do not know how to navigate the system to get care available. Some do not want care even if it is free, offered, and available. Need does not equal demand. The level of dental disease is often greater in the underserved and uninsured which may require extensive treatment. Some only want care when it is an emergent problem. Medicaid funding is inadequate to cover the costs of delivering care. Adult dental Medicaid benefits are minimal and not comprehensive. Managed care limits the financial liability of the state but does not meet the needs of the citizens dependent upon Medicaid. Some only want care when it is an emergent problem. Medicaid funding is inadequate to cover the costs of delivering care. Adult dental Medicaid benefits are minimal and not comprehensive. Managed care limits the financial liability of the state but does not meet the needs of the citizens dependent upon Medicaid.

4. How has the FDA provided care and avenues to care for the underserved population in the recent past? Advocacy efforts – Focused on increasing Medicaid dental reimbursement rates for over 15 years as Florida has consistently been in the bottom 3 states in reimbursement rates. – Obtained an increase in Medicaid dental fees in 2011. – Succeeded legislatively to authorize Health Access Licenses to allow dentists from other states to practice without taking the Florida clinical licensure examination. – Succeeded legislatively to expand the duties of dental hygienists to administer local anesthesia in 2012. – Succeeded legislatively to authorize dental hygienists to apply fluoride and dental sealants in health access settings without prior examination by a dentist. Advocacy efforts – Focused on increasing Medicaid dental reimbursement rates for over 15 years as Florida has consistently been in the bottom 3 states in reimbursement rates. – Obtained an increase in Medicaid dental fees in 2011. – Succeeded legislatively to authorize Health Access Licenses to allow dentists from other states to practice without taking the Florida clinical licensure examination. – Succeeded legislatively to expand the duties of dental hygienists to administer local anesthesia in 2012. – Succeeded legislatively to authorize dental hygienists to apply fluoride and dental sealants in health access settings without prior examination by a dentist.

5. How has the FDA provided care and avenues to care for the underserved population in the recent past? Emergency Room Diversion Programs – In 2010, there were over 115,000 ER visits in Florida for dental problems, with a price tag of over $88,000,000. – Brevard County Dental Society and Holmes Regional Medical Center collaborated to solve this problem that was overwhelming the ER and received a national award in the process. From June 2011 –June 2014, the Emergency Department Diversion Dental Program has provided: 1008 dental examinations 920 dental x-rays 889 extractions other services Total cost of care provided----- $248,315 Actual savings to the hospital-----unknown but if the average visit is $750, it would be nearly $750,000 assuming no “repeat performers”. Emergency Room Diversion Programs – In 2010, there were over 115,000 ER visits in Florida for dental problems, with a price tag of over $88,000,000. – Brevard County Dental Society and Holmes Regional Medical Center collaborated to solve this problem that was overwhelming the ER and received a national award in the process. From June 2011 –June 2014, the Emergency Department Diversion Dental Program has provided: 1008 dental examinations 920 dental x-rays 889 extractions other services Total cost of care provided----- $248,315 Actual savings to the hospital-----unknown but if the average visit is $750, it would be nearly $750,000 assuming no “repeat performers”.

6. How has the FDA provided care and avenues to care for the underserved population in the recent past? Outreach activities – Project: Dentists Care clinics Started in 1993 by the FDA and the FDA Foundation. 55 clinics across Florida ; 33 reported data from July 1, 2013 – June 30, 2014, so the data presented is underreported. Pro bono dental care was provided to over 5127 children and 20,915 adults and reduced fee care was provided to over 565 children and 4381 adults worth $9,857,817. 2621 dentists, 653 hygienists, and 1271 dental assistants volunteered over 23,231 hours. Outreach activities – Project: Dentists Care clinics Started in 1993 by the FDA and the FDA Foundation. 55 clinics across Florida ; 33 reported data from July 1, 2013 – June 30, 2014, so the data presented is underreported. Pro bono dental care was provided to over 5127 children and 20,915 adults and reduced fee care was provided to over 565 children and 4381 adults worth $9,857,817. 2621 dentists, 653 hygienists, and 1271 dental assistants volunteered over 23,231 hours.

7. How has the FDA provided care and avenues to care for the underserved population in the recent past? Outreach activities – Mission of Mercy Held in March, 2014 in Tampa Over 2 days, 1660 patients were treated pro bono with over 8,000 procedures worth $1,141,648. 294 dentists, 70 hygienists, 280 dental assistants, 19 laboratory technicians, and over 1100 support volunteers participated. The next Mission of Mercy will be held April 23-24, 2016 in Jacksonville at the Prime Osborn Convention Center. Outreach activities – Mission of Mercy Held in March, 2014 in Tampa Over 2 days, 1660 patients were treated pro bono with over 8,000 procedures worth $1,141,648. 294 dentists, 70 hygienists, 280 dental assistants, 19 laboratory technicians, and over 1100 support volunteers participated. The next Mission of Mercy will be held April 23-24, 2016 in Jacksonville at the Prime Osborn Convention Center.

8. How has the FDA provided care and avenues to care for the underserved population in the recent past? Donated Dental Services/Dental Lifeline Network – This program was started in South Florida in 1997 to connect volunteer dentists and laboratories with special needs and medically compromised patients. – The FDA Foundation pays half of the salary and donates space in the Headquarters Office for the coordinator to match the volunteers, the laboratories, the patients, and seek grants for lab fees not covered. – The milestone of $5,000,000 of donated care was reached last year in this program supported by FDA members and the FDA. Donated Dental Services/Dental Lifeline Network – This program was started in South Florida in 1997 to connect volunteer dentists and laboratories with special needs and medically compromised patients. – The FDA Foundation pays half of the salary and donates space in the Headquarters Office for the coordinator to match the volunteers, the laboratories, the patients, and seek grants for lab fees not covered. – The milestone of $5,000,000 of donated care was reached last year in this program supported by FDA members and the FDA.

9. SO, what is the FDA’s plan for the future???? A multi-faceted approach to the numerous factors that influence providing preventative and therapeutic care to the underserved and uninsured population!

10. FLORIDA’S ACTION FOR DENTAL HEALTH A comprehensive effort developed to improve the oral health and resulting overall health of all Floridians

11. Florida’s Action for Dental Health Objectives 1.Promote attainable dental care for the uninsured and underserved in Florida. 2.Collaborate to maximize use and capacity of the current dental workforce to optimally serve Floridians with preventive and therapeutic dental care. 3.Expand opportunities for public health dentistry to serve Floridians. Objectives 1.Promote attainable dental care for the uninsured and underserved in Florida. 2.Collaborate to maximize use and capacity of the current dental workforce to optimally serve Floridians with preventive and therapeutic dental care. 3.Expand opportunities for public health dentistry to serve Floridians.

12. Objective: Promote attainable dental care for the uninsured and underserved Strategies: Develop partnerships with other entities that serve patients who need a dental home (physicians, hospitals, nursing homes, county health departments, federally qualified health centers, advocacy and stakeholder groups, such as the Florida Medical Association, Florida Hospital Association, Florida Optometry Association, United Way, AARP, Florida Chambers of Commerce, Special Olympics). Connect patients needing care with a dental team in an appropriate facility and support a reimbursement process to cover the cost of care. Strategies: Develop partnerships with other entities that serve patients who need a dental home (physicians, hospitals, nursing homes, county health departments, federally qualified health centers, advocacy and stakeholder groups, such as the Florida Medical Association, Florida Hospital Association, Florida Optometry Association, United Way, AARP, Florida Chambers of Commerce, Special Olympics). Connect patients needing care with a dental team in an appropriate facility and support a reimbursement process to cover the cost of care.

13. Objective: Promote attainable dental care for the unsinsured and underserved Strategies: Increase effectiveness of the Medicaid dental program in providing preventive care & treatment. – Reduce administrative burdens on providers. – Increase reimbursement levels to cover the cost of care. Develop and implement an elder care protocol for dental care, focusing on caregiver education. Secure state funding for coordinators to match special needs and medically compromised patients with volunteer dentists through the Dental Lifeline Network (Donated Dental Services). Strategies: Increase effectiveness of the Medicaid dental program in providing preventive care & treatment. – Reduce administrative burdens on providers. – Increase reimbursement levels to cover the cost of care. Develop and implement an elder care protocol for dental care, focusing on caregiver education. Secure state funding for coordinators to match special needs and medically compromised patients with volunteer dentists through the Dental Lifeline Network (Donated Dental Services).

14. Objective: Collaborate to maximize use & capacity of the current dental workforce to optimally serve Floridians with preventive & therapeutic dental care Strategies: Increase use of private practices, educational institutions, and state and federally supported dental programs with capacity to treat patients. Develop mechanisms for dental team members to establish dental care programs/facilities in underserved and rural areas of Florida. Strategies: Increase use of private practices, educational institutions, and state and federally supported dental programs with capacity to treat patients. Develop mechanisms for dental team members to establish dental care programs/facilities in underserved and rural areas of Florida.

15. Objective: Collaborate to maximize use and capacity of the current dental workforce to optimally serve Floridians with preventive & therapeutic care Strategies: Establish Community Dental Health Coordinator (CDHC) education programs at dental, dental assisting, and dental hygiene schools in Florida and incorporate CDHCs into the dental team. Provide more preventive care by expanding dental assistant duties allowed under general supervision in all settings. Recruit &assist in dental lab technicians’ education. Strategies: Establish Community Dental Health Coordinator (CDHC) education programs at dental, dental assisting, and dental hygiene schools in Florida and incorporate CDHCs into the dental team. Provide more preventive care by expanding dental assistant duties allowed under general supervision in all settings. Recruit &assist in dental lab technicians’ education.

16. Objective: Collaborate to maximize use and capacity of the current dental workforce to optimally serve Floridians with preventive and therapeutic care Strategies: Allow for more efficient delivery of dental care by expanding auxiliary duties to include placement and finishing of restorations (with proper training and certification). Support and expand preventive oral care in pediatricians’ offices. Establish and expand emergency room diversion programs for definitive treatment. Strategies: Allow for more efficient delivery of dental care by expanding auxiliary duties to include placement and finishing of restorations (with proper training and certification). Support and expand preventive oral care in pediatricians’ offices. Establish and expand emergency room diversion programs for definitive treatment.

17. Objective: Collaborate to maximize use and capacity of the existing dental workforce to optimally serve Floridians with preventive and therapeutic care Strategies: Support and expand the volunteer safety net programs, including FDA-supported Project: Dentists Care clinics and Mission of Mercy events. Optimize dental care in nursing homes. Educate emergency room and nursing home facility staff on available resources for definitive treatment and establish referral lists of local dentists. Strategies: Support and expand the volunteer safety net programs, including FDA-supported Project: Dentists Care clinics and Mission of Mercy events. Optimize dental care in nursing homes. Educate emergency room and nursing home facility staff on available resources for definitive treatment and establish referral lists of local dentists.

18. Objective: Expand opportunities for public health dentistry to serve Floridians Strategies: Establish and adequately fund a dental student loan repayment program. Require oral health education in schools and public assistance programs. Expand funding for county health department dental programs. Increase state supported funding for community water fluoridation. Strategies: Establish and adequately fund a dental student loan repayment program. Require oral health education in schools and public assistance programs. Expand funding for county health department dental programs. Increase state supported funding for community water fluoridation.

19. Objective: Expand opportunities for public health dentistry to serve Floridians Strategies: Increase Medicaid dental reimbursement rates and require 85/15 medical loss ratio for dental care in managed care programs. Expand public/private partnerships with federally qualified health centers using private practice providers. Promote the Health Access Dental License to increase the number of providers in health access settings. Strategies: Increase Medicaid dental reimbursement rates and require 85/15 medical loss ratio for dental care in managed care programs. Expand public/private partnerships with federally qualified health centers using private practice providers. Promote the Health Access Dental License to increase the number of providers in health access settings.

20. 2015 Tactics to achieve the strategies Administrative rule changes at the Florida Board of Dentistry regarding expansion of restorative duties for dental auxiliaries are currently in process. FDA staff have been directed to seek BOD rules changes to expand supervision levels for dental assistants to perform preventive services under general supervision. Administrative rule changes at the Florida Board of Dentistry regarding expansion of restorative duties for dental auxiliaries are currently in process. FDA staff have been directed to seek BOD rules changes to expand supervision levels for dental assistants to perform preventive services under general supervision.

21. 2015 Tactics to achieve the strategies Legislation is currently in bill drafting and will be introduced to the 2015 Florida Legislature regarding: 1. Dental Care Access Initiative 2. Community Water Fluoridation Funding 3. Coordinators for Special Needs and Medically Compromised patients through Dental Lifeline Network. Legislation is currently in bill drafting and will be introduced to the 2015 Florida Legislature regarding: 1. Dental Care Access Initiative 2. Community Water Fluoridation Funding 3. Coordinators for Special Needs and Medically Compromised patients through Dental Lifeline Network.

22. Dental Care Access Account Initiative --A joint local and state dental care access account to promote economic development by providing financial support to qualified, Florida licensed dentists who practice in dental health professional shortage areas or medically underserved areas. --The state may award funds of up to $100,000 per year for the dentist’s account for up to 5 years. Dentists could spend funds from his/her dental care access account for repayment of student loans, investment in property, facilities or equipment to establish a dental practice. --A joint local and state dental care access account to promote economic development by providing financial support to qualified, Florida licensed dentists who practice in dental health professional shortage areas or medically underserved areas. --The state may award funds of up to $100,000 per year for the dentist’s account for up to 5 years. Dentists could spend funds from his/her dental care access account for repayment of student loans, investment in property, facilities or equipment to establish a dental practice.

23. 2015 Tactics to achieve the strategies Community Dental Health Coordinator curriculum integration into Florida dental programs. The first CDHC program in our state will begin in the Fall at Mattia College in Miami. Elder care training is now available through the ADA and several Florida dentists will enroll this Spring. Emergency Room diversion programs like in Brevard County are being expanded. Community Dental Health Coordinator curriculum integration into Florida dental programs. The first CDHC program in our state will begin in the Fall at Mattia College in Miami. Elder care training is now available through the ADA and several Florida dentists will enroll this Spring. Emergency Room diversion programs like in Brevard County are being expanded.

24. Community Dental Health Coordinator This team member is the dental version of the community health worker (CHW). Current dental assistants and dental hygienists are the ideal individuals to expand their education as CDHC’s. Greater health outcomes as a result of greater access and compliance can be achieved via the CHW and CDHC. Populations including diabetics, prenatal and perinatal, elderly, special needs, medically compromised, and children receive care as a result of the coordination of services. Connects patients with a dental home where treatment of their disease can occur. This team member is the dental version of the community health worker (CHW). Current dental assistants and dental hygienists are the ideal individuals to expand their education as CDHC’s. Greater health outcomes as a result of greater access and compliance can be achieved via the CHW and CDHC. Populations including diabetics, prenatal and perinatal, elderly, special needs, medically compromised, and children receive care as a result of the coordination of services. Connects patients with a dental home where treatment of their disease can occur.

25. Summary There is available capacity with the current dental team members in Florida. We need to better distribute our dentists, assistants, and hygienists to provide care to the underserved areas in our State. We need oral health education in our schools and a strong focus on prevention, implemented at an earlier age. The Florida Legislature needs to fund dental Medicaid programs to cover the cost of delivering care and the Dental Care Access Account Initiative program to place dentists in underserved areas. There is available capacity with the current dental team members in Florida. We need to better distribute our dentists, assistants, and hygienists to provide care to the underserved areas in our State. We need oral health education in our schools and a strong focus on prevention, implemented at an earlier age. The Florida Legislature needs to fund dental Medicaid programs to cover the cost of delivering care and the Dental Care Access Account Initiative program to place dentists in underserved areas.