1. Dental Summit Presented by: Sheldon Wolf Assistant Medicaid Director North Dakota Department of Human Services of Human Services April 14, 2000

2. Medicaid in North Dakota b Eligible recipients per month 22,000 children22,000 children 20,000 adults20,000 adults b Fee-for-service program b Use ADA claim form b Extra compensation for dentists who treat DD clients b Prior authorization for prosthodontics, orthodontics, and oral surgery

3. Medicaid in North Dakota b Electronic claims submission available b Claims turn around 10 days

4. Medicaid Dental Benefits b Children (Age 0-21 years) Covered under EPSDT (Health Tracks)Covered under EPSDT (Health Tracks) –diagnostic –preventive –restorative –limited orthodontics –limitations on endo, prostho, perio, and oral surgery –cleft lip/palate treatment covered Reimbursement - 85.7% of billed chargesReimbursement - 85.7% of billed charges

5. Medicaid Dental Benefits b Adults (over 21 years of age) Covered servicesCovered services –Diagnostic –Preventive –Restorative –Some limitations on endo, prostho, and oral surgery –Periodontal treatment Reimbursement - 72.3% of billed chargesReimbursement - 72.3% of billed charges

6. Medicaid Dental Strategies to Improve Access b Major fee increase in Dec. 1997 (shown in billed charges) (shown in billed charges) children - 70.7% to 85.7%children - 70.7% to 85.7% adults - 65.5% to 72.3%adults - 65.5% to 72.3% b Result Increase in provider participation rate - 3.4%Increase in provider participation rate - 3.4% Percentage increase in number of recipients served - 14.6%Percentage increase in number of recipients served - 14.6% Percentage increase in of number of services provided - 14.3%Percentage increase in of number of services provided - 14.3% b Net Result - stabilization of the program

7. Current Medicaid Dental Statistics b Annual budget - $4.95 million b 2000 Projected Expenditures - $5.4 Million (13% Increase from 1999) b Medicaid Recipients - 42,000 b Average Number Receiving Dental Services a month - 2,720 (6.5%) b 19,707 recipients received service in calendar year 1999 10,894 Children10,894 Children 8,813 Adults8,813 Adults b Average Cost Per Recipient - $326

8. Healthy Steps Information b April Enrollment - 1,524 b October - November 1999 Average Enrollment - 448Average Enrollment - 448 Preventive Services - 252Preventive Services - 252 Restorative Services - 53Restorative Services - 53 Periodontics/Surgery - 14Periodontics/Surgery - 14 Other - 44Other - 44