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Overview of the Virginia Medicaid Program

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Virginia s Smiles for Children Dental Program Presentation for the: National Academy for State Health Policy Patrick W. Finnerty, Director Department of Medical ... – PowerPoint PPT presentation

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Title: Overview of the Virginia Medicaid Program


1
Virginias 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
  • In FY 2003, only 23.4 of all
  • eligible children actually
  • received any dental services

3
Key Stakeholders Worked Together for Change
4
New Program Structure and a 30 Increase In Fees
  • General Assembly/Governor authorized an entirely
    new program structure recommended by Virginia
    Medicaid
  • Also approved a 30 increase in dental fees
  • 28 on July 1, 2005 additional 2 in May, 2006
  • An across the board increase of 23 the
    remaining amount was targeted to most critical
    codes (e.g., oral surgery codes)
  • Dental advisory committee participated in process
    for allocating fee increase

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

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

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

8
Program Changes Increased Provider Network
  • 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
  • Very high level of provider satisfaction

9
..And Increased Access to Care
Percentage of Children Receiving Necessary Dental
Care
24
32
30
39
Source CMS 416 Report for Virginia
10
Smiles for Children Has Received National
Attention
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