According to a press release and an article on the American Alliance for Dental Insurance Quality website, this past February, the Massachusetts Dental Society (MDS) and nine other dental organizations sent identical letters to the MassHealth Dental Program, requesting that fees be increased to address access to care issues for Medicaid recipients in the state.
Distance-to-provider access to care metric wrong
At issue is the methodology that MassHealth’s third-party administrator, DentaQuest, has been using to calculate compliance with federal access to care requirements for Medicaid children. The letter points out that the company’s method is in violation of federal statute 42 USC-1396a (30)(A), which states “…assure that payments are….sufficient to enlist enough providers so that care and services are available under the plan at least to the extent that such care and services are available to the general population in the geographic area.”
DentaQuest has been using a distance-to-provider metric based on the time it takes a Medicaid recipient to reach the office of a Medicaid provider from anywhere in the state. The standard for this metric has been 10 minutes to a general dentist and 30 minutes to an orthodontist/oral surgeon/pedodontist.
However, this metric does not show the state is in compliance with the access to care provision. The letter states: “Minutes to provider is a useless time-analysis, because it does not identify how long it takes to receive care and services. A patient may be 10-minutes away from a provider, yet months away from a cleaning or other procedure.”
Standard is treatment availability to Medicaid clients comparable to the general population
The standard for access to care needs to be the time it takes to get treatment from a provider which is based on the availability of service to the general public and whether the Medicaid dental system is comparable. And that this metric sets the payment rate for providers so that enough providers are in the system.
Letter requests immediate 10% increase and secret shopper comparison to set final rates
The letter requests that “MassHealth implement a secret shopper comparison of Medicaid provider availability of services against non-Medicaid availability of services, with a subsequent Medicaid rate increase to comply with the “at least” mandate in 42USC-1396a(30)(A).”
It requests an immediate 10% rate increase across the board to address the concerns of inadequacy in access to care, with a future adjustment based on the comparison when completed.
The letter is signed by nine prominent leaders in Massachusetts dentistry, including Dr. Abe Abdulwaheed, President of the Massachusetts Dental Society, Dr. Elon Joffre, President of the Massachusetts Association of Orthodontists, Dr. Derek Zurn, President of the Massachusetts Academy of Pediatric Dentistry, and Dr. Mouhab Rizkallah, President of AADIQ, who researched and produced the letter and is also the Chair of the MDS Dental Practice & Benefits Committee.
A copy of the letter is available on the American Alliance for Dental Insurance Quality website.
There should be an increase overall for providers in fees. The cost of materials is higher than what providers get paid.
I agree, for crowns we are reimburse $264.00 for Medicaid recipients and lab charges $140. There is no profit after material and man hours. This is just one example. A increase on fee schedule would be ideal for Dentist.