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This technical brief presents the findings of a POHRPC research project on state Medicaid coverage of selected dental procedures by Erica Caffrey, DDS, MS, 2016-2017 Samuel D. Harris Fellow. Designed as a state-level advocacy resource, it identifies the pediatric dental procedures most essential for coverage, catalogs the coverage of these procedures by state, and specifies problem areas of coverage for oral health services.
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If you are a new pediatric dentist, a pediatric dentist new to Medicaid, or both, you will find this toolkit an invaluable guide to getting a Medicaid program started in your practice. It features no-nonsense answers to common questions about how to appropriately administer Medicaid and offers a host of time-saving resources.
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Medicaid Toolkit: Valuable State Contacts and Resources -
The May 2016 Technical Brief provides an examination of the changes and decline in population pools for dental school programs, the challenges of securing adequate patient populations, and current approaches to solving patient shortages.
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The February 2015 Technical Brief analyzes the unique characteristics of pediatric dental practices crucial to the effectiveness of Medicaid audits. Pediatric dentists treat Medicaid patients who are younger, at higher risk for dental disease, and require more complex treatment. Therefore, when providing necessary treatment to large numbers of at-risk patients, pediatric dentists are caught unfairly in the net of supposed Medicaid overuse. The Brief provides recommendations for consistent audit methods grounded in sound clinical practice, information on the impact of Medicaid audits on access to dental care, as well as current case studies of pediatric dental audits.
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According to the December 2014 Technical Brief from the Pediatric Oral Health Research and Policy Center, AAPD Public Policy Advocates are in an ideal position in their own states to prepare members to comply with Medicaid rules. The Brief discusses how Advocates can establish state-level relationships with public and private entities that share the goal of improved oral health for children; promote fair and consistent auditing practices; and educate members about relevant regulations, documentation standards and appropriate billing practices. In addition, the Brief offers practical tips for surviving an audit as a pediatric dental provider.
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The focus of the April 2014 Technical Brief is the importance of early preventive dental visits, currently recommended for children by age 1. The brief presents scientific support for the effectiveness of early dental visits in improving health outcomes and greatly reducing dentally related costs.
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This Technical Brief addresses the topic of patient-centered care in the context of caries rates in pre-school children, limited resources, and a potential increase in patient demand due to the provisions of the Affordable Care Act.
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This Technical Brief discusses how the combination of patient and provider barriers leads to low utilization of dental care options by publically insured pediatric patients, higher dental disease rates and treatment costs.
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This Brief provides information in support of the assertion that general anesthesia may be a medically necessary when treating some dental patients and, therefore, should be included as an essential health benefit under both public and private medical insurance coverage for children.
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This Brief features an overview of the current research on caries risk assessment and its potential to improve its use in clinical care of children. Recommendations and considerations related to the use of caries risk assessment in an essential dental benefits plan are discussed.