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October 1, 2013 - September 30, 2014
The Department of Public Welfare (DPW) is committed to improving access to and utilization of dental services for Pennsylvania’s most vulnerable citizens. Collaborative relationships are an essential component of any successful campaign that strives to initiate a positive change in the community. As part of DPW's commitment to improving access to quality dental care for MA recipients, DPW is dedicated to continuing to build productive working relationships with stakeholders and advocates.
The content on this portion of the dental services section of this Web site provides stakeholders and advocates with valuable information about dental services provided in the MA program, Pennsylvania dental statistics, recent improvement initiatives, past and present outreach efforts and helpful links.
Dental Services Provided in the Medical Assistance Program:
The scope of benefits for which MA recipients are eligible differ according to recipients’ categories of assistance. MA covers the following:
All medically necessary dental services for children under age 21 enrolled in MA.
For additional information on covered services, refer to the Pennsylvania Code, Medical Assistance Manual.
Useful Statistics And Data:
According to the Pennsylvania Department of Health, more children are affected by dental decay than asthma. In Pennsylvania, tooth decay affects 48 percent of children by the age of eight. By age 15, this percentage increases to 50 percent. In low-income households, 33 percent of children have untreated tooth decay, in comparison to only ten percent of children in higher-income households. Like most other states, Pennsylvania is currently working to address several dental care delivery challenges. Pennsylvania’s challenges stem from the following factors:
Pennsylvania Department Of Public Welfare Dental Summit:
As part of its effort to address key issues facing the oral health of MA consumers, DPW has hosted two Dental Summits attended by health plans, consumers, advocates, providers and other stakeholders. These gatherings have generated a clear understanding of the dental issues Pennsylvania is confronting and have provided many ideas about how to improve the dental care delivered to members and the service extended to dental providers.
In 1999, the Department hosted the very first Dental Summit. MCOs, advocates, dental care providers and other stakeholders attended the Dental Summit. The purpose of the Summit was to discuss ways to improve the dental care accessed by MA recipients. At the Summit, attendees expressed significant concerns about the low reimbursement rates provided to dental providers and the adverse effects reimbursement rates were having on dental provider enrollment. In response to this concern, resources were devoted to researching the fees paid by the MA program relative to fees paid in the commercial markets and other public programs. As a result of these efforts, fees were increased for numerous services. Affected fees were increased as much as 76 percent. For a complete listing of the fee increases implemented since 1999, refer to MA Bulletin 03-01-03, MA Bulletin 03-99-01 and MA Bulletin 03-01-06.
In response to Pennsylvania’s specific challenges, five objectives were identified during the 1999 Dental Summit:
Since the identification of these five main objectives in 1999, the Department has steadily worked to improve the quality of and access to dental care provided by the MA program. In the past three years the Department has:
DPW is pleased to report the progress made thus far and looks forward to continuing to work with advocates, policymakers and stakeholders to continue improving the quality of care and accessibility of dental services provided to MA recipients.
In November 2001, the Department held the second Dental Summit in Harrisburg. The theme of the summit was "Meeting the Challenge At All Levels." Providers, recipients and stakeholders from around the Commonwealth joined the Department staff to discuss how to improve access to and quality of dental services in local communities. The Secretary of the Department of Public Welfare delivered the Summit’s opening address. Summit participants spent much of the conference meeting in zone-specific workgroups. Each workgroup developed strategies to improve access to dental services for MA recipients in their zone.
The Dental Summit Steering Committee is responsible for prioritizing, developing and implementing recommendations for improving the dental services provided to MA recipients on an ongoing basis. The Dental Summit Steering Committee is composed of 17 members that represent the Department of Public Welfare, Department of Health, Pennsylvania Dental Association, dental providers, recipients, advocates and managed care organizations.
Robert Wood Johnson Foundation Oral Health Grant:
Pennsylvania received a three-year grant of $939,590 in December 2002 from the Robert Wood Johnson Foundation to improve oral health. Pennsylvania and five other states will work with the Centers for Health Care Strategies, Inc. to produce "comprehensive, innovative approaches to improve access to oral health services for low-income, minority and disabled populations served by Medicaid and the State Children's Health Insurance Program (SCHIP)". Pennsylvania will use the grant money to develop a program that has the following three components:
Other State And Local Efforts:
Great strides are being made in Pennsylvania to improve MA recipients’ access to quality dental care. All across the Commonwealth, initiatives are being implemented through state and local partnerships. Provided below is a summary of some of those initiatives:
Medical Assistance Advisory Committee Updates:
The Medical Assistance Advisory Committee (MAAC) provides the Department with advice on how to improve access to quality health care in an efficient, economical and responsible manner to all MA eligibles. The MAAC is composed of 25 members representing consumers, advocacy organizations, providers and their associates, managed care organizations, medical centers and the Department. The MAAC meets once a month to discuss policy development and program administration issues, including dental care. For complete information on recent MAAC decisions and upcoming meetings, refer to the MAAC section of this website.
Helpful Links For Advocates:
Pennsylvania Department Of Health - Provides information regarding statewide and local dental initiatives, available grants and more.
American Dental Association - Provides information on legislative and regulatory issues, federal dental services, advocacy tips and more.
Pennsylvania Dental Association - Provides information on patient relations programs, consumer tips, current trends in dental care and more.
Eastern Dental Society - Provides information and continuing education opportunities to dental practitioners.