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Health & Spirit

Frail patients losing access to dental house calls

Ana B. Ibarra and Heidi de Marco, Kaiser Health News on

Published in Health & Fitness

Dental hygienists are generally allowed to practice without the direct supervision of a dentist in 40 states, including Nevada, Texas, Colorado, Michigan and Florida. But the type of patients they can see varies by state. So do reimbursement and preauthorization rules.

Washington state's Medicaid program pays providers $46 for a similar cleaning procedure, said Anita Rodriguez, a member of the Washington State Dental Hygienists' Association. Hygienists there don't have to obtain preauthorization to perform cleanings, but they are required to explain why the cleaning was necessary when they bill Medicaid.

"Our state makes access for our independent hygienists relatively uncomplicated though, like other Medicaid providers, we make pennies on the dollar for our care," she said.

Since California reduced payments for "maintenance" cleanings for these patients -- usually performed every three months to treat gum disease -- many hygienists have stopped seeing them. Eight hygienists, including Aminloo, filed a lawsuit in Los Angeles County Superior Court in 2016, arguing that the health care services department cut the reimbursement rate without first obtaining necessary federal approval.

At one point, it appeared as if the department had agreed to settle and cancel its rate change but then backed out, court documents show. The department said it will not comment on pending litigation.

At the time of the rate reduction, the state also started requiring dental hygienists to obtain prior authorization to treat gum disease in patients who live in special care facilities. Hygienists must submit X-rays along with their authorization requests. But they say it's almost impossible to take decent X-rays of elderly or disabled patients who have a hard time controlling their head movements, or who refuse to open their mouths widely.

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When hygienists do manage to get X-rays, their requests are often denied anyway, hygienists from across the state told California Healthline.

In a letter to the state legislature last year, the California Dental Hygienists' Association wrote that more than half of their authorization requests had been denied since the change. "Denti-Cal's sweeping new rules are destroying the lives of fragile patients and the women who own small businesses providing care at the bedside," the letter said.

But state statistics show a much lower denial rate.

From the time the change took effect in July 2016 through June 2017, the health care services department approved 10,000 of nearly 13,000 deep cleanings requested by these dental hygienists to treat gum infections, according to the data. It also approved 31,300 of the nearly 33,000 requests for routine cleanings that follow a deep cleaning. The state said it paid more than $2.5 million to dental hygienists for these procedures.

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