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A new program in Kansas is
designed to assist some adults with funding for dental
services, previously uncovered under Medicaid
Adults with one or more dependents
in their household who are Kansas residents making less than $56,857 are
eligible for services under a new pilot project coordinated through the Kansas
Association of Medically Underserved (KAMU).
"There is no requirement for a dentist to be enrolled in Medicaid to bill for
this care," says Chris English, Chief Quality Officer for KAMU.
"Medicaid is only mentioned as the base for the allowed amounts. There
will be a very short "contract" that a dentist would sign with KAMU that really
just outlines the program and the expectations for their office to receive
reimbursement."
The covered
services will be included with the contract and will
constitute most of the Medicaid covered services reimbursed
at the Medicaid rate with the remainder being a write off
that is not billable to the beneficiary.
While there is no benefit cap, there will be a limit on total expenditure
of the program. This amount is estimated at $1.4 million, however may be
subject to change.
This program will provide services ranging from exams to
full dentures, with examinations between June 1, 2010 and
September 30, 2010. Participants cannot have dental
insurance, must be over the age of 18, and be both a Kansas
resident and a U.S. citizen.
"I am encouraged by new creative ways use of funds in a way that may help people
attain dental treatment," said Dr. David Hamel, president of the Kansas Dental
Association.
"By providing funds for
patients to be treated outside of the Medicaid network office or any network
office increases access to treatment by those patients. Hopefully this will be
a beginning for agencies to begin adapting current programs to better provide
funding for patient care."
Reimbursement is provided through federal grant dollars as part of the American
Recovery and Reinvestment Act (ARRA) that are drawn quarterly, so payments for
June services will be made in July, and payments for July – Sept will be made in
October.
Invoices and eligibility
documentation will be sent to KAMU and to be manually reviewed, approved, priced
and paid. KAMU will be responsible for monitoring the program and ensuring
the $1.4 million is not exceeded.
"I like that it has begun a process of simplifying administration while creating
easier opportunities for private practices to incorporate this program into
their service to the public. Since private practice makes up over 90% of dental
practices it is important to have programs that can be used in that setting,"
said Hamel.
Funding for the program was retroactively established on June 1.
For more information or to sign up as a provider, contact
Chris English (785.233.8483) at the
Kansas Association for the Medically Underserved.
Frequently Asked Questions
Eligibility
Q - The patient has private dental
insurance, but the service needed isn't covered or the
coverage limit for the year has been reached. Is the patient
eligible for the program?
A - If the patient has private dental
insurance, he or she is not eligible for the Kansas Urgent
Dental Care Program.
Q - The patient is not the parent of
the dependent in the home. He claims he is the grandfather
(or uncle) and is the primary caregiver. Is that patient
eligible for the program?
A - Yes, for this program the patient
is considered eligible if he/she claims he/she is the
primary caregiver for the dependent child.
Q - The patient is eligible for
Medicaid. Is he eligible for the program?
A - If the patient is over age 21 and
is currently eligible for Medicaid, he is eligible for this
program. Or, if the patient's children are eligible for
Medicaid or SCHIP, he is eligible for this program.
Q - The patient is 19 years old, has
a child, and is eligible for Medicaid. Is she eligible for
this program?
A - No, patients between the ages of
18 and 21 who have a current Medicaid card are not eligible
for this program, because they have access to dental
services through Medicaid.
Q - Who is responsible for
determining eligibility for the program?
A - The service provider is
responsible for determining eligibility. The provider must
attest that the patient is eligible for the program, using
the program eligibility worksheet prior to providing
services. If the provider is able to secure an agreement
with the local health department to determine eligibility,
the provider must keep a copy of the letter of eligibility
provided by the health department.
Q - What documentation must be
provided to determine financial eligibility for the program?
A - The patient may submit the most
recent pay stubs or a letter verifying annual income from
the employer.
Q - What would happen if services are
provided and paid, and later the person is determined to
have been ineligible? The provider will be responsible for
reimbursing SRS for the cost of the service provided.
Invoicing for Services
Q - If the provider charges a sliding
scale fee, can the fee be charged to the patient before the
invoice is submitted for the program?
A –Yes.
The following is an example of reimbursement if a sliding
fee schedule is utilized:
Reimbursement without sliding
scale fee:
Total billed
$130
Total allowed
$120
- 20% In kind donation
$ 24
Clinic/Provider Payment
$ 96
Reimbursement with sliding scale
fee:
Total billed
$130
Total allowed
$120
-
20% In kind donation
$ 24
-
Patient Portion
$ 10
Clinic/Provider Payment
$ 86
Q - Can this program be billed
instead of Medicaid?
A - No, this program is the payer of
last resort. If the service is considered an emergency and
is billable to Medicaid, the service cannot be billed to
this program.
A - Is there a cap on the services
that can be provided to one patient?
Q - No, the only limit on the amount
of service that can be provided is that all services must be
completed no later than September 30, 2010.
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