Search Results: MCHLine

Annotation: The purpose of this project was to develop and apply a model for providing comprehensive nutrition services for children in Utah who have certain developmental disabilities or disease conditions. The objectives of the project were to (1) provide comprehensive nutrition care and expand resources; (2) demonstrate the costs and benefits of providing nutrition services to those children with selected developmental disabilities using an economic model; and (3) obtain third-party reimbursement for nutrition services provided to children with selected special health needs. [Funded by the Maternal and Child Health Bureau]

Keywords: Cystic Fibrosis, Developmentally Delayed/Disabled, Financing Health Care, Inborn Errors of Metabolism, Neonatal Intensive Care Unit(NICU), Nutrition, Reimbursement

Annotation: The goal of this project was to assist in the formation of a collaborative effort involving the government, providers, private payers, and families in order to reconcile the operational difficulties of achieving health care cost containment while retaining quality, access, and family-centeredness. The project sought to: develop approaches to health care financing that are sensitive to the needs of families with children who have special health care needs; assist families with special health care needs in dealing with financial problems which pose barriers to obtaining appropriate health services; and disseminate information regarding financing of care for children with special health care needs. Family health benefits counselors assisted approximately 1600 over the course of the project by conducting intake interviews, informing families about health care financing options, assisting in completing applications and/or filing appeals or denials of public or private benefits and facilitating negotiations with medical creditors. Consultation with legal backup and referral for legal intervention were distinguishing aspects of the project. Benefits counselors and project attorney worked with state and county administrative and regulatory agencies, private insurers and health care providers and associations to resolve systemic problems. [Funded by the Maternal and Child Health Bureau]

Keywords: Advocacy, Case Management, Chronic illnesses and disabilities, Families, Family health, Financial Counseling, Financing Health Care, Health Insurance, Health Maintenance Organizations (HMOs), Medicaid, Reimbursement

Annotation: This manual is designed to help non-oral-health professionals implement fluoride-varnish application for infants, children, and adolescents ages 6 months to 21 years who are enrolled in Massachusetts’ Medicaid program. The manual includes instructions on how to complete the online Smiles for Life training, which is required for health professionals to apply fluoride varnish for this population. It also discusses how to begin using fluoride varnish in a practice as well as how to keep fluoride varnish notes and how to bill for fluoride varnish application. Basic information about fluoride varnish application and information to share with parents and other caregivers is included.

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Keywords: Adolescents, Children, Clinical coding, Consumer education materials, Dental caries, Disease prevention, Fluorides, Infants, Manuals, Massachusetts, Medicaid, Oral health, Oral health care, Preventive health services, Reimbursement, Resources for professionals, Risk assessment, State programs, Training, Young adults

Annotation: This issue brief analyzes state Medicaid coverage of evidence-based perinatal services that can improve maternal and infant health outcomes, particularly during the postpartum period. The document examines coverage across four categories of services including alternative models of care delivery, whole-person wraparound care, mental and behavioral health support, and lactation support beyond the hospital. It finds wide variation in Medicaid coverage of these evidence-based perinatal services across states, with only 11 states requiring and reimbursing maternal depression screening during well-child visits and significant differences between Medicaid expansion and non-expansion states. The analysis emphasizes that despite growing recognition of postpartum care importance, state variation in Medicaid coverage likely influences maternal health outcomes and worsens place-based disparities.

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Keywords: Evidence based medicine, Health policy, Medicaid, Perinatal care, Postartum care, Reimbursement, State MCH programs, Statistics

Annotation: This report presents findings from the Expanding School Dental Services and Medicaid Billing in Pennsylvania project. The project aims to assess the scope of oral health care provided in public schools in the state, identify barriers to implementation and sustainability, support schools in serving as access points for preventive oral health care, and advocate for policy changes that would allow Medicaid reimbursement for oral health care delivered in schools.

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Keywords: Access to health care, Medicaid, Oral health, Pennsylvania, Prevention, Public policy, Reimbursement, School health programs, State information

Annotation: This toolkit is designed to support dentists and their practices in confidently and efficiently delivering financially sustainable care to Medicaid beneficiaries. It provides background information and offers strategies in the following categories: enrollment and credentialing, operational efficiency, payer mix and revenue strategies, reimbursement, and risk management and quality assurance. Strategies for advocacy and policy involvement are included.

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Keywords: Advocacy, Dentists, Low income groups, Medicaid, Oral health, Public policy, Quality assurance, Reimbursement, Risk management, Service delivery

Annotation: This report discusses the current landscape of adult Medicaid benefits, dentist participation in Medicaid and the Children’s Health Insurance Program (CHIP), dental care use among Medicaid beneficiaries, and Medicaid reimbursement for dental care. Key takeaways are provided.

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Keywords: Health care utilization, Low income groups, Medicaid, Oral health, Reimbursement, State Children's Health Insurance Program

Annotation: This summary provides information about the Improving Oral Health for Young Children in Connecticut Through Policy, Practice, Education, and Evaluation project, which was part of the Maternal and Child Health Bureau–funded Improving Oral Health Integration (MCH-IOHI) project. Summary topics include oral health scope of practice, Medicaid billing and reimbursement, and silver diamine fluoride (SDF) reimbursement and SDF application restrictions.

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Keywords: Connecticut, Medicaid, Oral health, Reimbursement, Service integration, Silver diamine fluoride, State programs

Annotation: This manual provides policies and procedures for Wisconsin Seal-A-Smile (SAS) grantees, with the goal of helping them administer programs and ensure consistency across programs. The purpose of SAS is to improve the oral health of Wisconsin children through school-based dental sealant programs. Topics include administrative and regulatory guidelines; program requirements; forms, reporting, and recording; and budget and funding information.

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Keywords: Administration, Data collection, Dental sealants, Disease prevention, Forms, Grants management, Oral health, Prevention programs, Reimbursement, School age children, School health programs, School health services, Screening, State programs, Wisconsin

Annotation: This brief provides information on how having access to a full range of oral health care, including minimally invasive care (MIC), can improve people’s oral health and overall health, their oral health care experience, and their ability to choose the care that is right for them. It discussing the importance for oral health integration for advancing equity, effective strategies for medical-dental integration that promote MIC, and ways that leaders can advance integrated care that employs MIC to support community health.

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Keywords: Access to health care, Health care delivery, Low income groups, Medicaid, Oral health, Oral health equity, Reimbursement, Service integration

Annotation: This brief provides data on variations across states in the recognition of and reimbursement for select oral health services for children. Content build upon two editions of the American Academy of Pediatric Dentistry's resource, Are Your Kids Covered? The brief also presents information on the importance of selected services. Time trends in state coverage for selected services for children are included, and data and methods are discussed.

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Keywords: Oral health, Reimbursement, Statistical data, Trends

Annotation: This report provides information about policies and practices related to paying for community health workers for their services, including oral health services, through Medicaid. The report discusses each state's approach to covering these services through Medicaid. It also includes a spreadsheet that can be filtered and sorted to identify states with various approaches. A summary of findings is included.

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Keywords: Administrative policy, Community health, Low income groups, Medicaid, Oral health, Personnel, Reimbursement, State information

Annotation: This report discusses systemic barriers to oral health care and overall health care coordination and how these barriers can be mitigated. It provides an analysis of 715 pieces of literature and categorizes them into five primary segments: education exploratory, education implemented, health professional exploratory, health professional implemented, and informative. The report highlights ways that the literature reflects four main themes: awareness, workforce development and operations, information exchange, and payment. Recommendations for developing frameworks to address oral health care and overall health care coordination are included. zzz

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Keywords: Care coordination, Oral health, Reimbursement, Research, Service integration

Annotation: This article examines lessons learned from California's experience with perinatal community health workers (CHWs) and provides recommendations for policy makers designing similar programs. It discusses how perinatal CHWs can help address disparities in maternal health outcomes by providing culturally appropriate support throughout pregnancy and postpartum periods. The authors, drawing from 15 years of experience in California's Medicaid system, outline key considerations including adequate reimbursement rates, payment flexibility for services provided in both clinical and community settings, program coordination to prevent inefficiencies, standardized data collection methods, and support systems to prevent CHW burnout. The document includes specific examples from programs at San Francisco General Hospital and Los Angeles County, and discusses implications for state Medicaid programs participating in CMS's new Transforming Maternal Health Model.

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Keywords: Barriers, California, Community health workers, Maternal health, Models, Payment, Perinatal care, Policy development, Postpartum care, Reimbursement, State programs

Annotation: This policy snapshot examines community-based doula policies across states as part of the 2024 Prenatal-to-3 State Policy Roadmap, identifying doulas as one of 12 evidence-based policies that impact the prenatal-to-3 system of care. The document explains that community-based doulas are trained social service professionals who provide non-clinical emotional, physical, and informational support to expectant parents from pregnancy through the postpartum period, and when integrated into larger support systems can improve child health outcomes, parenting behaviors, and birth outcomes. It identifies two key policy levers for states: expanding access through Medicaid coverage and reimbursement of doula services, and bolstering workforce sustainability through financial support for training and development. The snapshot shows which states cover and reimburse community-based doula services under Medicaid and which states provide financial support for doula training.

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Keywords: Access to health care, Community based services, Doulas, Medicaid, Policy development, Reimbursement, State policies, Statistics, Work force, trends

Annotation: This assessment and environmental scan provides information on and examples of how the integration of oral health care and medical care may impact the oral health care field. Topics include (1) oral health care pricing and reimbursement, (2) Medicare and the oral health care market, (3) tangential industries moving to Medicare-based payment models, and (4) value-based care models and their potential implications for oral health care.

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Keywords: Costs, Low income groups, Medical care, Medicare, Oral health care, Reimbursement, Service integration

Annotation: This profile provides information on state Medicaid dental programs. For each state, the following topics are discussed: category of care provided (e.g., diagnostic, exam, screen, preventive, restorative); diagnostic code; description of category; whether adults over age 21, adults with intellectual and developmental disabilities, and pregnant women are covered; adult fees; whether the category is part of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program; and EPSDT rates for pregnant women.

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Keywords: Adults, Costs, Developmental disabilities, Intellectual development, Medicaid, Oral health, Pregnant women, Prevention, Reimbursement, State information, State programs

Annotation: This toolkit focuses on how teledentistry can be used to maintain oral health and improve access to oral health care. It is intended for for dental boards, policymakers, health professionals, and advocates. The toolkit provides background information and discusses technology and practice and payment as they relate to teledentistry. A note for policymakers is included.

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Keywords: Access to health care, Health care delivery, Oral health, Public policy, Reimbursement, Teledentistry

Annotation: This report focuses on aspects of Medicaid's mission to ensure access to high-quality health services and the program's future as a major health care payer driving health system change toward value. The report focuses on topics of interest to Congress, including Medicaid’s responsiveness during economic downturns; concerns about high rates of maternal morbidity and mortality; improving hospital payment policy for the nation's safetynet hospitals, and the integration of care for people who are dually eligible for Medicaid and Medicare.

• 2022
• 2021

Keywords: Access to health care, Adolescents, Children, Children's Health Insurance Program, Costs, Financing, Health care reform, Health services delivery, Medicaid, Medications, Mental health, Oral health, Organizational change, Pregnant women, Reimbursement, Systems development

Annotation: This tip sheet for professionals providing transition services in pediatric and adult primary and specialty care settings summarizes innovative transition payment models. Contents include alternative payment methodologies and transition-related CPT codes and corresponding Medicare fees. Enhanced fee-for-service payments, pay-for-performance, capitation, bundled payments, shared savings, and administrative or infrastructure payments are among the topics covered.

• 2022

Keywords: Adolescents, Financing, Model programs, Pediatric care, Primary care, Reimbursement, Transition planning, Young adults