Carbondale Reporter

The Illinois Department of Healthcare and Family Services met July 27 to provide procedure updates.

Here are the meeting's minutes, as provided by the deprtment:

Illinois Department of Healthcare and Family Services Dental Policy Review Committee July 27, 2016 Dental Policy Review Committee Members Present Jorelle R. Alexander, Cook County Health & Hospitals System Mary Pat Burgess, Chicago Department of Public Health Jason Grinter, Onsite Dental Greg Johnson, Illinois State Dental Society Mary Margaret Looker, Central Counties Health Centers Kathryn Olson, Crusader Community Health Stacey Ballweg, Illinois Department of Public Health Henry Lotsof, Avesis Dental Policy Review Committee Members Absent Mary Hayes, Pediatric Dental Health Associates, Ltd W.H. Milligan, Southern Illinois University School of Dental Medicine Jim Thommes, Dental Director DentaQuest of Illinois HFS Staff Present Christina McCutchan, Shelly DeFrates, Mashelle Rose DentaQuest Staff Present Krista Smothers, Dionne Haney, LaDessa Cobb, Michelle O’Nail, Carol Leonard, Aaron Washburn Interested Parties Gerri Clark, DSCC Karen Moredock, DCFS Pam Cuffle, Illinois State Dental Society Judy Bowlby, Liberty Dental Julie Janssen, IFLOSS Timika Nunley-Thomas, Liberty Dental Louie Whitesman, All Kids Dental Center Chris Manion, Illinois State Dental Society Mona VanKanegan, Oral Health Forum Sherri Foran, Illinois Department of Public Health Theresa Romana, Liberty Dental Dana Flood, Avesis Louis Whitesman, All Kids Dental Center Scott Goldman, All Kids Dental Center Meeting Minutes I. Call to Order: The meeting was called to order July 27, 2016 at 1:10 p.m. by Christina McCutchan. A quorum was established. II. Introductions: Dental Policy Review members, HFS staff and interested parties were introduced in Chicago and Springfield. III. Old Business Illinois Department of Healthcare and Family Services Dental Policy Review Committee July 27, 2016 a. April 27th Meeting Minutes: There was one change to meeting minutes, changing Mary Margaret Looker’s company name. No other requested changes made. Mary Pat Burgess made a motion to discuss the minutes, which was duly second by Greg Johnson. A motion was passed by the committee to post the minutes on the HFS website once the minutes are updated. Motion was approved. b. Rules: Christina McCutchan provided an update on the status of Table D Rule and proposed Orthodontia Rule. Table D was published in the May 6, 2016 Issue of the Illinois Register on the Secretary of States Website at http://www.cyberdriveillinois.com/departments/index/register/home.html found on pages 77 – 80. Second notice is in process but not posted as of Issue 26. The proposed orthodontia rule was published on July 22, 2016 in the Illinois Register at http://www.cyberdriveillinois.com/departments/index/register/register_volume40_issue30.pdf found on page 38. • Dental Codes: At previous meeting, Jason Grinter, Dental Policy Member, had requested further discussion on dental codes D0140 and D9110. Dionne Haney presented a handout to the committee with additional information. • Dr. Grinter made a motion to follow the ADA definition and modify in the DORM. Kathy Olson seconded and Christina McCutchan tabled the motion for time to review old dental policy meeting notes. IV. New Business: a. DentaQuest Update: Dionne Haney, Illinois Executive Director DentaQuest of Illinois, discussed the provider notice that was sent out informing providers that DentaQuest headquarters has moved from Mequon, WI to Milwaukee, WI and any claims sent to Mequon may not be received and paid. b. Legislation Update: Greg Johnson, Illinois State Dental Society, gave an update on the current legislation that affects Medicaid and participating dentists. • The Governor signed HB5948 on June 27, 2016 and has a January 1, 2017 effective date. Rule will be completed by Department of Professional Regulation. • HFS confirmed that SB3080 will apply to dental MCOs even though the bills do not directly state MCO. Bill is currently at the Governor’s Office. • HFS confirmed that HB6213 will also apply to MCOs. This bill was sent to the Governor on June 27, 2016. Greg Johnson asked if HFS has determined what methodology they will use to respond to Federal CMS Access Rule on October 1st. Per Administration “We will be posting access plans in accordance with the federal guidelines.” There are no other details at this time. Illinois Department of Healthcare and Family Services Dental Policy Review Committee July 27, 2016 Greg Johnson also discussed the ACA HHS Office of Civil Rights Rule 1557. Some requirements went into effect July 18th but the posting requirements are as of October 16th. There are several concerns regarding taglines on publications for translation requirements for 15 languages. Greg Johnson spoke about the success of Mission of Mercy event that was held on July 15th and July 16th in Collinsville, Illinois. c. Managed Care and ACE/CCE Update: Christina McCutchan reported that the Bureau of Managed Care was unable to participate in meeting but hopes to be able to update at the next meeting. d. Impact Provider Enrollment Update: Mashelle Rose, Bureau Chief of Medicaid Integrity, gave update on IMPACT Provider enrollment. 1155 applications have been approved (300 new and 850 revalidated), with only 37 pending (23 new and 14 revalidations). Dionne stated that DentaQuest is working with HFS to start sending blast faxes to providers that have not revalidated. Mash informed the committee that the deadline for revalidation is August 30, 2016. All providers not revalidated will not be paid for any services provided on or after October 1, 2016 and the provider will have to start an application from scratch. Federal CMS is not allowing for back dating for providers that didn’t revalidate. Dionne Haney also stated that dental providers are having issues with having to have a certified W9 to get into IMPACT. Mashelle Rose informed the committee that this problem was supposed to be fixed with an IMPACT upgrade and there should be a box available for the dentists to check to get past the W9 certification since DentaQuest is issuing the checks at this time and not the State of Illinois. Mashelle Rose is going to verify that this fix has been installed. Dionne Haney asked Mashelle how long is it taking to get providers into HFS legacy? It is currently taking 2 to 3 weeks right now and HFS is working towards making this a daily update into legacy by October of 2016. e. DCFS 21 and Older: There has been great confusion regarding the benefit package for youth ages 21-25. Jamie Ursch from the Bureau of Medical Eligibility Policy gave an explanation of benefit package for youth age 21-25 specifically dental. In reviewing the rule 89 IL Admin Code 312.90(d)(1)(2), we see that medical and dental services available under the HFS Medical Assistance Program to individuals participating in the DCFS scholarship program. While the rule apparently provides that medical and dental services are available to individuals participating in the scholarship program, the rule does not define any particular service package available to scholarship program participants. The actual services available to Medicaid-eligible individuals are defined by the State Medicaid Plan and HFS rules. In accordance with HFS’s state Medicaid Plan and administrative rules, individuals who reach the age of 21 are no longer considered children and are limited to coverage of adult dental services in accordance with 89 IL Adm. Code 140.3(c)(15) and defined at 89 IL Admin. Code 140.420, as limited by 89 IL Admin Code 140.421. Therefore, regardless of an individual’s Medicaid eligibility group or participation in the DCFS scholarship program, we are not aware of any exception in rule or the State Medicaid Plan that would allow any such individual over the age of 21 to be covered for any dental services beyond those specified in HFS rule for adults. In other words, even in the event Medicaid eligibility may be established by DCFS, the individual is not covered for children’s services if over the age of 20. Illinois Department of Healthcare and Family Services Dental Policy Review Committee July 27, 2016 f. Procedures/DORM Updates: Dionne Haney, Illinois Executive Director DentaQuest of Illinois, informed the committee that theses sections of the DORM were updated on July 1, 2016: Section 1.04 All Kids/HFS Dental Program Copayments, Attachment BB, Attachment AA will have code D2394 added, Exhibit A will have Benefit Limitations for D1206/1208, and the new CDT codes D5221, D5222, D5223 and D5224. Dionne Haney presented the committee with a handout for D5221, D5222, D5223 and D5224 ADA Reference Codes which were added for children only with an effective date of July 1, 2016 and the new fee schedule has been posted on the HFS web site. g. Ortho Handicapping Labio Lingual Deviation (HLD) Index Score: Christina McCutchan informed the committee that HFS has decided to move away from the Salzmann score and Attachment G and use the Handicapping Labio-Lingual Deviation (HLD) Index Score. Do not know effective date as of yet. This will go into effect after approved by Joint Committee on Administrative Rules (JCAR) and transition is in place. Greg Johnson, from ISDS, raised the questions about who will be doing the scoring and will there be models. Christina informed the committee that we are just at the beginning of this process and there will be time to address all questions and concerns. h. Toothbrush Prophylaxis: D1120 Code: Stacey Ballweg, IDPH, raised the question of toothbrush prophylaxis and if this is allowable for school providers to provided and bill in place of an actual D1120. There is no scaling done with a tooth brush prophylaxis. Christina stated provided toothbrush prophylaxis should only be used as a last resort. Mary Margaret Looker, Central Counties Health Center, this can be an abused code if the tooth brush prophylaxis is allowed. Scott Goldman, AAPD, should be based on age. Mary Pat Burgess, Chicago Department of Public Health, should look at age limit, but only way to manage is to see how many are done in a day by a provider. V. Open Discussion: No issues were raised. VI. Adjournment: Henry Lotsof, Avesis, made a motion to adjourn the meeting, which was duly seconded by Jorelle Alexander, Cook County Health & Hospital System, and passed without objection by the committee. The meeting adjourned at 2:49 p.m. Next meeting is scheduled for October 26, 2016.