HFS – 2011 Annual Report Page 37
XI. DENTAL PROGRAM
The HFS Dental Program is administered by DentaQuest of Illinois, LLC (DentaQuest). Under a competitively procured contract, DentaQuest is responsible for dental claims adjudication and payment, prior approval of services, ongoing reporting to the Department, quality assurance monitoring, and developing and maintaining the Dental Office Reference Manual. DentaQuest provides additional services including provider recruitment and training, enrollee education and referral coordination, interactive Web site, toll-free telephone systems, and other functions required to assure beneficiary access to needed dental services.
The Dental Program offers a comprehensive dental package of services to children, including preventive, diagnostic, and restorative services. Dental coverage is limited to diagnostic and restorative services for the adult population. Over 75 percent of the services/reimbursements provided through HFS’ Dental Program are for children.
Beneficiary Outreach
HFS, in cooperation with DentaQuest, supports and encourages the concept of a “dental home” for all beneficiaries. Through the Beneficiary Outreach Initiative, beneficiary education and outreach programs were implemented in a variety of settings, including dental offices, medical offices, schools and community venues. A brochure is annually mailed to beneficiaries to reinforce the value of seeking treatment at a “dental home”.
These efforts are succeeding, as evidenced by the 2011 HEDIS results. The Department’s 2011 Annual Dental Visit HEDIS measurement shows that 54.55 percent of beneficiaries between 2 and 20 years of age, eligible for services, had at least one dental visit during the reporting period. This is up from 50 percent in 2009 and 51 percent in 2010.
Dental Program Expansion Efforts
HFS continues to work with publicly funded clinics to build the public health infrastructure necessary to improve dental care in underserved areas of the state. In July 2009, P. A. 96-0039 provided $2 million for dental clinic funding to the Capital Development Board over a three year period, as part of the 2010 capital budget. As of June 30, 2011, approximately $1.8 million of the $2 million in funds had been allocated to twenty-five entities to build or expand dental clinics. These grantees will be increasing access to dental services by adding seven new dental clinics and an additional 44 operatories throughout the state.
HFS has also developed a process to allow local health departments to claim Federal Financial Participation for the unreimbursed cost of providing dental services to Title XIX (Medicaid) clients. The cost must have been paid from local dollars and those dollars must not have been used to match any federal awards. To participate in the program the local health department must have a signed Interagency Agreement with HFS. Retroactive claiming from October 1, 2009 forward is allowed.
The All Kids School-based Dental Program offers out-of-office preventive dental services in a school setting to children ages 0-18 years. Providers who enroll with the All Kids School-based Dental Program must be able to render the full scope of preventive dental services including a comprehensive oral examination, prophylaxis, topical application of fluoride, and application of sealants. School-based providers must complete an Illinois Department of Public Health Proof of School Exam Form for each child seen, a School Exam Follow-up Form to be sent home with the student, and provide a referral plan for follow-up care. In addition, the provider must submit an
