special pull-out section affordable care act and you
impact on you, continued
39. Will medical carriers now be required to provide dental insurance?
No. If medical carriers do not provide dental coverage, they will need to develop a contractual relationship with a dental carrier. For example, Group Health Cooperative is planning to work with United Concordia to provide their enrollees with pediatric dental coverage.
40. Where can adults purchase dental insurance?
In 2014, adult dental insurance will not be offered on Washington Healthplanfinder. Adult dental coverage may be offered on the Exchange at a later date. Adult dental coverage can be purchased outside of the Exchange.
41. Will adults with Medicaid coverage have a dental benefit?
Yes. The Washington State Legislature restored funding for a comprehensive dental benefit for Medicaid eligible adults that takes effect on January 1, 2014. The legislature also decided to expand Medicaid eligibility to more low income adults. Under the Affordable Care Act, states have the option to expand Medicaid eligibility to all adults who earn less than 138 percent of the federal poverty level. Initially, the federal government will pay 100 percent of the cost of Medicaid benefits for this expansion population. The federal match eventually drops to a 90 percent match in a few years. Restoring a comprehensive dental benefit for the existing Medicaid-eligible adults allows the state to also provide a comprehensive dental benefit for adults who are newly eligible for Medicaid under Medicaid expansion.
42. If dental coverage is embedded into medical coverage, will dental offices have to use medical codes for dental procedures?
No. Dental codes will still be used for billing dental procedures.
43. Is there a mandate for dental offices to have electronic health records (EHRs)? No. The ACA does not require dental offices to integrate EHRs into their practices. However, the ACA does provide funding for dental offices to transition to EHRs if they decide to do so. For more information about electronic health record incentive payments, please contact Bracken Killpack at bracken@wsda.org.
44. What are Accountable Care Organizations (ACOs)?
The ACA established a pilot program called the Medicare Shared Savings Program which encouraged the formation of Accountable Care Organizations (ACOs). In general terms, ACOs are entities comprised of health care providers (hospitals, physicians, home health agencies and others) who collaborate to provide coordinated care to a defined population for a bundled payment. ACOs are designed to align provider incentives with the provision of quality care (employing evidence-based protocols) rather than the volume of services. ACOs consist of two main features. First, ACOs are designated accountable provider entities that share responsibility for treating a group of patients. Second, ACOs have new payment approaches that are based on performance measures. This could mean that fee-for-service could be supplanted by reimbursement based on patient outcomes and performance.
46. What do I need to do to become a provider for insurance carriers? If you would like to become a preferred provider with insurance carriers in Washington, you must contract the carriers directly to obtain their provider application and requirements. The following is a list of many of the carriers providing dental coverage in 2014:
Delta Dental
Provider Services team at (206) 528-7394 or (800) 238-3439 http://www.deltadentalwa.com/Dentist/Public/Join%20 WDS%20Networks.aspx
LifeMap
Loretta Eline, (206) 332-5012 or Alan Hong, (206) 3323937 https://www.lifemapco.com/provider/join-network/advantages
Lifewise
Provider Relations Department: 877-342-5258, option 4. https://www.lifewisewa.com/provider/join-our-network/
Premera
Provider Relations Department at 877-342-5258, option 4. https://www.premera.com/wa/provider/
Regence
regence_credentialing@regence.com http://www.wa.regence.com/provider/contracts-credentialing/ http://www.wa.regence.com/provider/docs/dental-consultants.pdf
United Concordia
Contact Number: 1-800-307-8514 www.unitedconcordia.com/dental-insurance/dentists/joinour-network/
Dental Health Services
www.www.dentalhealthservices.com/dentists
45. Will ACOs impact dentistry in Washington state?
There is no publically available information to indicate that any ACOs in Washington state are providing dental care. Some ACOs in Minnesota, New Jersey, and Oregon intend to provide dental care.
3 4 路 th e wsda ne w s 路 issue 1, october 路 2013 路 www.wsda.org