Medicaid Health Plans Michigan医疗卫生计划密歇根.pptVIP

MEDICAID HEALTH PLANSDental Services Dental, Craniofacial and Oral/Maxillofacial Surgery Nancy Gurzick, RDH, BS, MA Dental Policy Analyst Michigan Department of Community Health OBJECTIVES Understand the different oral/facial specialties and the services provided Understand which procedures are MEDICAL Which procedures are DENTAL Understand which procedures are the responsibility of the Health Plans Basic terminology GENERAL DENTISTRY General dentistry is not a benefit covered by the Health Plans General dentistry is a benefit covered by Medicaid Transportation for dental appointments should be arranged through the Department of Human Services (DHS) HEALTHY KIDS DENTAL HKD is a contract between Delta Dental and MDCH and covers dental services for Medicaid eligible beneficiaries 21 who reside in the 75 participating counties. DHS identifies the eligible beneficiaries on a monthly basis and provides this information through Bridges to CHAMPS. Eligible beneficiaries are assigned to the HKD program and this information is provided to Delta Dental. This 3-step process can result in delays in coverage so it is so important the verification of eligibility is done before every appointment. HEALTHY KIDS DENTAL Transportation for dental appointments for HKD beneficiaries and Medicaid FFS should be arranged by DHS. Delta Dental does not provide transportation for HKD beneficiaries. Most Medicaid eligible beneficiaries who reside in the 75 participating counties are automatically enrolled in HKD, but there will always be a FFS component in HKD counties due to special living arrangements. ORAL/FACIAL SPECIALTIES Oral/facial specialties cross-over between medical and dental in many areas. Need an understanding of each specialty: Craniofacial Reconstructive Surgeon Orthodontist Oral Surgeon HEALTH PLAN RESPONSIBILITIES Medical service is the responsibility of the Health Plan Dental is a “carved out” service and is not the responsibility of the Health Plan. TRAN