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Dental Services for Medicaid Adults in Long-Term Care Facilities in Texas
Healthy Aging Webinar
October 13, 2009
Linda M. Altenhoff, DDS
Background Incurred medical expense (IME) funds can
be used to pay for dental services Private pay arrangement between the
patient and the dentist outside of Medicaid No standardized dental fee schedule Regional nurses reviewed/approved all non-
routine dental services Disconnect regarding “routine” dental
services Dental provider concerns State program concerns
Legislative Direction
Senate Bill (SB)1188 passed during 2005 legislative session
SB 1188 required the state to:Use fee schedules for reimbursable
IME dental servicesForm a Dental IME workgroup to
assist in development of the dental fee schedule
Dental IME Workgroup
Began meeting in 2006 Members included:
Private practice dentistsNursing facility representativesLong-term care advocatesState staff
Dental IME Workgroup Goals
Establish a statewide dental fee schedule
Review and streamline the dental IME approval processInclude dentists in review processExpand routine dental services
Outcomes Achieved Established the use of the American
Dental Association Survey of FeesCost of living index adjustment
Defined routine dental services that do not require prior approval
Defined non-routine dental services that do require prior authorization
Utilize state dentists to review treatment plans for non-routine dental services
Contact Information
Linda M. Altenhoff, DDSState Dental Director/Oral Health
Program Manager
Texas Department of State Health Services
(512) 458-7111 ext 3001
