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Highlights

The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) required GAO to study children's access to dental care. GAO assessed (1) the extent to which dentists participate in Medicaid and the Children's Health Insurance Program (CHIP) and federal efforts to help families find participating dentists; (2) data on access for Medicaid and CHIP children in different states and in managed care; (3) federal efforts to improve access in underserved areas; and (4) how states and other countries have used mid-level dental providers to improve children's access. To do this, GAO (1) examined state reported dentist participation and the Department of Health and Human Services's (HHS) Insure Kids Now Web site for all 50 states and the District of Columbia and called a non-representative sample of dentists in four states; (2) reviewed national data on provision of Medicaid dental services and use of managed care; (3) interviewed HHS officials and assessed certain HHS dental programs; and (4) interviewed officials in eight states and four countries on the use of mid-level and other dental providers.

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Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Health and Human Services To enhance the provision of dental care to children covered by Medicaid and CHIP, and to help ensure that HHS's Insure Kids Now Web site is a useful tool to help connect children covered by Medicaid and CHIP with participating dentists who will treat them, the Secretary of HHS should establish a process to periodically verify that the dentist lists posted by states on the Insure Kids Now Web site are complete, usable, and accurate, and ensure that states and participating dentists have a common understanding of what it means for a dentist to indicate he or she can treat children with special needs.
Closed - Implemented
HHS has reported taking steps to improve the data on the Insure Kids Now website, including establishing an ongoing system to check that data are in the correct format and conducting validation surveys. The Centers for Medicare & Medicaid Services (CMS) has also provided training to Medicaid staff on identifying dentists' capabilities to treat children with special needs and has developed and disseminated a flyer for families on how to identify dentists who can treat children with special needs and questions to ask to ensure that dentists understand their needs.
Department of Health and Human Services To enhance the provision of dental care to children covered by Medicaid and CHIP, and to help ensure that HHS's Insure Kids Now Web site is a useful tool to help connect children covered by Medicaid and CHIP with participating dentists who will treat them, the Secretary of HHS should provide alternate sources of information, such as HHS's toll-free 1-877-KIDS-NOW telephone number, on the Insure Kids Now Web site when a page or link from the Web site is not functioning or taken offline for maintenance.
Closed - Implemented
The Insure Kids Now website now has the 1-877-KIDS-NOW phone number listed on the home page and every state specific web page, as a backup for when links from the website are not functional.
Department of Health and Human Services To enhance the provision of dental care to children covered by Medicaid and CHIP, and to help ensure that HHS's Insure Kids Now Web site is a useful tool to help connect children covered by Medicaid and CHIP with participating dentists who will treat them, the Secretary of HHS should require states to verify that dentists listed on the Insure Kids Now Web site have not been excluded from Medicaid and CHIP by the HHS-OIG, and periodically verify that excluded providers are not included on the lists posted by the states.
Closed - Implemented
As of June 2021, CMS reported that it has addressed both elements of this recommendation. First, to ensure that dentists who have been excluded from Medicaid and CHIP do not appear on states' lists of participating providers on the Insure Kids Now website, CMS has revised its technical guidance to explicitly require states to routinely verify that excluded providers do not appear on their lists, and if any are found, that states quickly remove them. Second, to establish a system to periodically verify that states have not listed any excluded providers, CMS expanded an existing vendor contract to include a cross-check for excluded providers. Specifically, CMS added an additional component to its existing contract for quality insurance support for the Insure Kids Now website, which requires the vendor to conduct an annual comparison to the List of Excluded Individuals and Entities. By taking these steps, CMS will help ensure that children covered by Medicaid and CHIP can locate participating dentists who have not been excluded from these federal programs.
Centers for Medicare and Medicaid Services To enhance the provision of dental care to children covered by Medicaid and CHIP, and to strengthen CMS oversight of Medicaid and CHIP dental services provided by dental managed care programs, the Administrator of the Centers for Medicare & Medicaid Services (CMS) should take steps to ensure that states gather comprehensive and reliable data on the provision of Medicaid and CHIP dental services by managed care programs.
Closed - Implemented
CMS has revised the instructions for its Form-416, beginning in FY 2014, to specify that fields collecting data on dental service utilization be inclusive of Medicaid beneficiaries enrolled in managed care.

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