Arizona – The National Academy for State Health Policy

Unwinding Medicaid’s Continuous Coverage Requirement: State Communication Strategies

September 8, 2022/in Health Coverage and Access, Policy Arizona, Arkansas, California, Hawaii, Illinois, Maryland, Nevada, New Hampshire, New York, Oklahoma, Utah, Wisconsin Blogs, Featured News Home COVID-19, Eligibility and Enrollment, State Insurance Marketplaces /by NASHP Staff

Engaging Tribal Populations to Improve Oral Health Care Access in Arizona

July 29, 2022/in Oral Health Arizona Featured News Home, Reports Oral Health /by Ella Roth and Allie Atkeson

State Innovations in Medicaid Managed Care for Mobile Crisis Services

March 18, 2022/in Medicaid Managed Care Arizona, New York, Virginia Blogs, Featured News Home Medicaid Managed Care /by Jodi Manz and Kitty Purington

Background

The American Rescue Plan Act (ARPA) establishes an enhanced 85 percent federal medical assistance percentage (FMAP) opportunity for mobile mental health crisis team services in Medicaid. This match supports states in ongoing efforts to build out mental health crisis systems that align to the core elements of a crisis continuum as outlined by the Substance Abuse and Mental Health Services Administration (SAMHSA): regional call centers, mobile response, and crisis stabilization facilities.

States may need to review and revise Medicaid state plans or other authorities in order to take full advantage of the enhanced FMAP opportunity. For states that deliver these services through managed care, Centers for Medicare and Medicaid Services (CMS) guidance indicates that qualifying crisis services must also be included in plan contracts, and the costs of those services integrated into corresponding capitation rates.

Prior to ARPA, several states expanded the delivery and payment of mobile crisis services under Medicaid care contracts. These innovations can continue as states seek the enhanced FMAP for mobile crisis services. Such innovations include:

Allowing assessments to be performed via telehealth. Section 9813 of ARPA requires that in order to qualify for the enhanced FMAP, mobile crisis teams must include at least one provider who can, under state requirements for scopes of practice, perform an assessment of an individual in crisis. Many states have or are considering allowing mobile crisis teams to conduct assessments via telehealth, as behavioral health workforce shortages and distance/transportation challenges can pose barriers, particularly in rural and underserved areas. For example:

Virginia’s Medicaid mobile crisis response services are included in the state’s Medallion 4.0 managed care contract, and the state’s mental health services manual outlines billing for “telemedicine assisted assessments” in which a non-licensed qualified mental health professional (QMHP) or certified substance abuse counselor (CSAC) can conduct an assessment with real-time remote support from a supervising licensed professional. This assessment is imperative to understanding the immediate factors contributing to a crisis, as well as the supports in place that can help to stabilize an individual; permitting the use of telehealth to provide an assessment can help to ensure that crises are de-escalated as quickly as possible and that mobile teams can make connections to follow up care as necessary.

Enabling managed care data transfer to support coordination and billing. As the first component of the crisis continuum, call centers triage crisis situations, assessing the for the need for higher levels of intervention from mobile crisis teams. Getting insurance information from callers in crisis may not be possible and may interrupt or distract from the primary functions of triage and assessment. This information is, however, necessary to facilitate Medicaid billing for these services.

Arizona takes a unique approach by contractually enabling information exchange among three entities: the state’s Regional Behavioral Health Authorities (RBHAs), their contracted call centers, and Medicaid managed care plans. Call centers receive minimal information from a caller – just first name, last name, and birth date – and use that to access an enrollment clearinghouse and data warehouse that contains both electronic health records and Medicaid managed care enrollment information submitted by the plans. Using these data, call centers can serve a further function, coordinating follow up services with community-based providers. This allows the centers to bill the managed care plans for both the call center services and care coordination after the call has been resolved.

Eliminating service authorization requirements. Behavioral health services may be subject to prior authorization requirements to ensure medical necessity before a service for a Medicaid beneficiary is approved for delivery. The nature of mobile mental health crisis services, however, makes prior authorization challenging. Several Medicaid managed care contracts explicitly state that plans may not require prior authorization for these services.

Virginia does not require prior authorization; instead, reimbursement for mobile crisis services is authorized using a registration process. This effectively notifies a Medicaid managed care plan of a provided service and indicates a need for ongoing coordination of care. This registration allows for eight hours (32 units) of services within a 72-hour period, and a service registration form must be submitted to the managed care plan within one business day.

Extending billable service windows post-crisis. Mobile crisis teams provide services for acute crisis events but also provide coordination of ongoing services or connections to higher levels of care upon resolution of the qualifying crisis.

New York’s billing guidance for mobile crisis intervention providers specifies that while services must be documented in clinical records within 24 hours of a crisis event, follow up services related to the event can be reimbursed within the 14-day period thereafter. During this time, providers can bill Medicaid managed care plans for follow up and coordination of services, including services to maintain stabilization and further engage community-based providers and other patient supports.

Aligning systems and innovation

The enhanced FMAP for team-based mobile crisis services offers an opportunity for states to develop innovations in mental health crisis systems, and Medicaid managed care contracts may be a helpful lever in maximizing state approaches. Issues such as workforce needs, systems coordination, and data infrastructure can be addressed in these contracts, connecting these services to broader state behavioral health systems. As states work across agencies to align existing resources and services in their Medicaid programs, leveraging managed care partners can help coordinate services and providers across the crisis continuum.

Acknowledgements: The authors at the National Academy for State Health Policy (NASHP) would like to thank the state officials from Arizona and Virginia who contributed their knowledge to this blog. In addition, we thank Health Resources and Services Administration Project Officer Diba Rab and her colleagues for their feedback and guidance. This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under co-operative agreement number UD3OA22891, National Organizations of State and Local Officials. The information, content, and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. government.

Through Coordination and Investment, Arizona Substantially Increases Access to School-Based Behavioral Health Services

April 26, 2021/in COVID-19 State Action Center, Policy Arizona Blogs, Featured News Home Back to School, Behavioral/Mental Health and SUD, Chronic and Complex Populations, Chronic Disease Prevention and Management, COVID-19, EPSDT, Health Equity, Integrated Care for Children, Maternal, Child, and Adolescent Health, Medicaid Managed Care, Medicaid Managed Care, Physical and Behavioral Health Integration, Population Health, Social Determinants of Health /by Anita Cardwell and Gia Gould

By leveraging federal Medicaid funding and state investment while simultaneously clarifying complex billing procedures and enhancing engagement with providers, Arizona has made remarkable progress in increasing student access to critical school-based behavioral health services.

Arizona’s efforts to improve school behavioral health services began in 2018 when its state legislature allocated $3 million from the state’s general fund to expand these services. The state’s Medicaid program, the Arizona Health Care Cost Containment System (AHCCCS), and the Arizona Department of Education (DOE) used $1 million of this funding to provide schools with mental health training, and the remaining $2 million was matched with federal Medicaid funds, resulting in a total $10 million in Medicaid funding to increase the number of behavioral health providers in schools.

To obtain Medicaid reimbursement for school-based services under the Medicaid School-Based Claiming (MSBC) program, Arizona’s local education agencies (LEAs) use two school-based claiming programs, the Direct Service Claiming (DSC) program and the Medicaid Administrative Claiming (MAC) program. LEAs seek Medicaid reimbursement through the DSC program to cover the cost of providing medical and behavioral health services to Medicaid-eligible students with an Individualized Education Program (IEP). The MAC program provides LEAs with reimbursement for administrative outreach services for Medicaid that are conducted in school settings. The state contracts with a third-party administrator, Public Consulting Group (PCG), to process Medicaid school-based claims.

In addition to claims processed through the MSBC program for students with IEPs, Medicaid services delivered by behavioral health providers contracted through one of AHCCCS’ managed care organizations can be reimbursed by Medicaid regardless of whether the student has an IEP.

Challenges and Solutions

Improving partnerships and coordination between schools and providers: While Arizona provided school behavioral health services before 2018, the additional state funding helped prioritize these services and facilitated the development of new relationships between behavioral health providers and schools. State officials reported that prior to the initiative to promote school-based behavioral health services, there were some challenges related to establishing relationships between schools and providers.

For example, some school administrators were skeptical if they could bill for school-based services or were concerned about the logistics of providing appropriate space to conduct behavioral health services without interrupting usual school activities. Many of these issues have been addressed through extensive and ongoing training sessions with both school administrators and provider groups. State officials also credited the cross-sector workgroup meetings that are held on a regular basis with helping improve interagency relationships.

Another key factor in Arizona’s success was incentivizing partnerships between schools and behavioral health provider agencies to create a differential adjusted payment for behavioral health providers. The enhanced payment became effective in October 2019, and provides a 1 percent rate increase for providers that have a memorandum of understanding with three or more schools to provide behavioral health services, and a 3 percent rate increase for providers that are autism Centers of Excellence.

State officials at AHCCCS also are in the process of improving data sharing with the DOE. By matching school identifier numbers on claims for services provided on a school campus, or as the result of a referral from an educational entity, the state will be able to obtain a better understanding of where and which services are delivered. Improving these data-matching processes will also provide information about where students are being referred for additional services and help identify where future focus should be directed within the state to enhance school-based behavioral health services.

Another key partnership to support students’ behavioral health needs is AHCCCS’ collaboration with the Arizona DOE on several grants, including Project Aware, which is funded by the Substance Abuse and Mental Health Services Administration (SAMHSA). Project AWARE works with three school districts to provide suicide prevention and behavioral health resources.

Addressing lack of behavioral health providers and service delivery challenges: Arizona state officials identified the lack of behavioral health providers, particularly in rural regions, as an issue faced by many states. However, Arizona officials are pleased and encouraged by the number of providers who are participating in the state’s expansion of school-based behavioral health services. One factor that likely incentivized greater provider engagement was the implementation of the differential adjusted payment, although state officials indicated that there had already been a growing interest among behavioral health providers to develop new school partnerships to reach more students due to the statewide focus on the issue.

School districts in Arizona have also developed creative solutions to connect their students to behavioral health services. One school district in Arizona responded to provider shortages and space limitations by setting up a dedicated mobile unit in the school parking lot for behavioral health services. Prior to bringing in the mobile clinic, providers did not have financial incentives to travel to the school because it was difficult to secure an appropriate office during the school day. With the mobile unit, the district can provide consistency for their providers as well as a private space for students to receive behavioral health care. However, because the care is not technically provided in the school building, the district needed to work with the state Medicaid agency to find a way to appropriately bill under school-based behavioral health services.

Clarifying qualifying services and billing procedures: The state’s increased focus on the provision of behavioral health services in schools also helped to improve the accuracy of billing code processes. When efforts to expand school-based behavioral health services were initially launched, state officials at AHCCCS actively worked to address some of the existing misunderstandings about the allowability for those services to be provided at a school campus outside of the MSBC program. State officials recognized that due to errors in coding related to where services are provided, some school-based behavioral health services were not being correctly captured, resulting in the state not having a clear picture of the scope of services being provided to students.

To address these issues, AHCCCS coordinated and led many informational learning sessions throughout the state for both educators and provider agencies, including trainings about billing procedures. Once providers learned how to assign the correct place of service code, state officials reported a notable increase in the quantity of behavioral health services provided. State officials attributed the increase not only to the coding improvements that more accurately captured completed work, but also due to new services provided as a result of the state’s overall emphasis and investment in school behavioral health services.

Like many states, Arizona uses a Random Moment Time Study (RMTS) to assess the amount of time providers spend engaged in Medicaid-reimbursable activities. Each LEA has a RMTS coordinator who facilitates the administration of the program. As the third-party administrator, PCG manages the overall RMTS process, and provides program-specific introductory trainings for new coordinators and LEAs as well as recurring trainings to provide program updates and address areas of concern. AHCCCS coordinates with PCG to improve the RMTS process, and at present, AHCCCS consistently meets RMTS compliance standards, despite having to transition to virtual trainings during the COVID-19 pandemic.

Effect of COVID-19: The transition to mobile learning due to COVID-19-related school closures has presented an opportunity for schools to provide behavioral health services through virtual platforms. State officials report there has been a reduction in the number of claims that use place-of-service codes, which indicate when services are provided at an educational institution, most likely due to the decrease in the number of students attending school in person because of the pandemic. However, officials indicated that they have observed a dramatic increase in the amount of behavioral health services currently delivered through telehealth as more students have had to operate within a remote learning environment.

For districts without local providers, the ability to work with students without travel has helped connect more children to care. According to one Arizona state official, many behavioral health providers have gone above and beyond to connect with children whose need for care has been exacerbated by stress and isolation resulting from the pandemic.

State officials said there is anecdotal evidence that the pandemic has caused an increase in the number of parents expressing concern that their children are exhibiting depression and/or suicidal tendencies. However, officials also noted they have observed a greater willingness among parents to discuss issues concerning mental health, which could result in parents more actively advocating to ensure that schools continue to offer behavioral health services.

Overall Success

Since the start of the state’s efforts to expand behavioral health services in schools in 2018, officials report progress has been remarkably successful throughout 2019 and into early 2020, and there has been a substantial increase in the number of students who have received behavioral health services from an educational entity or institution. While declines in the number of youth suicides cannot be directly correlated with the state’s expansion of behavioral health services — and data from the effect of the pandemic is not yet available — there was a 41 percent decrease in youth suicides from 2018 through 2019.

State officials report their efforts have been so successful that in 2020 the state legislature passed SB 1523, which established and allocated $8 million to a new Children’s Behavioral Health Services Fund that will further enhance school-based behavioral health services. The fund will be administered by AHCCCS and provides behavioral health services to students who are not Medicaid-eligible but are uninsured or under-insured and who receive a referral for services from an educational institution.

In reflecting on lessons from Arizona’s expansion of school-based behavioral health services that might be used by other states, officials explained that determining how to handle nuanced billing situations, such as telehealth and the state’s mobile unit, was an important factor in ensuring that all provided services were accurately captured and reimbursed. They commented, “If Arizona can do it, anyone can do it — we are ranked 51st in [the nation for] education funding, and we have the poorest counselor-to-student ratio in the nation…that said, we have this great state Medicaid agency, and we’ve been able to figure out how to reach more kids with the dollars given to us. And so, if Arizona can figure out how to do this sort of work and get these partners on school campuses, then any other state can do this.”

The National Academy for State Health Policy (NASHP) would like to thank state officials from Arizona for their time and contribution to this publication. Support for this work was provided by the David and Lucile Packard Foundation. The views expressed here do not necessarily reflect the views of the foundation.

Nine States Advance Prescription Drug Affordability Board Legislation

March 15, 2021/in Prescription Drug Pricing Arizona, Colorado, Minnesota, New Jersey, New Mexico, Oregon, Rhode Island, Virginia, Wisconsin Blogs, Featured News Home Model Legislation, Newly-Enacted Laws, Prescription Drug Pricing, State Rx Legislative Action /by Jennifer Reck and Trish Riley

More than 200 bills to lower drug prices have been filed across states during this session and nine states are proposing prescription drug affordability board (PDAB) legislation.

PDABs are somewhat analogous to public utility commissions. They investigate high-priced drugs and, when necessary, set more affordable rates for certain drugs for purchasers within a state. Establishing health care provider and hospital payment rates is a common approach states use to ensure services are affordable. State PDABs extend this strategy to a subset of very costly prescription drugs, while avoiding unlawful patent preemption because they establish drug payment rates – not prices. The National Academy for State Health Policy (NASHP) developed model legislation for this approach in 2017 and in 2019 Maryland became the first state in the nation to enact PDAB legislation.

This chart highlights nine states’ bills to create prescription drug affordability boards, including their implementation timelines, funding sources, enforcement, and purchasers impacted.

Nine states (AZ, CO, MN, NJ, NM, OR, RI, VA, and WI) are currently advancing PDAB bills in their legislatures. While a number of these bills are similar to Maryland’s approach that phases in upper payment limits by initially limiting them to public purchasers before potentially expanding them to include private purchasers, the majority of the currently proposed bills map more closely to NASHP’s original model legislation, which implements payment limits across all payers (public and private) in a state in a more expedited fashion.

The bills are generally similar in two approaches:

They use similar price thresholds to identify a drug for investigation by their PDABs, and
They apply the same factors when setting an upper payment limit for drugs found to be otherwise unaffordable – such as weighing the cost of administering the drug and delivering the drug to consumers.

Minnesota’s bill, however, includes unique language that empowers its PDAB to consider both the “the range of prices at which [a] drug is sold in the United States and the range at which pharmacies are reimbursed [for it] in Canada.” This language creates a bridge between the PDAB model and a newer approach in a recently released NASHP model law that creates payment rates for certain high-priced drugs based on Canadian pricing. This approach, reflected in NASHP’s Act to Reduce Prescription Drug Costs Using International Pricing, offers states a more streamlined approach than establishing a PDAB, which requires the complex task of determining the appropriate value of a drug in order to set an affordable payment rate. Five states (HI, ME, OK, ND, and RI) are currently considering international reference rate bills that use (or “reference”) Canadian prices to set more affordable rates.

As states consider PDABs and international reference rate approaches to achieve the goal of setting more affordable payment rates for drugs, there are several key factors to consider.

While international reference rates look to Canada’s drug prices when establishing appropriate payment rates, PDABs keep the task of identifying affordable rates within a state.
While PDABs may be conceptually preferable for this reason, the time and resources required to implement this approach may not make PDABs feasible for all states. For those states, using Canadian prices to set rates may be the most viable option.

Minnesota’s bill, however, points to a third option, a hybrid approach in which a PDAB would consider Canadian pricing as part of its process.

Explore this chart to compare the different state approaches and implementation timelines of the nine PDAB bills proposed as of March 9, 2021.

Webinar: Avoiding Dual Epidemics – State Strategies to Prevent Flu during COVID-19

October 13, 2020/in Policy Arizona, Illinois Webinars Chronic Disease Prevention and Management, COVID-19, Health Equity, Population Health, Social Determinants of Health /by NASHP Staff

Strategic planning for the 2020-2021 flu season during the COVID-19 pandemic is critically important to ensure that states do not experience dual epidemics this year. In this November, 2020 webinar, NASHP, in partnership with AcademyHealth and Immunize Colorado, provided a national overview of flu prevention priorities from the Centers for Disease Control and Prevention (CDC), and a closer look at state strategies in Arizona and Illinois.

Speakers discussed how states can ensure equitable access to the flu vaccine, including expanding access to immunizations through pharmacies and other delivery sites to reach vulnerable populations, and various payment and reimbursement strategies. This webinar was funded by the CDC.

Participants included:

Moderator: Jill Rosenthal, MPH, NASHP Senior Project Director
Sam Graitcer, MD, CDR, Medical Officer and Pandemic Influenza Coordinator, Centers for Disease Control and Prevention
Jami Snyder, MA, Director, Arizona Health Care Cost Containment System
Ngozi Ezike, MD, Director, Illinois Department of Public Health

4 p.m. (ET) Thursday, Nov. 12, 2020

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Arizona CHIP Fact Sheet

December 5, 2019/in Policy Arizona /by NASHP Staff

States Increase Access to Oral Health Services and Support Overall Health

November 25, 2019/in Policy Arizona, Minnesota Blogs, Featured News Home Chronic Disease Prevention and Management, Community Health Workers, Health Coverage and Access, Health Equity, Medicaid Managed Care, Medicaid Managed Care, Oral Health, Population Health, Workforce Capacity /by Carrie Hanlon and Neva Kaye

State officials continue to develop new approaches to increase access to oral health services, and many of their innovations were highlighted at National Academy for State Health Policy’s 2019 conference. There are ongoing initiatives, such as deploying community health workers in Minnesota, a New Hampshire Medicaid and Women, Infants, and Children Nutrition Program pay-for-prevention, bundled payment pilot for children’s preventive oral health services, and implementation of new Medicaid policies to expand access in Arizona and Utah.

These oral health policies underscore the critical relationship between increased access to oral health for overall health, a relationship that is highlighted in two new NASHP fact sheets that explore how states are expanding their oral health workforce: Minnesota Deploys Community Health Workers and Dental Therapists to Advance Equity and Arizona Uses Dental Hygienists to Improve Hospital Patient Safety.

For ventilator-assisted patients, good oral health supports patient safety. As an Arizona Department of Health Services representative discussed at NASHP’s conference, state legislation enacted in May 2019 changed scope-of-practice laws to allows dental hygienists working in hospital settings to practice under the supervision of a licensed physician.

A volunteer project enabled Arizona to test the use of dental hygienists to provide oral health care to ventilator-assisted patients — a strategy recommended by the US Centers for Disease Control and Prevention to reduce ventilator assisted pneumonia (VAP). VAP, which is usually caused by oral bacteria, was the leading cause of death from nosocomial infections in critically ill patients and significantly increased hospital costs. This project identified the scope-of-practice law, which required supervision by a dentist, as a key barrier to having dental hygienists in hospitals to improve oral health to support the overall health of ventilator-dependent patients. To learn more, read Arizona Uses Dental Hygienists to Improve Hospital Patient Safety.

Good oral health also supports overall health among adults with substance use disorder (SUD). As a representative from the Utah Department of Health’s Division of Medicaid and Health Financing highlighted at the conference, the state added dental benefits for targeted adult Medicaid beneficiaries with SUD in January 2019. The beneficiaries receive dental care at the University of Utah School of Dentistry and affiliated providers. The policy builds on the innovative Project FLOSS – Facilitating a Lifetime of Oral Health Sustainability for Substance Use Disorder Patients and Families. Project FLOSS demonstrated that providing comprehensive integrated dental and SUD care was associated with increased SUD treatment completion, employment, and drug abstinence, along with reduced homelessness among adults.

Emerging health professionals, such as community health workers (CHWs), promote overall health and health equity. Minnesota is one of just a few states that include a specific CHW role to promote oral health — helping to link oral health and overall health. In 2005, Minnesota became the first state to implement a for-credit, transferrable-credit CHW certificate program through its state college system and private higher education institutions. CHWs work under the supervision of eligible Medicaid providers in the state, including dentists. By providing culturally competent, high-quality access to services and increasing the health knowledge of the individuals they serve, CHWs can help reduce disparities. To learn more about the role of CHWs and dental therapists, read Minnesota Deploys Community Health Workers and Dental Therapists to Advance Equity.

In 2020, NASHP will continue to track state policy changes and efforts to increase access to pediatric and adult oral health services as part of states’ commitment to promote overall health.

The DentaQuest Partnership for Oral Health Advancement supported the conference session and these fact sheets.

Expanding the Oral Health Workforce to Promote Overall Health: Arizona Uses Dental Hygienists to Improve Hospital Patient Safety

November 25, 2019/in Policy Arizona Reports Chronic and Complex Populations, Chronic Disease Prevention and Management, Cost, Payment, and Delivery Reform, Health Coverage and Access, Health Equity, Health System Costs, Medicaid Managed Care, Medicaid Managed Care, Oral Health, Population Health, Workforce Capacity /by Neva Kaye

Arizona recently made an innovative change in its scope-of-practice rules governing supervision of dental hygienists to enable hospitals to more easily use these providers to help prevent ventilator-assisted pneumonia (VAP) – the leading cause of death from nosocomial infections in critically ill patients. VAP, the second most common nosocomial infection, increases the duration of hospitalizations by seven days and health care costs by approximately $40,000 per hospitalization.¹

Preventing VAP is important to reducing both hospital-acquired infections and health care costs. VAP usually occurs when a patient aspirates oral bacteria. The US Centers for Disease Control and Prevention, in recognizing the importance of oral care to VAP prevention efforts, suggests that hospitals, “develop and implement a comprehensive oral-hygiene program (that might include the use of an antiseptic agent) for patients in acute care settings or residents in long-term care facilities who are at high risk for health-care-associated pneumonia.”²

Nurses often provide oral-hygiene care to ventilator-dependent hospital patients, but some hospitals prefer to use dental hygienists to provide that service because of hygienists’ expertise and to give nurses more time for other responsibilities. However, hospitals in Arizona encountered challenges to assigning dental hygienists to this task. States’ scope-of-practice laws usually allow dental hygienists to provide care only under the supervision of a dentist. But hospitals may not have dentists on staff, or if they do, the dentist may not be available to order the care when needed.

In May 2019, Arizona enacted HB 2058, which allows dental hygienists working in hospital settings to practice under the supervision of a licensed physician. In addition, the supervising physician must be available for consultation but does not need to be physically present when the care is administered.

Changing the Scope of Practice Required Innovative Partnerships Among Providers

HB 2058 affects how physicians, oral hygienists, nurses, hospitals, and dentists work together. For example, nurses had traditionally provided oral health care in hospitals and they needed to understand that the change would not reduce their role, but rather free up their time to provide other critical services. Also, physicians needed to understand their responsibilities in supervising dental hygienists. As a result, crafting the legislation required partnerships and cooperation among the associations representing these providers. A volunteer project fostered these partnerships and generated real-life examples that confirmed that the scope-of-practice laws needed to be changed to enable hospitals to use dental hygienists to effectively provide dental hygiene in hospital settings.

Remaining Challenges and Next Steps

Although changing dental hygienists’ scope of practice facilitates their ability to practice in hospitals, challenges remain. For example, allowing hygienists to provide services does not obligate public and private insurers to pay for those services. Even before the bill passed, one regional hospital began hiring dental hygienists to work in its intensive care unit and the hospital then sought reimbursement for the hygienists’ services through medical billing — an action made possible by the change in the scope-of-practice rule. However, because Medicare does not recognize dental hygienists as a provider type, the hospital will not receive payment from Medicare. At this time, it is not known whether other payers will choose to pay for oral hygiene services provided to hospital patients by oral hygienists.

State health officials are tracking the results of this new innovation. They plan to assess patient outcomes, including VAP reduction, costs, and whether more hospitals implement this innovation. Depending on the results, officials are considering developing education programs or training to foster the innovation’s expansion. State policymakers are also considering expanding the physician-supervision model to long-term care facilities.

Acknowledgements: The National Academy for State Health Policy (NASHP) would like to thank officials with the Arizona Department of Health Services who shared their time and insights. The author also thanks Carrie Hanlon, Elinor Higgins, and Trish Riley of NASHP. She also would like to thank Trenae Simpson, M. Parrish Ravelli, and the DentaQuest Partnership for Advancing Oral Health for funding this project.

Notes

[1] Timsit, J.J., et al. (2017) Update on ventilator-associated pneumonia. F1000 Research. 6:2061. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5710313/
[2] Centers for Disease Control and Prevention (2003). Guidelines for Preventing Health-Care—Associated Pneumonia. CDC Morbidity and Mortality Weekly Report. https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5303a1.htm

Ten States Selected to Attend Palliative Care Summit in Chicago

June 18, 2019/in Policy Arizona, Colorado, Hawaii, Kentucky, Massachusetts, Minnesota, Ohio, Oklahoma, Pennsylvania, Texas Blogs, Featured News Home Care Coordination, Chronic and Complex Populations, Chronic Disease Prevention and Management, Cost, Payment, and Delivery Reform, Health Coverage and Access, Long-Term Care, Medicaid Managed Care, Medicaid Managed Care, Palliative Care, Physical and Behavioral Health Integration, Population Health, Primary Care/Patient-Centered/Health Home, Quality and Measurement /by NASHP Writers

NASHP is pleased to announce the 10 states selected to attend the State Policymakers Palliative Care Summit, supported by a grant from The John A. Hartford Foundation. Policymakers, including legislators as well as Medicaid and public health officials from Arizona, Colorado, Hawaii, Kentucky, Massachusetts, Minnesota, Ohio, Oklahoma, Pennsylvania, and Texas, will participate in the day-long summit where they will learn from national and state experts about strategies to improve access to and quality of palliative care. For more information about palliative care, explore NASHP’s Palliative Care Resource Hub and sign up for its palliative care listserv.