New Child Oral Care Benefit Required as Preventive Care
United States Preventative Services Task Force
Final Recommendation on Children’s Fluoride Varnish Treatments
Who: Children covered for insurance under Medicare, Medicaid or private insurance (individual and group plans whether insured or self-insured) subject to the Preventive Care requirements of the Patient Protection and Affordable Care Act (PPACA).
When: Starting the later of January 1, 2015 or the beginning of their next plan year.
What: The PPACA requirement for preventive care coverage at 100% (no patient out of pocket costs) has been expanded by the United States Preventive Services Task Force (USPSTF) recommendation to include fluoride varnish to the primary teeth of all infants and children starting with primary tooth eruption.
Executive Summary: Fluoride varnish is a temporarily adhesive form of fluoride applied to the tooth surface that helps prevent childhood caries (tooth decays). The new USPSTF recommendation for preventing childhood caries adds child fluoride varnish treatment. This updates the previous childhood dental recommendation issued in 2004 (included in the original list of PPACA preventive care services), when only the oral fluoride supplementation was recommended for children in areas with fluoride levels below 0.6 ppm in the local drinking water. That recommendation remains, with the fluoride varnish added based on new research.
Both interventions are now recognized as “USPSTF B recommendations” and therefore are required by the Affordable Care Act to be covered by insurers without out of pocket costs to the patient, as with all preventive care services that receive an A or B recommendation.
The target audience for USPSTF recommendations is primary care clinicians, who provide a wide range of health care services to children and adults. Although dentists can be considered primary care providers of oral health needs, for the purposes of this recommendation statement, a primary care clinician or primary care provider is defined as a non-dental health care professional (e.g., physician, nurse practitioner).
Actions: Employers Plan sponsors should consult with their agent, broker, plan consultant, legal counsel, or Human Resources Department to determine if and when any contract changes are required to satisfy the new preventive services requirement for fluoride varnish treatments. They should also assure that their employee notifications properly inform plan participants of any changes. Insurers will need to review their plan offerings to assure compliance.
For more details go to: http://www.uspreventiveservicestaskforce.org/uspstf12/dentalprek/dentchfinalrs.htm
The information presented and contained within this article was submitted by Ronald E. Bachman, President & CEO of Healthcare Visions and Chairman of the IHC Editorial Advisory Board. This information is general information only, and does not, and is not intended to constitute legal advice. You should consult legal advisors to determine the laws and regulations in your state. Any opinions expressed within this document are solely the opinion of the individual author.