Health and Human Services Commission
FREW Medical and Dental Initiatives
Proposal:
Attachment A: Mobile Dental Unit in HHSC Region 11 (Rio Grande Valley)
Children living in rural, border, and frontier areas of Texas who are enrolled in
Texas Medicaid may experience challenges accessing a Medicaid dental provider
as a result of the lack of dentists located in the area the child is living in, the current
limited number of dentists enrolled as Medicaid providers across the state, and/or
transportation issues. Mobile dental units (MDUs) have been utilized by state oral
health programs, city/county health departments, dental academic institutions, nonprofit professional, community- and faith-based organizations, and for-profit
private practice dentists as an alternative delivery system to provide access to
needed dental services in underserved locations in Texas. The utilization of a MDU
in Region 11 could provide access for Medicaid enrolled children to dental services
that may otherwise not be readily available, convenient or would require extensive
travel in order to access.
MDUs are typically equipped in order to provide the following scope of treatment:
Background:

Preventive services such as oral exams, x-rays, cleanings, fluoride
treatment, and dental sealants;

Restorative services including fillings, stainless steel crowns, root canals,
and simple extractions; and

Educational instruction for parents and children on correct brushing,
flossing techniques, and complete oral care.
The MDUs may be funded and sponsored by public dollars, private companies,
non-profit entities or a combination of these sources.
The target population for MDU services may be all children, only Medicaid
children, certain low-income adults, and/or any uninsured clients. The number of
individuals treated varies by location, number of staff working the MDU, hours of
operation of the MDU, and the scope of dental services offered through the MDU.
Staffing for MDUs typically includes a general dentist, dental hygienist, dental
assistant, an administrative assistant to facilitate scheduling and billing, and a
driver (may also function as the administrative assistant). Although the MDUs are
generally outfitted to be self-contained, in order to function for extended clinical
time frames, operational sites need to have appropriate electric, water, and waste
hook-ups. Additionally, MDUs are required to be ADA compliant for persons with
disabilities. Adequate parking and easy accessibility is also important.
Target operational locations are usually designated health professional shortage
areas as defined by the US Health Resources and Services Administration or may
include communities that have requested special access to dental services to assist
the underserved residents.
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October 2007
Health and Human Services Commission
FREW Medical and Dental Initiatives
Proposal:
Attachment A: Mobile Dental Unit in HHSC Region 11 (Rio Grande Valley)
Description of HHSC should fund a MDU in the Region 11 as specified in House Bill (HB) 15.
Proposal:
The following assumptions were considered in determining the cost of MDU:

Minimum physical plant requirements for the MDU would include:
o Two fully equipped dental operatories (chair, light, unit)
o Digital radiography, both intra-oral and panoramic
o Electronic medical records
o Satellite internet access
o Access capacity consistent with Americans with Disability Act
o Sterilization equipment required to meet OSHA and Texas Dental
Practice Act standards of care

Minimum staffing requirements for the MDU would include:
o Full-time dentist
o Full-time dental hygienist
Fiscal
Assumptions and
Impact:
o 2 Full-time dental assistants
o Full-time business assistant

Optional staffing that may be considered by contractor:
o Part-time case manager
o Part-time dental assistant
o Part-time driver

Minimum instrumentation requirements would include:
o Dental handpieces necessary to provide restorative dental services to
eight patients a day.
o Dental hand instruments necessary to provide diagnostic, preventive,
and restorative dental services to 16 patients a day.
o Dental surgical instruments necessary to provide routine oral
surgery services to 4 patients a day
o Digital radiography accessories necessary to provide radiographic
services to 8 patients a day
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October 2007
Health and Human Services Commission
FREW Medical and Dental Initiatives
Proposal:
Attachment A: Mobile Dental Unit in HHSC Region 11 (Rio Grande Valley)

Minimum initial disposable dental materials and equipment sufficient to
provide comprehensive dental services for two months, e.g. prophy angles,
prophy materials, filling materials, disposable dental supplies, etc.

Minimum office supplies and equipment sufficient to initiate operations.

Emergency contact available 24/7

Estimate $500,000 for purchase of MDU with identified physical plant
minimums1

Estimate $30,000 for purchase of minimal instrument set and initial
disposable supplies2

Estimate $44,195 for minimum staffing costs with benefits for two months.

Estimate $33,938 for travel, lodging, meals for five staff.

Assume continuing staffing costs will be borne by contractor and paid from
Medicaid reimbursed funds.
Therefore, this proposal assumes a one time general revenue cost of $608,133.
Texas Medicaid currently reimburses for medically necessary dental services
Current Texas
provided to Medicaid enrolled children ages birth through 20 years when claims for
Medicaid Policy:
dental services are submitted to TMHP by Medicaid enrolled dentists.
Many states have MDUs used by several types of entities including private; public,
such as Medicaid and public health; and professional, community- and faith-based
Other States: organizations.
Telephone communications with ADI Mobile Health, MedCoach/Medical Coaches, and St. David’s Community Health
Foundation.
2
Telephone communications with Drs. Patrice Coons and Marsha Cook, St. David’s Community Health Foundation, THEO
Project, October 5, 2007 re: purchase of MDU and initial instrument/supply costs.
1
3 of 6
October 2007
Health and Human Services Commission
FREW Medical and Dental Initiatives
Proposal:
Attachment A: Mobile Dental Unit in HHSC Region 11 (Rio Grande Valley)
Advantages:
 Access to Medicaid dental services in underserved areas of Region 11 can
be established.
 The potential to increase participation in dental services by Medicaid
enrolled children.
 Initiate preventive dental services for very young children enrolled in
Medicaid whose caretakers chose to access services.
 Dental specialty services such as endodontics, pediatrics, and orthodontics
may be available.
 Decrease transportation time for clients and Medicaid medical
transportation costs.
 A set schedule of operational times and locations can be established and
published to assist clients in accessing services.
Application to
Texas –
Advantages & Disadvantages:
 Significant capital investment may be needed for start up.
Disadvantages to
Funding this
 Operation of the MDU at a school site will not qualify as a school-based
Proposal:
dental clinic.
 Current state statute and Medicaid rules require parental accompaniment for
dental services to be rendered to children under age 15.
 MDUs are subject to significant maintenance needs if moved frequently and
repair facilities may not be readily available. Prolonged down time could be
experienced.
 In the event of an emergency, clients receiving dental services via the MDU
may not have ready access to emergency dental care if the MDU has
relocated to another community.
 MDU staff will need local lodging accommodations and transportation
resources.
 MDUs do not support the dental home concept.
Meets FREW
related Objective
Increase the
number of children
who receive
THSteps medical
and dental checkup
Other Stand Alone Option
X
Increase
participation of
medical and
dental providers
who serve
children in the
Texas Medicaid
Program
X
4 of 6
X
Improve
Appropriate
Utilization of
Medically
Necessary
Services
X
Improve
Coordination of
Care
This Option should be considered in conjunction with other
FREW Strategic Initiatives
October 2007
Health and Human Services Commission
FREW Medical and Dental Initiatives
Proposal:
Attachment A: Mobile Dental Unit in HHSC Region 11 (Rio Grande Valley)
Considerations
State and Federal
Approval(s)
Required:

House Bill 15, 80th Session, authorizes the operation of a MDU
in Region 11.
1115 Waiver
Federal
Rules
Other Waiver(s),
State
Legislation
State Plan Amendment
Affected Stakeholders

Texas Dental Association, Texas Academy of Pediatric Dentistry, Texas
Academy of General Dentistry, Baylor College of Dentistry, University of
Texas Health Science Center Dental Branch, Houston, University of Texas
Health Science Center at San Antonio Dental School, Dentists Who Care,
Methodist Healthcare Ministries, private practice dentists in Region 11, the
residents in Region 11, and families receiving Medicaid services in Region
11 are interested stakeholders in this initiative.
Other Considerations
Implementation
Considerations &
Timeframes:

A MDU operating in Texas must register annually and comply with Texas
State Board of Dental Examiners’ rules, regulations, and reporting
requirements.

X-ray equipment ownership, certification, and registration issues must be
addressed.

MDU lease option availability needs to be explored. Contract oversight and
contractor reporting requirements must be developed and assigned to
appropriate agency staff.

Items to be addressed in the RFP and/or contract
o Scope of provided services – comprehensive
o Dental home for Medicaid children
o Availability of MDU – minimum operational schedule
o Minimum standard of care
o Minimum service levels
o Target populations for service provision

Evaluation of Project
o Types and number of dental procedures provided by procedure code
o Number of referrals for specialty dental services made and
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October 2007
Health and Human Services Commission
FREW Medical and Dental Initiatives
Proposal:
Attachment A: Mobile Dental Unit in HHSC Region 11 (Rio Grande Valley)
completed
o Number of specialty dental services provided via the MDU
o Number of dental treatment plans completed via the MDU
o Number of days MDU is operational
o Number of sites that MDU is operational at in Region 11
o Number of days MDU is operational at each site
o Level of care needed as determined at initial visit
The workgroup struggled with how to structure an RFP for this service in the
Valley given that many mobile units serve the underserved populations in a given
HHSC Interagency
region not just Medicaid. The workgroup requested direction on whether the RFP
Workgroup
could be structured in a way to allow these units to provide a minimum level of
Recommendation:
services to Medicaid children but to also allow the provision of dental services to
other underserved children in the Valley.
Of the 12 members present, six indicated that this proposal had no merit and six
indicated that this proposal should be placed on hold.
FREW Technical
Advisory
Committee
Recommendation:
A dentist on the Committee mentioned that the Valley has the highest dental
screening rate for Medicaid children and have adequate access to dental services
compared to the rest of the state. If HHSC has to proceed with this project, the
committee recommended minimum requirements be placed on the vendor
providing these services in the mobile unit (many of these recommendations have
been incorporated above).
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October 2007