Access to Care Committee
June 19, 2009
Page 1 of 5
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
ACCESS TO CARE COMMITTEE
MEETING
JUNE 19, 2009
Minutes
Present
Dr. Bernadette Logan (2), Chair
Dr. Mark Goldstein (1)
Dr. David Shapter (9)
Dr. Joseph Greenberg (2)
Dr. Christopher Luccy (10)
Dr. Ross Wezmar (3)
Absent
Dr. Gary Davis (5)
Dr. Eugene McGuire (2)
Dr. Thomas Gamba (1), O-L
Staff/Guests
Dr. Paul Westerberg, chief dental officer, Department of Public Welfare
Dr. David Kelley, chief medical officer, Department of Public Welfare
Dr. Howard Tochinsky, public health dentist, Department of Health
Mr. Jon Dale, director, divison of school health, Department of Health
Marisa Swarney, director of government relations
Matthew DiLoreto, government relations coordinator
Welcome/Chair’s Remarks
Dr. Logan welcomed new members to the committee and thanked those in attendance for
taking the time to attend the meeting.
Approval of Minutes
The committee unanimously approved the minutes from the April 17, 2009, conference
call.
Meeting with the Department of Public Welfare (DPW)
Physician Fluoride Varnish Program
The committee discussed DPW’s proposed physician fluoride varnish program with Dr.
Westerberg and Dr. Kelley. The committee expressed its belief that the program should
contain the following components:

PDA’s website should include a section for physicians to access information
about the fluoride varnish program, including a link to the Academy of Pediatric’s
These minutes are confidential and are not for distribution outside the Access to Care Committee
and the Board of Trustees.
I:worddoc\Marisa\acc\minutes_june09.doc
Access to Care Committee
June 19, 2009
Page 2 of 5
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83







(AAP) continuing education program and pictures that instruct physicians and
their staff on the appropriate way to evaluate patients and apply the varnish. PDA
will also provide continuing education information for physicians about how best
to treat at-risk patients, acceptable levels of treatment and guidelines for treating
patients with behavioral issues.
DPW should develop a list of dentists who are willing to accept referrals from
physicians after the varnish is applied. These dentists will evaluate patients and
provide further treatment. The committee emphasized that referrals to dentists for
further evaluation and treatment, and to establish a dental home, must be an
essential component of the program.
DPW should certify physicians and their applicable staff who complete the
requisite training. The applicable staff is nurses, physicians assistants and nurse
practitioners.
Physicians and their staff should evaluate patients and complete the AAP’s Caries
Risk Assessment form. They must perform a visual examination of the teeth, wipe
the teeth and apply the varnish on at-risk patients.
Physicians and their staff must complete and give a referral form to parent(s).
DPW should not pay physicians unless the referral is made. The committee
recommends that DPW consider a second reimbursement for physicians when the
referral is complete and dentists have seen the patient. This will provide an
additional incentive for physicians to guarantee that the referral is complete.
DPW should consider contracting with suppliers to sell fluoride varnish to
physicians at reduced rates.
PDA will actively recruit dentists to serve as referrals and to volunteer to visit
physicians’ offices for personal training.
Dr. Kelley reported that DPW has given direction to Pennsylvania’s seven managed care
organizations (MCOs) to begin paying physicians who are now trained to apply fluoride
varnish and make the appropriate referral to a dentist. The MCOs need to verify that the
referral was made before reimbursing physicians. DPW will issue a Bulletin in July for
notifying physicians and dentists in the state’s fee-for-service program.
Dr. Westerberg and Dr. Kelley assured the committee that physician referrals to willing
dentists are an essential component of the program. DPW’s goals are to increase the
number of dentists who are willing to treat patients referred by physicians, improve
communication between the dental and medical community, increase awareness of oral
health among medical professionals and improve access-to-care for at-risk children.
They commended the committee for its idea to encourage members to visit physicians’
office to provide further training and improve communication with the medical
community.
These minutes are confidential and are not for distribution outside the Access to Care Committee
and the Board of Trustees.
I:worddoc\Marisa\acc\minutes_june09.doc
Access to Care Committee
June 19, 2009
Page 3 of 5
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
Dr. Kelley indicated that DPW would consider the committee’s idea of providing an
additional financial incentive to those physicians who ensure the referral is completed by
having patients seek further treatment from dentists. However, its primary goal is to have
the program operational this summer before considering adding another code for a second
reimbursement for physicians.
Virtual Dental Van
The committee discussed the draft Virtual Dental Van, which contains information for
the public about prevention and maintaining oral health and insurance information, as
well as information for the dentists about public insurance programs and providing
appropriate care.
Dr. Westerberg stated that DPW generally agrees with points made in the revised draft of
PDA’s Virtual Dental Van, but has concerns that some of the advice that is given to
dentists may discourage them from joining the Medical Assistance (MA) program. DPW
is supportive of the concept of posting the Virtual Dental Van on PDA’s website as a
source of information but believes there is too much editorializing in the current draft.
The committee responded that it has the duty to present accurate information to members
about the potential problems and complications that may arise in the dental office when
becoming an MA provider, but the intent of the Virtual Dental Van is to encourage
participation in the MA program and the Children’s Health Insurance Program. Dr.
Westerberg also suggested that PDA consult with MCO officials to ensure the accuracy
of information given to dentists about contracting directly with MCOs.
Dr. Kelley suggested that PDA send representatives to the next meeting of DPW’s
committee handling issues regarding managed care organizations. He will contact PDA
staff when the meeting date is scheduled.
The committee will contact officials from Pennsylvania’s managed care organizations
(MCOs) to request their review of the draft Virtual Dental Van and offer
recommendations to improve the advice given to dentists who contract with MCOs to
treat Medical Assistance patients. (06/09ACCDA1)
Meeting with the Department of Health (DOH)
The committee discussed the school dental program and examination form with Dr.
Howard Tolchinsky, DOH’s public health dentist, and Mr. Jon Dale, director of school
health programs.
Mr. Dale gave an overview of the statute and regulations governing the school health
programs. Students receive notification when dental examinations take place and parents
can opt to have their children seen by their family dentist. Even though not required by
These minutes are confidential and are not for distribution outside the Access to Care Committee
and the Board of Trustees.
I:worddoc\Marisa\acc\minutes_june09.doc
Access to Care Committee
June 19, 2009
Page 4 of 5
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
law, most schools now require parental consent before examining those children who are
treated in a school setting. DOH supplies a sample dental examination form to all of
Pennsylvania’s school districts. The school districts are not required to return the forms
to DOH. Thus, DOH does not collect and analyze any of the data found on these forms.
Mr. Dale is not optimistic that schools would submit the forms to DOH upon request.
The committee commented that there is not much value to the examination if it does not
ask for the right information that will be assessed by the state to determine oral health
trends in Pennsylvania.
The committee commented that dentists are confused about the information needed to
accurately complete DOH’s dental examination form and recommended that DOH
combine the form used by the school dentist or hygienist and the form used by private
dentists. The form used by private dentists should include the instructions included in the
form used by school dentists and hygienists so that private dentists know to include
information about missed, filled and decayed teeth. The committee encouraged DOH to
collect and analyze this information.
Mr. Dale responded that there is no money available in the state’s budget to revise,
reproduce and send the form to all school districts. The committee encouraged DOH to
consider working with PDA to revise the current form and print a new dental examination
form for distribution once the inventory of current forms is depleted. Mr. Dale agreed to
continue to work with the committee and to consider incorporating its suggestions for
changing the school dental form.
The committee asked whether DOH would become involved in discussions about
integrating oral health education for children in kindergarten, third, seventh and eleventh
graders. Mr. Dale referred the committee to the Department of Education, which has the
authority to change the curricula for schools. This will entail working with the state
board of education to change existing regulations.
Dr. Bernadette Logan will contact officials at the Department of Education to request a
meeting to discuss the integration of oral health education in curricula for kindergarten,
third, seventh and eleventh graders. The committee will also request that curriculum for
eleventh graders also include information about the benefits of joining the dental
profession. (06/09ACCDA2)
New Business
CHIP Update
Dr. Ross Wezmar reported that changes to the CHIP program allow an individual to
purchase an individual dental policy even if they already have health insurance
elsewhere. The committee believes that PDA should contact the Insurance
These minutes are confidential and are not for distribution outside the Access to Care Committee
and the Board of Trustees.
I:worddoc\Marisa\acc\minutes_june09.doc
Access to Care Committee
June 19, 2009
Page 5 of 5
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
Commissioner regarding standardized fees/codes (especially regarding anesthesia) for the
CHIP wrap-around program as administered by Aetna and the Blues and encourage that
the coverage should be at least as comprehensive as the state’s ACCESS Plus program.
Staff will forward a recommendation to the Council on Dental Practice that PDA contact
the commissioner of the Department of Insurance to advocate for standard fees and codes
for the Children Health Insurance Program’s wrap-around program administered by
Aetna and the Blues insurance companies, and that the coverage be identical to the fees
reimbursed in the ACCESS Plus program. (06/09CGRDA3)
Mobile Dentistry
The committee discussed the merits and potential negative consequences of mobile
dentistry units. The general consensus among committee members is that mobile units
operate primarily to make large profits and might not necessarily be concerned about
creating a dental home for patients, many of whom have the misperception that they have
received adequate care by the mobile unit.
The committee will forward a recommendation to the Board of Trustees by its September
12, 2009, meeting that PDA discuss with the State Board of Dentistry the need to develop
regulations or a policy statement that will improve the operation of mobile dentistry units.
(06/09ACCDA4)
The meeting adjourned at 3:00 p.m.
These minutes are confidential and are not for distribution outside the Access to Care Committee
and the Board of Trustees.
I:worddoc\Marisa\acc\minutes_june09.doc