Insurers' policies on coverage for behavior management services and the impact of the Affordable Care Act.
The impact of the Affordable Care Act (ACA) on dental insurance coverage for behavior management services depends upon the child's source of insurance (Medicaid, CHIP, private commercial) and the policies that govern each such source. This contribution describes historical and projected sources of pediatric dental coverage, catalogues the seven behavior codes used by dentists, compares how often they are billed by pediatric and general dentists, assesses payment policies and practices for behavioral services across coverage sources, and describes how ACA coverage policies may impact each source. Differences between Congressional intent to ensure comprehensive oral health services with meaningful consumer protections for all legal-resident children and regulatory action by the Departments of Treasury and Health and Human Services are explored to explain how regulations fail to meet Congressional intent as of 2014. The ACA may additionally impact pediatric dentistry practice, including dentists' behavior management services, by expanding pediatric dental training and safety net delivery sites and by stimulating the evolution of novel payment and delivery systems designed to move provider incentives away from procedure-based payments and toward health outcome-based payments.
Professor of Dental Medicine and Health Policy & Management, Columbia University Medical Center, NewYork, N.Y., USA; Senior Fellow in Public Policy and President Emeritus, Children's Dental Health Project, Washington, D.C., USA. ble22@columbia.edu.
Burton L
BL
Edelstein
D000293:Adolescent; D000328:Adult; D000766:Anesthesia, Dental / Q000191:economics; D000768:Anesthesia, General / Q000191:economics; D032763:Behavior Control; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D016292:Procedural Sedation / Q000191:economics; D003695:Delivery of Health Care; D019140:Dental Care for Children; D006801:Humans; D007342:Insurance Benefits / Q000191:economics; D007343:Insurance Carriers / Q000191:economics*; D019458:Insurance Coverage / Q000191:economics*; D007347:Insurance, Dental / Q000191:economics*; D008484:Medicaid / Q000191:economics; D009042:Motivation; D010350:Patient Credit and Collection; D058991:Patient Protection and Affordable Care Act; D010377:Pediatric Dentistry / Q000191:economics / Q000193:education; D017149:Private Sector / Q000191:economics; D017150:Public Sector / Q000191:economics; D064876:Safety-net Providers / Q000191:economics; D014481:United States