The following editorial regarding Incurred Medical Expense (IME) appeared in the Jan/Feb 2013 issue of the CDS Review.
Penny wise, pound foolish
By Walter F. Lamacki, DDS
Editor, CDS Review
In June, Gov. Pat Quinn signed legislation extracting $2.7 billion from the state’s $14 billion Medicaid program, ostensibly to save the program. One of the changes is the elimination of coverage for adult dental care, a bankrupt idea that former Gov. Jim Edgar tried in the 1990s and had to abandon when emergency room costs skyrocketed, thus eliminating any phantom savings. The $51 million adult dental program represents about 2 percent of the cuts. A 2005 study by the Kaiser Foundation concluded that any savings from the elimination of adult care are miniscule.
While one door slammed shut another opened a crack for those, I believe, to be the most underserved population of patients: those 100,000 residents living in nursing homes in Illinois. Up until now, those who received care under Medicaid were treated by volunteers and a few Medicaid providers on a hit or miss basis — miss being the operative word. But a quirk in the maze of federal regulations can increase access to care for this neglected patient pool.
Incurred Medical Expense (IME), until now an obscure provision of the Medicare/Medicaid regulations, can help many residents of nursing homes receive necessary dental care. The resident must be enrolled in Medicaid and have some income, usually Social Security. Typically residents assign their Social Security payments to the facility to pay for their monthly fees. However, they do not relinquish total control of their Social Security checks. When a resident with Medicaid receives a bill for services not offered by the facility, they may qualify for IME. They can elect to apply their Social Security checks to pay their dental bills. In most cases, the dentists will be paid their usual and customary fees. Medicare then will reimburse the nursing home for the lost income. Most states do not require pre-treatment authorization.
Please visit www.ada.org for a more detailed explanation of IME and the steps dentists must take to receive payment for their services. We don’t know — at this time — what changes, if any, the Affordable Care Act will bring, but my guess is some similar program will be in place.
If you chose to take care of nursing home residents (and I hope you will), your treatment presents a whole new perspective. Patients can have diabetes, chronic heart failure and other chronic conditions. The most difficult condition you will face is varying degrees of dementia and its big brother, Alzheimer’s disease. As Shakespeare’s Hamlet tells us, “Old men are twice children;” compassion and patience will be valuable tools in your armamentarium.
You won’t have pretty pictures of your patient’s mouth, with a dozen pearly white porcelain veneers made possible by your persuasive skills. Many of the residents have outlived their closest relatives and seem to be warehoused out of sight and mostly forgotten. Improving the quality of their lives and giving them back their dignity will enrich you immeasurably.
Post your response below, or email the editor at email@example.com
access to care
health care reform
The CDS Foundation Dental Clinic in Wheaton has been hopping since opening their door at the end of February. Here’s a quick look at how far they’ve come in the first two months.
- 167: patients of record as of April 30
- 92: volunteer hours logged by dentists and hygienists in April (a month made shorter by massive flooding that closed several local streets)
- 328: procedures performed in April, at a total value in excess of $34,000
Patients are asked to complete an exit survey at the end of their appointment. Here’s what a few of them have said:
- “My experience this visit is very positive.” (First appointment)
- “Nice people. Good doctors.” (Third appointment)
- “Thank you so very much!” (Second appointment)
- “Everyone was very helpful and professional. I was very satisfied with the service.” (Second appointment)
Many slots are still open for volunteers on a weekly, monthly, or annual basis. Call today to reserve your seat chairside: 630.260.8530.
The CDS Foundation Dental Clinic is located at 416 E. Roosevelt Rd., Suite 102, in Wheaton.
access to care
The Chicago Dental Society learned this week that the Knox County Sheriff’s Department, with assistance from the FBI Laboratory and the National Missing and Unidentified Persons System (NamUS), has established an updated profile and facial approximation of “Jane Doe,” the unidentified skeletal remains found in the East Galesburg Brickyards in 1996. They are looking for dentists, specifically, to further their investigation.
To facilitate the public’s help to identify Jane Doe, the Knox County Sheriff’s Department has established the “Jane Doe Tip Line,” at 309.345.6790. Photos, press releases, printable flyers, investigation information, case updates, media packets and other information are available for viewing and download on the Unsolved Crimes page at www.knoxcountysheriffil.com, a webpage dedicated to the Jane Doe investigation.
Jane Doe is a caucasian women, age 55-85. She weighed 130-160 lbs., and was between 4' 11" and 5' 5" tall. She also had a pronounced overbite/over jet, was missing several teeth, and likely had osteoarthritis and DISH. Authorities believe she died sometime between 1984 and 1996. More information, including a rendering, is available online.
Anyone with information on this investigation or possible leads to the identity of Jane Doe is urged to call the Tip Line or e-mail firstname.lastname@example.org.
The Knox County Sheriff’s Department is particularly interested in speaking with the following people at this time:
- Former employees of the Galesburg State Research Hospital/Galesburg Mental Health Center, especially between 1980 and the date the facility closed.
- Dental Professionals who may have provided dental care to residents of this facility between 1980 and the date the facility closed.
- Anyone associated with a charitable or other organization that provided food, clothing or shelter to homeless or disadvantaged people between the mid 80’s to mid 90’s.
- Anyone with a female friend or family member missing between 1980 and 1996.
Detective Sergeant Jason Landers
Knox County Sheriff’s Department
152 S. Kellogg Street
Galesburg, IL 61401
309.345.3733 or email@example.com