The Special Needs Code

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The Special Needs Code
New Mexico Medicaid Approach
Ray Lyons, D.D.S., FADPD Los Lunas Community
Program
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Aim of the Special Needs Code (SNC)

• Network of skilled practitioners
• Components of the SNC
• Financial justification for the SNC
• Preventing exploitation of the SNC

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Mission and Goals

• Create access to comprehensive care
• Seek least restrictive approach
• Offer experiential training
• Develop consultative resources
• Create Statewide network
• Provide safety net backup

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Is Dentistry Really Health Care?

• Clinical dental treatment is the most exacting
  and demanding medical procedure that individuals
  with disabilities must undergo on a regular basis
  throughout their lifetimes
• Importance of lifelong care
• Medicaid allows physicians to utilize billing
  codes that compensate for additional time.

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Origins Demonstrate Need to Policymakers

• Deinstitutionalization - legal pressure
• ADPD Policy Statement - preservation of quality
  oral health care services for people with
  developmental disabilities
• Establish/preserve Centers of Excellence
• Cabinet level support
• Identify legislators with interest
• Must justify issues to people with the money
  (HSD)

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Strictly Define Patient Eligibility

• Developmental disability- a severe chronic
  disability that is attributable to a mental
  and/or physical impairment, originating prior to
  age 22, which can be expected to continue
  indefinitely and constitutes a substantial
  handicap resulting in limitations in three or
  more areas, including self-care, receptive and
  expressive language, learning, mobility,
  self-direction, capacity for independent living,
  and/or economic self-sufficiency.
• Require medical diagnosis
• Documentation of approaches to care in dental
  progress notes

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Providers

• Identify core providers
• Respected practitioners already providing care
• Ask their help in review/curriculum development
• Grandfather credential

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Provider Training

• Core curriculum
• Define experiential clinical component
• Obtain CE certification from Dental Board
• Offer free CE credits for each stage

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Core Curriculum

• Self study training modules
• Specific literature review
• Standard of care documents
• Chaptered topics SAID courses
• Product resource guide
• Sensitivity training
• Document examples
• Post tests

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Elective Curriculum

• Videos
• Additional chapters
• Online training
• Conference attendance

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Clinical Hands-on Training

• Once self-study/post tests complete
• Two clinical centers
• 40 hours (or as needed)
• Allow key staff to attend with dentist
• Hygienists (in conjunction with a certified
  dentist)

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Has It Worked?

• 77 practitioners have sought out training (57
  dentists, 20 hygienists)
• 37 have completed training and been certified to
  HSD (28/9)
• Presently, children and adults with DD have
  access to comprehensive clinical care in New
  Mexico
• Travel is often required (New Mexico is a big
  state)!

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Lessons Learned

• You cant just throw at it
• Poor results in other States
• High level of collaboration is necessary
• Advocacy organizations
• Departments of Health and Human Services
• SNC works
• Importance of oral health
• Helps maintain a provider network
• Encouraging the team concepts

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The Future of the Special Needs Code

• Threats
• No Soul, No Memory!
• Medicaid cuts
• Block grants
• Shrinking dental workforce
• Fraudulent abuse of similar initiatives
• Supports
• Governors Oral Health Council
• Medicaid carveouts
• Federal Special Care Dentistry Bill

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Contact Information
Ray Lyons P.O. Box 1269 Los Lunas, NM
87031 Phone [phone] Fax (505)
841-5316 curlylyons_at_msn.com
Britt Catron 2025 South Pacheco St. P.O. Box
2348 Santa Fe, NM 87504 Phone (505)
827-1348 Fax [phone] Britt.Catron_at_state.nm
.us