Dental groups ask lawmakers to improve access to dental surgeries in operating rooms for children, adults with special needs

Washington - The American Academy of Pediatric Dentistry, American Dental Association and American Association of Oral and Maxillofacial Surgeons are asking lawmakers to help improve access to dental surgical services for children and adults with special needs and disabilities.

In comments filed Feb. 17 with the House Ways and Means' Subcommittee on Health on the Bridging Health Equity Gaps for People with Disabilities and Chronic Conditions hearing, the groups stressed the need for oral health equity and elimination of disparities in oral health treatment, particularly when addressing the needs of disabled and special needs populations, including those with chronic health conditions.

One of the biggest challenges is operating room access.

"Our organizations have collectively witnessed a major decrease in operating room access for dental procedures over the last decade," the groups wrote.

They noted that surveys conducted by the American Academy of Pediatric Dentistry have found that in a majority of states, operating room access for pediatric dentists is a persistent problem, and in most states - particularly rural states - it is a severe problem. Waiting times for operating room appointments can be six months or longer.

"In most states this access problem, which predominantly impacts the disabled and those with special health care needs, has worsened even as the worst of the COVID-19 pandemic seems to have subsided in many communities," the three organizations wrote.

AAPD, ADA and AAOMS said they attribute operating room access challenges to the lack of a sustainable billing mechanism for dental surgical services in both Medicare and Medicaid. They pointed out that while the dental services are covered services under both programs, the facility services to provide them are "not separately recognized or valued for what they include: expertise on staff to address emergencies, anesthesia, equipment, medication, recovery services and infection control."

"The bottom line is that dental rehabilitation surgical services for children and adults with complex dental needs does not have a specific Medicare billing code or fair associated reimbursement when these services are provided in a hospital," they wrote.

Another challenge is that there is currently no billing mechanism to allow for additional operating room sites, such as ambulatory surgical centers.

"The lack of a viable billing mechanism in Medicare also directly impacts the Medicaid program serving children with disabilities and special needs," the groups wrote, noting this is because the majority of state Medicaid programs look to Medicare billing codes and payment policy as a benchmark for determining Medicaid billing codes and payment rates for surgical services.

The comments concluded with the groups urging the committee to support AAPD, ADA and AAOMS' efforts to ensure equitable access to dental surgical services for children and adults with special needs and disabilities and to encourage CMS to address this problem.

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