Medical-dental Integration Environmental Scan Results: Arizona, Colorado, Montana, and Wyoming

Background: The Rocky Mountain Network of Oral Health (RoMoNOH) is an oral health learning network comprised of Arizona, Colorado, Montana, and Wyoming Primary Care Associations (PCAs). PCAs recruited Federally Qualified Health Centers (FQHCs) from each state to focus on the integration of oral health services for children ages 0-40 months and pregnant people into primary care. An environmental scan was conducted around the scope of practice laws, reimbursement, and policy to inform this project.

Methods: The American Academy of Pediatrics (AAP) worked with the Center for Oral Health Systems Integration and Improvement (COHSII) and three regions (East Coast, Midwest, and Rocky Mountain) to develop an environmental scan tool focused on medical and dental providers scopes of practice, Medicaid payment for oral health services, and state policies. To complete the scan, AAP staff conducted online research and interviewed PCA staff, Medicaid officials, and state dental offices. The scan will be completed yearly for five years. The results presented here are from year one.

Results: Arizona, Colorado, Montana, and Wyoming vary widely by population, racial demographics, scopes of practice for different providers, and approved reimbursement codes. For example, Arizona has the smallest age range for non-dental clinical providers to apply fluoride varnish (up to the age of 2) of any state in this region. In Colorado, an oral health leader in the region, dental hygienists can bill Medicaid directly, own their own dental hygiene practice, and have a broad scope of practice. Montana has the lowest rate of public fluoridated water of the four states, and one of the lowest in the nation. In Wyoming, FQHCs interested in embedding a dental provider in a medical setting are challenged by dental hygienists not able to bill Medicaid directly.

Conclusion: Policies related to medical-dental integration vary from state to state. Each state showed unique barriers and facilitators for oral health integration. Interpretation of state-level oral health policies, regulations, reimbursement rates, and guidelines is complex and at times unclear which can create hindrances to successful medical-dental integration. Conducting state focused oral health policy environmental scans can help advocates to identify opportunities for change and highlight policy changes over time.