A two-paragraph provision in North Carolina’s new state budget has left oral health advocates uncertain about its implications for Medicaid coverage of dental procedures performed at ASCs, North Carolina Health News reported July 17.
Five notes:
- The budget, signed into law July 7, includes two paragraphs that appear to sunset modifications to the Medicaid program, including billing codes for ASC dental services on July 1, 2027. Advocates said they cannot determine the intent of the provision or its practical effect.
- Mark Casey, dental director for Medicaid at the North Carolina HHS Department, said he does not think the provision bans dental surgeries covered by Medicaid, but said he is still seeking clarification on the language.
- Nearly three-fourths of Medicaid claims from ASCs involve pediatric care, often for young children who require anesthesia to receive dental treatment in an operating room setting.
- ASCs can file three types of claims for dental services: one for anesthesia provided at the facility, another from a pediatric dentist or oral surgeon performing the procedures and a third for pre- or post-operative services and equipment provided to patients.
- The confusion reflects a broader pattern within the state’s budget process in which significant policy changes are embedded in legislative language developed with little public or committee input, advocates said.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
