Role of the Managed Care Organization (MCO)
Mobile Dental Practice (utilizing portable equipment) is a provider traveling to various locations and using portable dental equipment to provide dental services outside of a dental office/clinic in settings to include but not limited to facilities, schools and residences.
- Facilities: These providers are expected to provide on-site comprehensive dental care (to include intra-oral radiographs), necessary dental referrals to general dentist or specialists and emergency dental care in accordance with all New Jersey State Board of Dentistry regulations and the NJ FamilyCare MCO Contract. The sites served by the Mobile Dental Practice must allow members access to treatment and allow for continuity of care.
- Schools: These locations are not considered dental homes and are limited to providing the following services: oral assessment/screening, prophylaxis, fluoride treatment, emergency care and referral to the member’s dental home when known or his or her MCO for assistance in locating a dentist.
- Private residences and other residential settings: These providers are expected to provide onsite dental care for the homebound based on patient safety and ability to tolerate procedures outside of a clinical setting.
The MCO is responsible for assisting the member, family, facility or school in locating a dentist when referrals are issued. Patient records must be maintained at the facility when this is a long-term care facility, skilled nursing facility or school, and duplicates may also be maintained in a central and secure area in accordance with State Board of Dentistry regulations. Providers must submit documentation to the MCO of all locations they visit and serve and include the days and times for each location, except when a visit is to a residence.
Mobile Dental Practice (utilizing van) is a vehicle specifically equipped with stationary dental equipment and is used to provide dental services within the van.
- Providers using a mobile dental van to render dental services must also be associated with a dental practice that is located in a “brick and mortar” facility in New Jersey that serves as a dental home offering comprehensive care, emergency care and appropriate dental specialty referrals to the mobile dental van’s patients of record (members). They must demonstrate their ability to render dental treatment services and assist with dental referrals as needed.
- An exception to the brick and mortar requirements can be considered for providers using mobile dental vans that demonstrate they are only providing dental services to NJ FamilyCare enrollees residing in a long-term care facility or that are in a private residence/group home and unable to travel.
- The distance between the dental practice and the sites and locations served by the mobile dental van must not be a deterrent to the member accessing treatment and allow for continuity of care by meeting the network standards for distance in miles as described in section 4.8.8 Provider Network Requirements of the MCO Medicaid contract.
- When a mobile dental van is used for school visits, health fairs or other one-time events, services will be limited to oral screenings, exams, fluoride varnish/topical fluoride treatment, prophylaxis and palliative care to treat an acute condition. State board regulations must still be followed and patient records are to be maintained in accordance with State Board of Dentistry regulations.
Providers utilizing Mobile Dental Vans must submit to the MCO documentation of all locations they will visit including the days and times (except when visit is to homebound members). Provisions will be granted for visits to a member’s place of residence, long-term care facility, skilled nursing facility or medical day care facility when medically necessary and where available. The contractor must monitor on an annual basis the standard of dental care rendered and ensure that needed referrals for dental treatment that cannot be provided by a mobile dental practice occur.