Healthy Smiles Ontario July 2015

Transcription

1 Healthy Smiles Ontario July 2015

2 Low Income Dental Integration Commitment In December 2013, government announced an integrated dental program for children and youth from low-income families. Current benefits and/or programs to be integrated include: o dental benefits for children under Ontario Works; o dental benefits for children under the Ontario Disability Support Plan (ODSP); o dental benefits for children under the Assistance for Children with Severe Disabilities program; o Children In Need Of Treatment program; o Healthy Smiles Ontario program; and o Preventive oral health services within the Ontario Public Health Standards, The new integrated program will aim to: o improve access to oral health services through streamlined eligibility and enrolment; o reduce inequalities through the provision of responsive and appropriate care; o streamline administration for clients and providers; o improve the oral health status, and oral health outcomes for enrolled clients; o allow for measurement of program successes including improvements in the oral health status of clients 2

3 Need for Integration and Key Goals The need to improve oral health services for children and youth in Ontario was prompted by: o the Poverty Reduction Strategy announced in 2008 which identified dental care as a key priority; o Key reports highlighting the importance of oral health for low-income Ontarians including: Ontario s Chief Medical Officer of Health (CMOH) special report Oral Health - More Than Just Cavities (April 2012); Staying Ahead of the Curve: A Unified Public Oral Health Program for Ontario? (October 2012); and The Ontario Dental Association s submission as well as the Report of the Commission for the Review of Social Assistance in Ontario (2012). 3

4 Current Dental Programs for Children and Youth in Low-Income Families Cabinet directed Ministries to integrate the following oral health programs and/or services into a single 100% provincially-funded program: Program Current Primary Delivery Agent/Partner Healthy Smiles Ontario Children In Need Of Treatment (CINOT) and CINOT Expansion Ontario Works (OW)/ Temporary Care Assistance Ontario Disability Support Program (ODSP) Assistance for Children with Severe Disabilities (ACSD) Ontario Public Health Standards Preventive Oral Health Services Public Health Units (PHUs) Preventive and treatment services delivered through PHUs, FFS and other partners such as CHCs, with a focus on good oral health awareness Public Health Units (PHUs) Urgent care services delivered through PHUs, FFS and other partners including CHCs Municipalities and First Nations (Ontario Works Delivery Agents); District Social Services Administration Boards (DSABs) Claims-based dental services provided by fee for service providers as well as by PHUs and others Province Claims-based dental services provided by fee for service providers as well as by PHUs and others Province Claims-based dental services provided primarily by FFS providers Public Health Units Preventive services provided through PHUs 4

5 Context for Action Evidence related to oral health The importance of oral health to overall health is well supported by evidence as well, evidence demonstrates that children and youth from low-income families have lower oral health status than the general population Tooth decay is one of the most prevalent and preventable chronic diseases, particularly among children. Untreated tooth decay, and gum disease, can have a number of negative sequalae including contributing to other disease(s). Oral health problems in children can: affect their ability to learn, have an impact on nutritional status and lead to more serious health problems later in life. In in Canada, day surgeries for early childhood caries constituted 31% of all day surgeries for children age 1 to younger than 5, making it the leading cause of day surgery for children this age. Rates were 3.9 times higher for children from the least (versus the most) affluent neighbourhoods. First Nations children are disproportionately affected by oral health issues and experience greater barriers to access. 5

6 Government Principles/Drivers Re: Low Income Dental Integration Children will not lose access to services as a result of the integration of the programs Children and families first no wrong door Continued support of mixed delivery system incorporating community-based clinics and fee for service providers; make PHU role more robust, and focused on the core functions of public health Continue to increase partnerships with First Nations, Inuit and Métis communities to improve access to oral health services, in partnership with the federal government. Move oral health services upstream to provide the right services to the eligible population and prevent disease before it happens Maintain commitment to streamlined administration improve the experience of participating fee for service providers 6

7 Key Features of the Integrated Program Governance and Funding The integrated program will be 100% provincially funded by the Ministry of Health and Long-Term Care There will continue to be a mixed delivery system (Fee for Service and PHUs), and arrangements will continue with Public Health Units and other partners, including Community Health Centres, regarding their role in the delivery of the new program. Centralized Enrollment and Eligibility Adjudication Children aged 0-17 who are Ontario residents and who are: o Member of a social assistance benefit unit (Ontario Works, ODSP or ACSD); or o Member of a family whose previous year s income is at or below the threshold which provides 90% of the Ontario Child Benefit (OCB). Children with parents in receipt of social assistance will be automatically eligible for the dental program Non-social assistance clients will apply and have their eligibility assessed and verified based on their family income as reported to the Canada Revenue Agency. There will also be a manual process for applying to the dental program for clients who did not file income tax or whose financial circumstances change after having filed their previous year s income tax. Children not eligible for, or not yet enrolled in, the full program may also be eligible to receive preventive services and/or emergency and essential care. 7

8 Key Features of the Integrated Program (cont d) Centralized Claims Administration Under the integrated program all fee-for-service claims will be processed through a single program administrator. MOHLTC underwent a rigorous procurement process for the third party program administrator and a successful vendor has been awarded the contract. Eligibility and Access to Services The financial eligibility requirements (for non social assistance recipient low income families/children) have been expanded from the previous HSO thresholds (which occurred on April 1, 2014 and again on July 1, 2014), making more children and youth from low-income families eligible to receive services. In addition, starting in January 2016, eligibility for other dental insurance will not automatically deem a child ineligible for the new program. 8

9 Dental Service Schedule Review Expert Panel An Expert Panel (the Dental Service Schedule Expert Panel (DSSREP)) has provided the Ministry with advice and supporting rationale for a new service schedule for the integrated program including: Core dental services: Basic dental services, including: preventive, treatment and restorative services Emergency and Essential treatment services, including a definition of emergency and/or essential clinical need, and a related basket of services Services for clients with special medical conditions: List of medical conditions/medications that warrant additional dental services and the type and frequency of these dental services In addition, the DSSREP has provided advice on: The basket of services to be considered for the preventive services stream Services to be considered for clients under exceptional circumstances Frequency limitations and/or restrictions for certain services The Ministry is currently reviewing the advice from the Panel, and will seek input from First Nations to inform its deliberations and analysis before making decisions regarding the new service schedule. 9

10 Key Features of the Integrated Program cont d Healthy Smiles Ontario Eligibility and enrollment Preventive Services Only Stream (PSO) Core HSO Program Emergency and Essential Care Stream (EECS) Eligibility: clinical need and financial hardship (incl. age and Ontario residency) Eligibility: 90% OCB income level, age, Ontario residency Eligibility: clinical need and financial hardship (incl. age and Ontario residency) Eligibility assessment and enrolment: PHU completes eligibility assessment and enrols client Eligibility assessment and enrolment: Completed centrally with client support provided by PHUs, as required Eligibility assessment and enrolment: PHU completes eligibility assessment in most cases and client is enrolled centrally Client navigation; children referred from preventive and emergency and essential streams to core treatment stream 10

11 Key Features of the Integrated Program cont d Healthy Smiles Ontario services, and delivery Preventive Services Only Stream (PSO) Core HSO Program Emergency and Essential Care Stream (EECS) Services: preventive services basket Services: core basket of routine treatment Services: urgent treatment basket of services; including comprehensive treatment to fully address urgent issue as well as underlying issues Service delivery: Publicly funded dental clinics and FFS providers (as required) Service delivery: Publicly funded dental clinics and FFS providers Service delivery: Publicly funded dental clinics and FFS providers 11

12 Public Health s Role - Future State Assumptions OPHS Review/Revise relevant protocols (for discussion) Healthy Smiles Ontario Program Oral health assessment and surveillance: School-based screening Oral health assessment, surveillance and identification of risk populations Health promotion and policy development: Oral health awareness Referral to community oral health programs Oral health disease prevention: Risk-based services Health promotion Research and knowledge exchange Clients can go to the PHU HSO Program Hub for assistance with connecting to services: enrollment, referral to services, client navigation, case management, treatment HSOII Program Hub Public Health Units Health promotion, community engagement and outreach incl. with referral sources (incl. FFS providers) HSO client navigation/ case management Program information Identification Enrolment referral and assistance Referrals to service providers Case management and follow-up Preventive, routine and urgent treatment (for discussion) Oral Health Services: preventive, routine and emergency and essential Community dental clinics (e.g., CHC/PHU clinics, mobile coaches, portable units) Private dental clinics (FFS Providers) 12

13 Oral Health in First Nations as a Priority Ontario and the federal government have committed to developing an integrated and comprehensive public health system through improving public health services to First Nations communities in Ontario through: Resolving jurisdictional issues Building/enhancing partnerships with Public Health Units Developing creative approaches for remote communities Increasing access to oral health services has been identified as one of 5 priority areas of the Public Health Working Group (PHWG) established under the Trilateral First Nations Health Senior Officials Committee (TFNHSOC). A First Nations Dental Sub-Group was established to lead pilot initiatives to improve oral health status. Progress to date includes: Completion of an Ontario First Nations Oral Health Survey by Chiefs of Ontario to address gaps in the availability of First Nations oral health data; 13 Two dental pilot programs to increase availability of preventive dental care, treatment, and oral health education services to previously underserved First Nation communities. Pilots have been established in northwestern Ontario and along the James and Hudson Bay Coast.

14 Oral Health in First Nations as a Priority Northwestern Dental Pilot Project With guidance from PHWG s Dental Sub-Group, the Northwestern Health Unit launched a pilot project to deliver dental services in Sabaskong and Big Grassy First Nations in November The pilot used provincial infrastructure under the Healthy Smiles Ontario program through a mobile dental bus to deliver services while retaining federal fiduciary responsibility through the bill-back mechanism for NIHB-eligible clients and services. The pilot also leveraged federal services provided under the Children s Oral Health Initiative (COHI). The program was expanded in 2013 to include the community of Lac La Croix. Third visits to Sabaskong and Big Grassy First Nations took place in the fall of 2014, and a third visit to Lac La Croix is scheduled for spring Fourth visits for Big Grassy and Sabaskong will begin in fall The program continues to be a successful avenue to deliver dental services to underserved communities, and has since become part of the health unit s ongoing work. The Northwestern Health Unit has reported an increased uptake of services and level of client engagement with each subsequent community visit. 14

15 Oral Health in First Nations as a Priority COHI James Bay/Hudson Bay Dental Pilot Project A second pilot project in a different clinical and geographic setting was established in partnership with the Weeneebayko Area Health Authority (WAHA), Porcupine Health Unit, Health Canada and MOHLTC. Intended to complement existing services provided through WAHA by a Dental Hygienist and Dentist, the project integrated provincial and federal programming to deliver preventive care. Beginning in fall 2013, Porcupine Health Unit staff visited the communities of Attawapiskat, Fort Albany, Kashechewan and Peawanuck to conduct screening, fluoride varnish, and provide oral health education to clients. A second round of community visits concluded in spring 2015, and planning is underway for a third phase to begin this fall. Client participation in the program has increased with each round of visits. 15

16 LIDI Timelines July 2015 Jan Expert panel advice to Govt. mid-june Delivery partner change mgt. guidance July 2015 Implemen tation with program Administrator Summer to Fall Engagement & comms. to fee for service providers Summer months Devlpt. of new program policy documents Summer to Fall Grandparenting of current clients Fall/ Winter Detailed program delivery guidance - Fall New Service schedule released in the Fall Preparation for launch Fall Jan. Ongoing engagement of key partners and stakeholders including communications and information 16

17 Next Steps MOHLTC wants to ensure that no child loses access to dental services as a result of integrating the different programs, and that appropriate reimbursement between the federal and provincial governments should be sought later. MOHLTC has been working in partnership with First Nation communities and the federal government to improve access to oral health services to First Nations and is committed to continuing to expand this work. The newly integrated program is intended to build on previous successes, and continue to facilitate improved delivery of oral health services in First Nations communities in partnership with the First Nations communities and the federal government. MOHLTC is prepared to engage in further discussions with First Nations representatives if they wish to explore opportunities for conducting their own analysis on the data collected by the Program Administrator in accordance with OCAP principles. 17

18 Appendix 18

19 First Nations Engagement The Ministry of Health and Long-Term Care, along with Interministerial partners, have held meetings regarding First Nations engagement on LIDI. January 14, 2014 Joint Health, Social and Education Units meeting Attended by MOHLTC, COO and the SHE Units Topics included an overview and discussion of the Low Income Dental Integration commitment Information Session on May 7, 2014 Attended by MOHLTC, MCSS, COO, Union of Ontario Indians, GCT#3, ONWAA, and NIHB Navigators Topics included an overview of the LIDI commitment, discussion of NIHB and First Nation client access issues Meeting on August 18, 2014 Attended by MOHLTC, MCSS, COO Topics included barriers to accessing dental care for First Nation clients and enrolment of children on Social Assistance into HSO Teleconference on October 31, 2014 Attended by MOHLTC, MCSS, COO Topics included barriers to accessing dental care for First Nation clients and engaging First Nation Social Assistance Delivery Agents Meeting on June 8, 2015: Attended by MOHLTC, MCSS, COO Topics included a LIDI Status Update and the enrolment of children on Social Assistance into HSO 19