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How-to guide for IME

ADA resource covers use of incurred medical expense option to cover dental care costs

A new resource developed by the ADA Council on Access, Prevention and Interprofessional Relations offers dental professionals, state and county Medicaid caseworkers and nursing home residents and their representatives information on how to use the incurred medical expense mechanism—or IME—to cover dental care costs.

IMAGE: Dr. Folse
Dr. Folse

The IME option, widely used by residents who need new eyeglasses, hearing aids or podiatry services, can also be applied to dental services that are medically necessary but not covered by Medicaid, said Dr. Gregory J. Folse, a member of the ADA National Elder Care Advisory Committee.

“The law is not new, but the dental profession has not widely applied it to funding for needed dental care,” said Dr. Folse. “Using the IME option requires state governments to process a fair amount of paperwork and there is a learning curve for dentists, nursing homes, patients and government representatives. But now dentists have a tool that they can use to understand how they can treat patients they serve in nursing homes and get paid for the services they provide.”

Essentially, the process enables nursing facility residents to use their monthly income, usually applied to their nursing home care, to receive health care services not covered under Medicaid. The resident makes an arrangement with the caseworker to reduce his or her payment toward expenses at the nursing facility during that month and use the funds to pay for the health care services. Medicaid temporarily increases the amount it pays to the facility, so the end result is that the patient receives the care, the health care provider is paid at his or her private rate and the nursing home is still receiving its normal monthly fee.

The document includes guidelines for three distinct groups: dental professionals; state and county Medicaid caseworkers; and nursing home residents and their representatives.

IMAGE: Dr. Helgeson
Dr. Helgeson

“We’re very excited to provide this information to dentists across the U.S., as well as to caseworkers, patients and their nursing facility staffs,” said Dr. Folse, “because it gives dentists the opportunity to increase access to care for this population group. This document will also give guidance to nursing homes and health department staff on how to implement this funding mechanism.”

“The process of using the IME option is not intuitive and is quite complicated,” said Dr. Michael Helgeson, another NECAC member. “It can take four or five months to have state and county government agencies, nursing facility staff, patients and families all up and running. But it’s vastly better for the seniors in nursing facilities to receive needed services and it also gives providers the opportunity to receive their private rate.”

The IME option is just as accessible for private practice dentists as it is for group practices, Dr. Helgeson added.

“If a private dentist wants to serve a local nursing home, using the IME option can really open up opportunities for him or her to serve people in the community who really need the care.”