Note: This grant program has been closed but the information in the Colorado RFP may be useful to other state health departments.


REQUEST FOR APPLICATION – HANC207081HCPF
Colorado Department of Health Care Policy and Financing
Fiscal Year 2001-2002
Dental Start-Up Grants

Table of Contents

ISSUE AND TIMELINE INFORMATION

WHO MAY APPLY

PURPOSE OF GRANTS

BACKGROUND, OVERVIEW & GOALS:
DENTIST IN COLORADO MEDICAID
CLIENTS SERVED BY FISCAL YEAR
FQHC DENTAL SERVICES – FISCAL YEAR 1999-2000
CHANGES IN ELIGIBLES AND CLIENTS IN URBAN VERSUS RURAL AREAS
COUNTIES WITHOUT A MEDICAID-PARTICIPATING PROVIDER
DENTAL EXPENDITURES
DEFINITIONS
REQUIREMENTS & APPLICATION FORM:
REQUIREMENTS FOR GRANT RECIPIENTS
OTHER REQUIREMENTS
APPLICATION FORM
MANDATORY QUALIFICATIONS
ACHIEVEMENT OF GOAL
OUTCOME OF GOAL
PROVIDER QUALIFICATIONS
BUSINESS AND FINANCIAL STABILITY
SPECIAL SERVICES
AVALIBILITY OF MATCH
RURAL DENTAL PROJECTS

APPLICANTS’ RESPONSE FORMAT:

INFORMATION ABOUT APPLYING FOR THIS GRANT

EVALUATION CRITERIA

BUDGET:
APPENDIX A-EPSDT DENTAL SERVICES
APPENDIX B-MEDICAID ELIGIBLE-CHIDLREN AND CLIENTS BY COUNTY
APPENDIX C-MEDICAID ELIGIBLE-CHILDREN AND PROVIDERS BY COUNTY
APPENDIX D-CHART OF CHP+ BY COUNTY
APPENDIX E-STATE DENTAL NEEDS ASSESSMENT (PDF document)
PROPOSED CONTRACT

SIGNATURE PAGE


ISSUE AND TIMELINE INFORMATION

 

  1. ISSUING OFFICE: This Request for Proposal (RFP) #IHANC207081HCPF is issued for the State of Colorado by the Department of Human Services, Division of Procurement for the benefit of the Colorado Department of Health Care Policy and Financing. The Division of Procurement is the SOLE point of contact concerning this RFP. All communication must be done through the Division of Procurement.
  2. INVITATION TO SUBMIT PROPOSALS: The State of Colorado will e-mail and mail this RFP to prospective offerors and other interested entities; it will not be posted on the BIDS system. Please read and be aware of the administrative information attached to this RFP.
  3. PURPOSE: This RFP provides prospective offerors with sufficient information to enable them to prepare and submit proposals for consideration to satisfy the need for expert assistance in the completion of the goals of this RFP.
  4. SCOPE: This RFP contains the instructions governing the proposal to be submitted and the material to be included therein; mandatory requirements which must be met to be eligible for consideration; and other requirements to be met by each proposal.

E. SCHEDULE OF ACTIVITIES: TIMELINE (Local Time)

EVENT TIME DATE
1. Request for Proposal/Grant Applications are available through Jennifer.Bergman@state.co.us; please use email to receive a request for proposal/grant application. 8/1/01
2. Written Inquiry Deadline. Any questions about the grant application must be submitted to Jennifer Bergman (email preferred). No questions accepted after this date. 4:00 PM 8/17/01
3. Grant Applications Submission Deadline 2:00 PM 9/14/01
4. Grantee selection (estimated week of) 9/24/01
5. Contract finalized (estimated week of) 12/1/01
6. Contract period (period where grant funds will be available and are expected to be spent) 12/15/01 – 6/30/02

SUBMIT ONE (1) ORIGINAL (marked “ORIGINAL”) AND SIX (6) COPIES OF THE PROPOSAL IN THE SAME SEALED PACKAGE.

Who May Apply

 

  1. Any dental facility, dental school, dentist, dental hygienist, or public hospitals that serves CHP+ (Child Health Plan Plus) and/or Medicaid-eligible children, or will with the assistance of this grant, serve CHP+ and/or Medicaid-eligible children, is eligible for this grant. This includes, but is not limited to: dentists in private practice; dental hygienists in private practice; dental partnerships; Community Health Centers; local health departments; Rural Health Clinics or Centers; primary care clinics; Federally Qualified Health Centers; and School-Based Health Centers.
  2. A facility with multiple sites may apply for more than one grant, but must submit one application for each specific site and address the issues of that specific site.

Applicants who have previously received a dental capital expenditures grant from the Department must indicate the grant purpose and the grant amount in the Dental Start Up Grant Application. Previous applicants may apply for this money for a new or alternate site or an unrelated project.

Purpose of Grants

Applications for Dental Start-Up Grants are being solicited by the Colorado Department of Health Care Policy and Financing (the Department) through the Department of Human Services North Central Procurement. These grants will be awarded as described in footnote 45 of Senate Bill 01 – 212 which is the State of Colorado’s Budget:

Department of Health Care Policy and Financing, Medical Programs Administration, Dental Incentive — It is the intent of the General Assembly that this funding be used for clinic start-up to ensure the expansion of the dental network and expansion of dental service delivery for eligible low-income children. It is furthermore the intent of the General Assembly that these funds be available for both dentists and dental hygienists and that the Department give preference to grantees that provide matching funds. The Department is requested to provide a status report to the Joint Budget Committee on the expenditure of these funds by no later than November 1, 2002.

Grants will be awarded for the explicit goal of increasing dental services to low income children. Grant applications must clearly specify how this goal will be met, understanding that the grants are not to be used solely to improve the business of the provider. Grants will be awarded for one time costs that are directly related to the development of a new clinic, clinic expansion, clinic renovation, or expansion of dental services.

Awards will be made to qualified providers who demonstrate that they will expand primary, preventive, and tertiary dental health care services to low-income residents of Colorado. The Department has separated the funds available into two categories in order to allow a significant number of grants to be awarded and wider distribution of the available dollars. The total amount available for all grants is $2 million. Grants will be awarded for projects costing up to $100,000 and projects costing from $100,001 to $400,000. Grant applicants may apply in only one category. Grants will not be considered for funding above $400,000 and grant applicants must not submit budgets for more than this amount except to reflect other sources of financing for the project.

Grant moneys may only be used for expansion of the dental network and/or expansion of dental service delivery for eligible low-income children. Examples of appropriate use of grant funds include but are not limited to: capital construction to build, renovate, or expand a dental facility; purchase of dental equipment; incentive or retainment funds for dental personnel; administrative systems expansion or development; property purchase, portable dental units; or transportation vehicles to provide community based care.

BACKGROUND, OVERVIEW & GOALS

The grants awarded under this Request for Proposals will result in the provision of dental care for both Child Health Plan Plus (CHP+) children and Medicaid-eligible children in Colorado.

The Child Health Plan Plus (CHP+), or Children’s Basic Health Plan (CBHP) is a public/private partnership providing subsidized health insurance for children in low-income families statewide who are not eligible for Medicaid. The Program is administered by the State of Colorado Department of Health Care Policy and Financing through private contractors who provide various services. Created in 1997 under Title XXI of the Social Security Act, the State Children’s Health Insurance Program was allocated $48 billion nationally, over ten years, to expand health care coverage to uninsured children. The program enables states to insure children from working families with incomes too high to qualify for Medicaid but too low to afford private health insurance, with some latitude to adjust upper-income limits. Until now, the CHP+ has not provided dental care to its clients. In the 2001 Legislative Session, the General Assembly funded a dental benefit for CHP+ children. In addition, $2 million was appropriated from the CBHP Trust Fund for the grant opportunity described in this Request for Proposals.

The CHP+ dental benefit plan will not be implemented until early 2002. Additionally, it is important to note that the CHP+ dental benefit plan will likely differ from the Medicaid dental plan currently in affect under the EPSDT requirements referenced below. Specifically, the scope of services covered under CHP+ may not be as comprehensive as Medicaid. CHP+ reimbursement for covered procedures may be closer to amounts established under private dental plans. Grant proposals which include plans to effectively address these differences will be given additional weight in the evaluation process.

Under Medicaid’s Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program, Colorado is required by federal regulations to provide comprehensive dental health care for individuals under the age of twenty-one. EPSDT was defined in the Omnibus Budget Reconciliation Act of 1989 (OBRA 89) and includes periodic screening, vision, dental, and hearing services. In addition, the Social Security Act requires that any medically necessary health care service be provided to an EPSDT client even if the service is not available under the State’s Medicaid plan to the remainder of the Medicaid population. The EPSDT program requires that dental services be provided at reasonable periods according to standards of dental practice. States are required to work with dental organizations involved in providing care to children to establish intervals for screening.

EPSDT screening services must include, at a minimum, relief of pain and infection, restoration of teeth, and maintenance of dental health. Dental services cannot be limited to emergency services. Although medical doctors may conduct oral screening as part of a physical examination, the oral screening cannot substitute for an examination by a dentist. When a screening indicates the need for further evaluation, then diagnostic services must be provided. The referral must be made in a timely manner and follow-up should occur to ensure that the client receives the complete diagnostic services. Lastly, EPSDT requires that health care must provide treatment to correct or ameliorate defects, of physical and mental illnesses or conditions discovered by screening. The Colorado EPSDT Dental Program recognizes oral health as a vital component of overall health. The program addresses oral health issues and provides professionals and families with a shared understanding of the essentials of oral health care services.

The Department proposed a “Dental Plan to Improve Access to Dental Care for Children” in November 1997, in a report to the Joint Budget Committee. The proposal included a gradual increase in Medicaid dental rates from the then current rate of 50% of the American Dental Association (ADA) mean up to 80% of the ADA mean for the Mountain Region. Eighty percent of the ADA mean was chosen as the goal due to the Colorado Dental Association statement that this level of reimbursement is needed for dentists to be Medicaid providers in Colorado. Medicaid dental reimbursement rates were increased to 65% of the ADA mean for FY 1998 – 1999 and to 68% of the ADA mean for FY 1999 – 2000.

The Department also proposed awarding capital expenditure grants to existing or new dental clinics that serve Medicaid-eligible children to enable these clinics to serve more children. In FY 1998-1999, a $100,000 “seed money” grant was awarded to a Medicaid-only clinic located in Denver.

In July 1999, Medicaid dental reimbursement was increased from 65% of the American Dental Association (ADA) mean to 68% of the ADA mean. Although this was not the full percentage stated by the dental community as necessary to achieve access for under-served populations, it was a step and a place for measurement of progress. Since July 1, 1999, the number of dentists enrolled with Medicaid has increased by 14%, but the number of dentists providing services to Medicaid-eligible clients has decreased by 5.3%. From 1999 to 2000, the overall number of Colorado dentists increased by 8.4% (from 3,521 active licensed dentists in 1999, to 3,818 dentists in 2000).

Dentists in Colorado Medicaid
Medicaid Enrolled Dentists Medicaid Participating Dentists
861 (July 1, 1999) 487 (FY 1998-1999)
873 (September 30, 2000) 431 (FY 1999-2000)
+12 -26

Colorado Department of Health Care Policy and Financing, Report to the Joint Budget Committee, December 2000

One of the ways to measure the impact of the increased reimbursement is to compare the number of clients receiving services. The following table illustrates the number of Medicaid-eligible children that were entitled to dental services (eligibles), those that actually received dental services (clients), and the total number of dental units (procedures) provided to clients. In FY 99-00, 1,930 more children (4.1% increase) received dental services than the preceding fiscal year. In addition, each child received approximately 22% more units of service. Despite these changes, the percent of eligibles declined.

Clients Served by Fiscal Year
Fiscal
Year
Number of Eligibles Number of Clients Served Percent of Eligibles Served Total Number of Dental Units Units per Client
1998-1999 209,403 47,390 22.6% 705,707 14.9
1999-2000 221,396 49,320 22.28% 861,444 17.5

Colorado Department of Health Care Policy and Financing, Report to the Joint Budget Committee, December 2000

The overall percent of Medicaid-eligible children in Colorado receiving dental services is 22.3%, although this number does not include the children seen by Federally Qualified Health Centers. Together, penetration rate is estimated roughly at 26.1%.

FQHC Dental Services – Fiscal Year 1999 – 2000
Number of Providers Number of clients Total Payments
FQHCs 95 8,374 $3,043,801
Non-FQHC Providers 464 49,320 $18,563,694
Total 559 57,694

Colorado Department of Health Care Policy and Financing, Report to the Joint Budget Committee, December 2000

The Colorado Commission on Children’s Dental Health was convened to study key public policy issues related to improving children’s oral health and to provide recommendations on how to improve the current system of dental care for Colorado’s children. Beginning May of 2000, the Commission studied the extent and nature of the problem of children’s oral health care in Colorado. The Department of Health Care Policy and Financing worked closely with the Commission to provide data and develop a plan to increase services for Medicaid-eligible clients.

Children in both metropolitan and rural areas of Colorado are under-served. Half of Medicaid-eligible children live in the Denver/Boulder metropolitan area (111,610), and many require dental services. The services provided by the Smile High clinic, funded with last year’s seed money, has assisted in addressing the needs of metro-area children. However, with so many children requiring dental services, and private dentists, for the most part, are reluctant to accept these children, many go without needed dental services.

Children living in rural areas have a critical access problem. There are not many dentists in the rural areas of the State. Many of the dentists that do practice in the rural areas do not accept Medicaid-eligible children. Although a child living in the Denver metropolitan area may have access to a dentist, often there is a waiting list. Anecdotal information reveals that some children in rural areas do not have access to a dentist in their area.

  Changes in Eligibles and Clients in Urban versus Rural Areas
FY 98-99 FY 99-00
Area Medicaid-Eligible Children Clients Who Received Services Percent of Eligibles Who Received Services Medicaid-Eligible Children Clients Who Received Services Percent of Eligibles Who Received Services
Urban 151,471 30,096 19.9% 161,521 38,613 23.9%
Rural 57,932 17,294 29.9% 59,875 10,707 17.9%
Total 209,403 47,390 22.6% 221,396 49,320 22.3%

*Urban Counties are Adams, Arapahoe, Boulder, Clear Creek, Denver, Douglas, El Paso, Jefferson,

Larimer, and Pueblo. Colorado Department of Health Care Policy and Financing, Report to the Joint Budget Committee, December 2000

The number of counties without a participating Medicaid dentist did not change from 1999 to 2000, resulting in twenty-two counties without Medicaid dentists to provide services. The table below specifies which counties do not have providers.

Counties Without a Medicaid-Participating Dentist
Fiscal Year Counties Without a Medicaid-Participating Dentist Change
1998 – 1999

and

1999-2000

Bent, Chaffee, Cheyenne, Costilla, Crowley, Custer, Dolores, Elbert, Gilpin, Grand, Hinsdale, Jackson, Kiowa, Mineral, Moffat, Ouray, Phillips, Pitkin, San Juan, San Miguel, Sedgwick, Washington. None – 22 counties without a Medicaid dental provider.

Colorado Department of Health Care Policy and Financing, Report to the Joint Budget Committee, December 2000

Below is the total expenditures illustrating the increase in dental reimbursement per fiscal year.

Dental Expenditures
Fiscal Year Percent of ADA Mean Total Expenditures Expenditures Per Client Served
1998-1999 65% $ 13,109,704 $277
1999-2000 68% $ 18,563,694 (estimate) $376
2000-2001 68% $ 21,693,368 (projection) $409

Colorado Department of Health Care Policy and Financing, Report to the Joint Budget Committee, December 2000

In FY 00-01, four $50,000 grants were awarded to dental clinics which provide services to Medicaid-eligible children. Two of these grants were awarded to rural clinics.

In the 2001 legislative session, additional action was taken by the Colorado General Assembly to address dental issues for children. Funding was allocated to the State’s Children’s Basic Health Program, known locally as Child’s Health Plan Plus (or CHP+), for the addition of a dental benefit. Legislation was approved which 1) allows dental hygienists to bill the Medicaid program directly for independent practice, 2) provides a tax incentive for dentists practicing in rural areas, and 3) creates a State-funded loan repayment program for dentists and dental hygienists. The dental hygienist billing for Medicaid will require several months for systems changes to be implemented. The Legislation approved a $2,000,000 fund for start-up grants for dental providers willing to serve CHP+ and Medicaid-eligible children. The CHP+ dental benefit will not be accessible until late in fiscal year 2001-2002. The Department is requiring several months to implement the system changes necessary to allow dental hygienists to bill Medicaid directly.

Definitions

“Rural County”, for the purpose of this grant, is defined as any Colorado county except Adams, Arapahoe, Boulder, Clear Creek, Denver, Douglas, El Paso, Jefferson, Larimer, Mesa, Pueblo, and Weld.

“Applicant” is defined as an entity that is submitting an application (proposal) in response to this Request for Proposals/Grant Application (RFP).

“Independent Dental Hygienist” is a Colorado-licensed dental hygienist enrolled with the Colorado fiscal agent as a billing and rendering provider, who operates his/her own business independently as authorized under the scope of that license.

“Public Hospital” is a Colorado hospital that is owned by a state, county or local government entity.