training through health education centers and geriatric programs. The new patient navigator program, which helps enable people work through the health care system, may also be of use to the oral health system. HRSA may also be able to tap into its relationships with state offices of rural health and primary care associations to examine what is working at the state level and look at the impact of the economic downturn on access to oral health care services, professional groups, and education and training institutions.
HRSA may have a role in improving access to oral health care services by increasing the amount of available data. Historically, HRSA has done a lot of work with different segments of the health care workforce, and so might be able to engage even more with oral health professionals. In addition, the Health Workforce Information Center provides a single portal for accessing information on the health care workforce and enables different groups to share information on upcoming meetings, funding opportunities, reports, and best practices.
Finally, HRSA has a mediation role. HRSA will be working with the new administration as it engages in health care reform; oral health needs to be kept as a part of that discussion. HRSA may also act as a convener to bring people together to continue to engage in dialogues about improving access to oral health services.
A. Conan Davis, D.M.D., M.P.H.
Centers for Medicare and Medicaid Services
The Centers for Medicare and Medicaid Services (CMS) is a partnership between the federal government and the state Medicaid agencies, creating a sharing of responsibilities. The states drive a number of the initiatives that take place in Medicaid to establish eligibility and establish the scope of services to be provided. States also establish payment rates that are then matched by the federal government providing they fit within federal guidelines. CMS has a number of oversight responsibilities from the federal level.
CMS is a payor and must abide by federal guidelines and regulations regarding payment. For example, the Code of Federal Regulations basically defines dental services as being provided by a dentist or someone supervised by a dentist. A number of new programs license other types of professionals to deliver oral health services. When a state licenses a nondentist professional to provide these services, there is a mechanism in the regulations that allows CMS to approve those professionals to be compensated if the State Medicaid Agency chooses to cover them. However, complications can arise. For example, the Early Periodic Screening Diagnosis and Treatment