The American Association of Orthodontists have updated their definition of “medically necessary” care to include “emotional well-being.” They have done so because they state that recent studies have linked a “patient’s dental appearance and the incidence of bullying.”
Will such a change in definition by the AAO have any effect on Texas Medicaid or cause HHSC or its OIG to reconsider what is cosmetic and what is medically necessary treatment?
The full statement from the AAO website states:
AAO Board Addresses Medically Necessary Care
The AAO Board of Trustees met recently in St. Louis and took action on numerous issues that impact AAO members. Board actions include:
Board Recommends Updated Definition of Medically Necessary Care
The Board elected to recommend to the 2014 AAO House of Delegates revision of the definition of medically necessary care, as found in the AAO Policy Manual, to the following: “Medically necessary orthodontic care is defined as the treatment of a malocclusion (including craniofacial abnormalities/anomalies) that compromises the patient’s physical, emotional, or dental health. This treatment should be based on a comprehensive assessment and diagnosis done by an orthodontist, in consultation with other health care providers.”
The AAO Council on Orthodontic Health Care developed the revised wording after considering the American Dental Association definition of Medically Necessary Care, with thought toward sending a similar message to third party payers. The group also reviewed and considered inclusion of qualifying criteria and indices and opted to keep the definition more general in nature until more is known about the impact of the Affordable Care Act (ACA) on the orthodontic landscape.
The committee included reference to a patient’s emotional well-being in the definition after concluding that, although a patient’s emotional status cannot be measured, recent research publications should be taken into consideration as the final definition was developed. The publications address a patient’s dental appearance and the incidence of bullying.