Secret‑shopper review finds dental appointment access well below state benchmark

State quality staff told the Technical Advisory Committee on Aug. 7 that a secret‑shopper evaluation of dental access found provider directories and appointment availability far below regulatory benchmarks.

"Well, the overall compliance rate was 10.7% for routine appointments and 11.7% for non urgent appointments are substantially below the 80%," Angie Parker, director in DMS's Division of Quality and Population Health, said, summarizing the IPRO (external quality review) dental access and availability survey for state fiscal year 2024. Parker said the reviewers sampled about 1,200 dental provider listings and made up to four attempts per listing.

DMS staff, including assistant director Liana Trainor, told TAC that directory inflation and incorrect location listings were major problems: some providers were listed at an excessive number of locations (one provider was listed at 42 locations), and the state's dental network was inflated by an estimated 32% in the initial review. "We are cross referencing back to our geo access report as well as the network status report to confirm the terminations have been completed as reported by the MCOs," Trainor said.

MCO and provider representatives pushed back on a single diagnosis. Jeff Chapman (Passport by Molina) and other MCO representatives said roster delegation, reporting methodology, mobile dentistry and practices limiting new Medicaid patients can produce low secret‑shopper results even when pockets of access exist. Chapman said the data "doesn't account for a lot of nuanced different things" and cautioned against interpreting the results as intentional dishonesty.

Why it matters: Appointment access drives network adequacy compliance and member care. DMS said it has submitted corrective action plans to the MCOs and will continue to refine network reports to capture hours worked at each location, new‑patient availability, and specialty breakdowns.

Representative quote: "Approximately 20% of the survey providers were not able to be contacted ... the provider was not at site for 56, almost 57% of the survey providers among routine appointment calls," Parker said, describing directory and contact‑information accuracy issues.

Ending: DMS told TAC it will provide updated, enhanced reports at the next TAC meeting to show provider impacts per MCO and to support contract compliance decisions.