Texas Dentists for Medicaid Reform

Lifetime Limitation for Restorations and Stainless Steel Crowns

September 18, 2018

Back in August, a notice appeared on the TMHP website that Texas Medicaid was going to impose a lifetime limit for restorations and stainless steel crowns on September 1. Lifetime limits The notice said: Effective for dates of service on or after September 1, 2018, lifetime limitations for restorations and stainless steel crowns will change for Texas Health Steps. The lifetime limitation for restorations and stainless steel crowns for primary teeth may be reimbursed up to $149.12 per tooth ID. The lifetime limitation for direct restorations and stainless steel crowns for anterior … [Read More...]

Dentist Quits MCNA in Disgust Over $33,000 Recoup Demand

September 12, 2018

From time to time, TDMR receives correspondence from dentists expressing their frustration and anger with one or both of the current DMOs managing Texas Medicaid. Last week, we received an email from a dental provider about a recoupment demand made by MCNA. Apparently, it took the company three years to review the documents he had sent them per … [Read More...]

TDA Weighs in on DMO RFP and Capitation

September 7, 2018

In the last edition of TDA Today, the Texas Dental Association goes to bat for dental Medicaid providers on two issues. First, the publication reported that the TDA's Council on Public Health and Access to Care met with HHSC (HHSC, HHS; tomato, tomahto) reps from the Quality Oversight, Finance and the Medicaid/CHIP Services Department. They … [Read More...]

Valley Providers Heap Scorn on Medicaid Managed Care

August 30, 2018

The Statesman published an article this morning about the scathing testimony heard by the House Committee on Human Services, chaired by Rep. Richard Peña Raymond, at a special hearing held yesterday in Edinburg. Wanted public and provider feedback on managed care The Committee traveled to the Valley to hear testimony from Medicaid providers … [Read More...]

Surprise! Medicaid Dental Reimbursement Rates Drop by 2.5% on September 1

August 28, 2018

You just found out about this? So did we. Just learned of it TDMR learned of it about 10 days ago when a provider gave us a copy of a letter they received from DentaQuest dated July 27 but received in their office August 13. It announced a 2.5% reduction on dental codes from D2140 to D9999 that was approved at a "recent" HHSC rate hearing. … [Read More...]

New Executive Commissioner of Texas Health and Human Services Chosen

August 24, 2018

By Marissa Evans, The Texas Tribune Aug. 23, 2018 Courtney Phillips is the new executive commissioner for the Texas Health and Human Services Commission, Gov. Greg Abbott announced Thursday. Phillips is currently the chief executive officer for the Nebraska Department of Health and Human Services. She starts her role as commissioner Oct. … [Read More...]

Comments about Dental Medicaid: Rep. Richard Peña Raymond

August 20, 2018

TDMR recently reached out to Rep. Richard Peña Raymond, chair of the House Human Services Committee to get his views on the current scene and the future of dental Medicaid in Texas. Supporter of dental Medicaid Raymond has been a major force for dental Medicaid providers. It was before his committee at public hearings in 2012 that dentists … [Read More...]

Texas Medicaid Dental Provider Forum NOW OPEN

August 9, 2018

Medicaid dental providers apparently want an online forum to securely discuss mutual problems with Texas Medicaid and DMOs. Some 92% of those taking our survey answered a resounding "yes" to having such a forum. Comments Here are some of the comments left by those answering the survey. "IT CAN BE VERY DIFFICULT AT TIMES, THEY CHANGE THE CRITERIA … [Read More...]

Dentists Comment About DMO Problems & Request for Proposals

August 6, 2018

Since our recent stories about the new dental RFP for Medicaid and DentaQuest's capitation payment move, TDMR has received several emails from dental providers about their concerns over the RFP choices and provider lack of power against such large companies. Comments from dental providers Number … [Read More...]

TDMR DMO Survey 2018 Results: MCNA Improves, DentaQuest Has More Problems, Dentists Frustrated

July 26, 2018

We have closed our revised 2018 Dental Management Organization annual survey and are today giving you the results. Our survey sample is not that large, unfortunately. At the end of the day, only 39 providers entered the survey as we decided to ask for actual names and provider numbers to prevent … [Read More...]

Six DMOs Likely to Vie for Texas Medicaid Dental RFP But Newcomers May Not Get a Contract

July 23, 2018

An industry insider has told TDMR that he thinks six dental management companies will vie for the Texas Medicaid dental contract RFP that closes in September. He named the two current contractors, MCNA and DentaQuest, and included Liberty Dental and Delta Dental out of California, Avesis, and … [Read More...]

RFP Released Last Week for Dental Services for Texas Children’s Medicaid and CHIP

July 18, 2018

Rendering of new HHS Building It is finally here, not with a bang but with a sigh. It's been out over a week and not a whisper about it until today despite the fantastic anticipation by dental Medicaid providers over the last number of months, if not years. But with the recent foofaraw and … [Read More...]

State Audit Finds Billion-dollar Errors in Texas Health and Human Services’s Contracting Process

July 18, 2018

The new audit is yet another scandal at an agency plagued by contracting woes. Six of the commission's leaders have left in the last several months. BY EMMA PLATOFF Republished from the Texas Tribune A new state audit has found that Texas’ health agency may have awarded more than $3.4 billion in … [Read More...]

Dental Providers Riled Up About DentaQuest Capitation Payment Plan

July 16, 2018

TDMR has received an email from a group calling itself "Texas Dentists for Fairness." Per their email, they are a group of owners of individual clinics from around the state Other than that we don't know anything about them. They are tremendously concerned by DentaQuest's "private conversations … [Read More...]

New HHS-OIG Report Criticizes MCO Identification of Medicaid Fraud and Abuse

July 12, 2018

The U.S. Department of Health and Human Services Office of the Inspector General issued a report yesterday that found that managed care organizations are not doing enough to identify Medicaid waste, fraud and abuse. HHS-OIG undertook the review because it and "others have ongoing concerns about … [Read More...]

DentaQuest Now Promoting Capitation Payments Instead of Fee-for-Service to Some Providers

July 9, 2018

TDMR has confirmed rumors that a number of Texas dental providers have been approached by DentaQuest to change their payment method from managed fee-for-service to capitation. Capitation to "share the financial risk" with providers A capitation payment is a fixed amount of money per patient … [Read More...]

House Committees Hear Concerns on Medicaid Managed Care Program for Medically Vulnerable Texans

June 28, 2018

By Marissa Evans June 27, 2018 Linda Badawo says she doesn’t know if managed care works or not — but it hasn’t worked for her family. Sitting with her son D'ashon beside her in his wheelchair, Badawo told legislators during a joint hearing of the House General Investigating & Ethics … [Read More...]

Dentist Quits MCNA in Disgust Over $33,000 Recoup Demand

TDA Weighs in on DMO RFP and Capitation

Valley Providers Heap Scorn on Medicaid Managed Care

Surprise! Medicaid Dental Reimbursement Rates Drop by 2.5% on September 1

New Executive Commissioner of Texas Health and Human Services Chosen

Latest TDMR Research and Articles

Lifetime Limitation for Restorations and Stainless Steel Crowns

Dentist Quits MCNA in Disgust Over $33,000 Recoup Demand

TDA Weighs in on DMO RFP and Capitation

Valley Providers Heap Scorn on Medicaid Managed Care

Surprise! Medicaid Dental Reimbursement Rates Drop by 2.5% on September 1

New Executive Commissioner of Texas Health and Human Services Chosen

Comments about Dental Medicaid: Rep. Richard Peña Raymond

Texas Medicaid Dental Provider Forum NOW OPEN

Dentists Comment About DMO Problems & Request for Proposals

TDMR DMO Survey 2018 Results: MCNA Improves, DentaQuest Has More Problems, Dentists Frustrated

Six DMOs Likely to Vie for Texas Medicaid Dental RFP But Newcomers May Not Get a Contract

RFP Released Last Week for Dental Services for Texas Children’s Medicaid and CHIP

State Audit Finds Billion-dollar Errors in Texas Health and Human Services’s Contracting Process

Dental Providers Riled Up About DentaQuest Capitation Payment Plan

New HHS-OIG Report Criticizes MCO Identification of Medicaid Fraud and Abuse

DentaQuest Now Promoting Capitation Payments Instead of Fee-for-Service to Some Providers

House Committees Hear Concerns on Medicaid Managed Care Program for Medically Vulnerable Texans

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