Comments about Dental Medicaid: Rep. Richard Peña Raymond

Rep. Raymond briefing the Commission on his amendments.

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 affected by the great Texas orthodontic debacle courageously first spoke out. It was at that meeting that he personally grilled Jack Stick, the now long gone and unlamented former deputy inspector general for enforcement, about his wild and until then unquestioned estimates of dental Medicaid fraud in the state. That hearing marked the beginning of the end for Stick and his boss Doug Wilson who were both gone by the end of 2014 and replaced by more reasonable minds.

Raymond and his committee recently held hearings on HMOs and their performance in Texas Medicaid.

DMO performance

We asked Rep. Raymond, considering his recent hearings on HMOs and the release of the RFP (request for proposals) for new DMOs, what he thought of DMO performance in Texas so far.

He said that there will always be complaints from providers about performance. It is the nature of the beast. There will never be enough money in the program to provide the reimbursement rates that everyone wants. There will always be complaints about performance in one way or another. It is an unfortunate fact.

The solution, he said, was for everyone to work together to make the best Medicaid system possible for the sake of the individuals served by the program. To do this, he said that legislators, providers and insurers needed to keep the lines of communication open so that problems were worked out as best as possible. He was very hopeful this could be done.

Will funding continue?

In fact, when questioned about continued funding of the program considering the crisis just before last Christmas at the federal level, he said that there is tremendous bipartisan support at both the state and federal level to keep the program in place. He was optimistic about the future and didn’t expect major changes at either level.

DMO RFP

Lastly we asked Chair Raymond for his thoughts on the current RFP for dental managed care. We expressed our concern that HHS has barriered the entrance of new DMOs into the program by stipulating that “at least two Dental Contractors” will be awarded, instead of the anticipated minimum of three.

He didn’t agree. He said he thought the RFP did not limit the number of possible DMOs to be selected and was pleased that HHS had left it open ended.

We pressed him on this point because it seems to us that by limiting the possible number of contracts to two, there would be less incentive for other DMOs to incur the tremendous expense of submitting a proposal. The incumbents MCNA and DentaQuest both have a tremendous advantage of having a solid provider network in place. There is the distinct possibility that HHS could simply re-award them and that would be that.

Again, Raymond did not see it that way. He said the RFP did not limit HHS to awarding only two contracts. There was a strong likelihood they might award more. Further, he didn’t feel other DMOs would balk at spending the necessary money to file a proposal. That was the nature of the game and the one they played. He reiterated his pleasure that HHS had left the number of contracts to be awarded open ended.

Optimistic about future

Based on all the above, Chair Raymond said he was optimistic about the future of the dental Medicaid program in Texas. He felt there was a lot of support to keep it going and make it the best possible system for those that it served.

We thank him for his time.

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