Back on May 19, Sen. Chuy Hinojosa and Rep. Richard Peña Raymond hosted a town hall meeting for providers on Medicaid managed care in Edinburg at the Edinburg Conference Center at Renaissance.
It has taken a while but here are some collected observations about what occurred at the meeting.
Well attended but geared more for medical providers
First of all, the meeting was well attended. So much so that the meeting moved from a large conference room to the auditorium at the conference center. It is estimated about 200 providers attended.
While the attendance generally was good, the number of dentists who attended was small. Apparently, only four or five were there including Dr. Joey Cazares of McAllen Dental Associates and president-elect of the Texas Dental Association, Dr. Chad Evans of Smile Magic and Dr. Juan D. Villarreal of Harlingen Family Dentistry. It appeared that the meeting was set up more for medical Medicaid providers.
This fact was highlighted further as neither MCNA or Dentaquest were among the six managed care organizations that were on the dais to answer questions.
Joining Sen. Hinojosa and Rep. Raymond on the dais were Rep. Bobby Guerra, Charles Smith, the current deputy commissioner of the Health and Human Services Commission and their host Dr. Carlos Javier Cardenas along with six MCO representatives. About-to-retire HHSC Executive Commissioner Chris Traylor, Medicaid director Gary Jesse and Inspector General Stuart Bowen participated by phone as bad weather had prevented their travel to the valley from Austin.
Key dental issues raised – main dental home and credentialling
Here are the takeaways from the meeting:
- Providers are having problems with MCOs similar to dentists with Dentaquest and MCNA. They complained about denial of necessary procedures, a burdensome administrative process to get kids basic care, recommended treatment by a specialist being denied by a lesser trained individual at an MCO.
- Two issues relating to dental care were brought up by Dr. Evans and Dr. Cazares. The first was credentialing of new dentists. It is taking up to six months by Dentaquest. MCNA is taking about two to three weeks. It was learned that, per their contract, the dental MCOs are supposed to credential a new dentist to an existing practice within 30 days or at least allow them to bill within 30 days if they can’t complete the credentialing. The HHSC reps said that HHSC will fine and penalize the dental MCOs if this is not occurring.
- The second issue is that of main dental home for Medicaid patients. Dr. Evans told a story about a dentist he works with who recently bought a practice from his brother who is also a dentist. By the time the changeover of ownership had taken place, every Medicaid patient in the practice had been reassigned a new dental home by Dentaquest and MCNA. The new owner had no idea where they had gone. Dr. Cazares made the same point as his office staff have to check every patient at their appointment to ensure their dental home has not changed. It is basically a disaster.
- The consensus among providers was that the MCOs were up there giving all the right answers about how the program is supposed to go but this didn’t mesh with reality and their experience at all. Worse, there’s nobody holding them accountable and making them administer the program the way it is supposed to be administered.
Provider MCO workgroup to be established
As a result of the town hall, Rep. Raymond is establishing a provider workgroup to be organized this summer. It will consist of both providers and representatives from the MCOs so they can work together on a more intimate level and resolve these issues.
Dental providers who wish to participate can email him at richard.raymond@house.texas.gov.
I am Dr. Cazares, responding to comments in this article. First of all, I clarified before speaking that my comments were as an individual Medicaid-providing dentist and not as President-elect of the Texas Dental Association. Once again, my comments here are my own and do not necessarily represent that of the Texas Dental Association.
The article seems to suggest that I agreed with Dr. Chad Evans concerning his story and that I thought that the credentialing and main dental home process is “a disaster.” This is not correct. Credentialing does have a place in the profession, and needed to adequately check backgrounds to protect the patients of Texas.
As for the dental home, I believe in the main dental home concept. The intent of the main dental home is the establish and maintain the relationship between a patient and his dentist, who hopefully can maintain that relationship for a lifetime. I defended the main dental home concept during this town hall meeting.
It is frustrating to have to check main dental home assignments on a daily basis, but that is mainly due to unethical dentists who “bribe” unsuspecting patients at grocery stores, flea markets, hardware stores, etc. into changing their dental home. When patients realize what has happened, we then have to change them back to their original dental home. That is what is causing increased frustration to the ethical dentists who have always provided ethical care for these patients for many years prior to this current wave of providers who seem to think that ethics and rules do not apply to them. Those were my actual comments.
Dr. Cazares
Thank you for supplying your comments. In relation to the dental home concept, it is the administration of the program that is a disaster, not the concept itself. We have had complaints regarding both credentialing and the main dental home from other dentists.
As a Medicaid provider I wish I knew about this meeting so more dentist could attend and hear the problems and how to solve it !!
My main problem is lots of dentist around my area somehow asigned themaelves in the area school and some one who is None dentist goes there and ck the kids teeth and diagnosed with several decay and force the parents to change and as some parents are smarter and coming back to me for second opinion but also we see their providers already changed !!
Some they don’t believe when I insist they don’t need ssc and this filling will hold on for long time !!
I even went to those school and ask how can I come and educate the student and answer was we will get back to you since we have another dentist !!
They lie to the patients that kids should go to this clinic !! It’s truly not fair for someone like me with 17 years in one area and none dentists owning dental practices be able to do such a huge marketing and get your patients away !!! What shall we do !!!