The State Medicaid Managed Care Advisory Committee of HHSC is holding a public meeting in Austin on December 12. Here is the information: December 12, 2018 - 1:00pm Health and Human Services Commission, Brown-Heatly Building, Public Hearing Room 4900 North Lamar Blvd. Austin, TX 78751 This meeting will be webcast. To access the webcast, go … [Read more...]
Questions Linger about Capitation and DMO RFP
We've heard from various dentists that they have questions about controversial issues that have come up over the last several months. So we assume there are more out there that have the same questions or heard the same rumors. Primarily they are concerned about DMOs moving to a capitation plan as DentaQuest was seeking to do and what is currently happening with the RFP. So … [Read more...]
HHSC reviews state Medicaid and CHIP programs
The Texas Health and Human Services Commission (HHCS) recently published its “Rider Report 61,” a review of Medicaid and Children’s Health Insurance Program (CHIP) managed care contracts commissioned by the legislature. The report aims to be a comprehensive assessment of the structure and function of Medicaid Managed Care system in Texas the integrity of which is particularly … [Read more...]
UPDATE: New RFP Out – Say What? Dental RFP Canceled by HHSC Over Proposal Problems
UPDATE: Christine Mann, the Press Officer at HHSC, has informed us that new RFP is out as of yesterday. The information is below and is available at http://www.txsmartbuy.com/sp/HHS0002879 Medicaid CHIP Dental Status: Addendum Posted Solicitation ID: HHS0002879 Response Due Date: 11/30/2018 Response Due Time: 2:00 PM Agency … [Read more...]
Lifetime Limitation for Restorations and Stainless Steel Crowns
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 … [Read more...]
Dentist Quits MCNA in Disgust Over $33,000 Recoup Demand
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 their initial request. He … [Read more...]
Valley Providers Heap Scorn on Medicaid Managed Care
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 and public about "the impact … [Read more...]
Surprise! Medicaid Dental Reimbursement Rates Drop by 2.5% on September 1
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. What? We knew nothing about … [Read more...]
Texas Medicaid Dental Provider Forum NOW OPEN
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 SO FREQUENTLY." "The … [Read more...]
Dentists Comment About DMO Problems & Request for Proposals
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 of DMOs - "We need 3-4 DMOs so dentists can refuse to accept DMOs that are run … [Read more...]