New Texas Medicaid and CHIP Guide, the Pink Book, Now Available
HHS has published the 12th edition of a reference guide for Texas Medicaid and CHIP, commonly known as the Pink Book. The new version that has under gone a complete redesign is posted here.
“I Guess No One Really Cares” – HHSC OIG Director of Medicaid Integrity
In the same Xerox/Conduent court filing from July 2018 mentioned in our previous article, there is another exhibit worth mentioning. It is the complete email chain involving HHSC OIG officials discussing OIG investigator Ray Acuña’s meeting notes on the Xerox/Conduent … Read More
Public Meeting in Austin on Managed Care December 12
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 … Read More
State cancels health contracts with anti-abortion Heidi Group
An anti-abortion group that continuously failed to provide reproductive health services to the number of patients it told the state it could is getting its contracts terminated — and is facing an investigation by Texas’ health agency over questionable billing. … Read More
UPDATE: HHSC Proposes to Reduce Monies an MCO Obtains from Fraud Recovery to 50% from 100%
UPDATE: We’ve added below an additional HHSC presentation given to the House Committee on General Investigating & Ethics which gives further details of MCO contract management. This morning HHSC sent out a notice that it was looking for public comments … Read More
State cancels health contracts with anti-abortion Heidi Group
An anti-abortion group that continuously failed to provide reproductive health services to the number of patients it told the state it could is getting its contracts terminated — and is facing an investigation by Texas’ health agency over questionable billing. … 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 … 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
TDA Weighs in on DMO RFP and Capitation
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, … 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 … Read More
Gov. Greg Abbott announces new leader of Texas’ state health agency
Gov. Greg Abbott has tapped Courtney Phillips, the head of Nebraska’s health department, to lead Texas’ state health agency, effective Oct. 19. Phillips, the chief executive officer of the Nebraska Department of Health & Human Services since 2015, replaces Charles … Read More
TDMR DMO Survey 2018 Results: MCNA Improves, DentaQuest Has More Problems, Dentists Frustrated
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 … Read More
Six DMOs Likely to Vie for Texas Medicaid Dental RFP But Newcomers May Not Get a Contract
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 … Read More
How Texas can start fixing its health and social services contracting mess
We knew there were serious problems with Texas Health and Human Services Commission handling of billions of dollars in contracts for health care and social services, but new audits show this mess of a system is even worse than we … Read More
Audit at Texas Health and Human Services Commission finds latest in long line of problems
AUSTIN — Texas’ sprawling bureaucracy for regulating health care and providing social services is vulnerable to a “perception of impropriety” because it routinely lets individual contracting personnel open bids on their own, without any witnesses, a new internal audit says. … Read More
Texas health building invaded by mold, raising health concerns
Only one word comes to mind looking at photos that Texas Department of State Health Services employees took of gray, green and brown-hued mold dotting their office furniture: Ew. As of July 10, as many as 127 state workers have … Read More
RFP Released Last Week for Dental Services for Texas Children’s Medicaid and CHIP
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 … Read More
State Audit Finds Billion-dollar Errors in Texas Health and Human Services’s Contracting Process
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 … Read More
State audit finds billion-dollar errors in Texas health agency’s contracting process
A new state audit has found that Texas’ health agency may have awarded more than $3.4 billion in contracts erroneously — another scandal at an agency that has lost six of its top leaders over the last several months in … Read More
New HHS-OIG Report Criticizes MCO Identification of Medicaid Fraud and Abuse
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 … Read More
DentaQuest Now Promoting Capitation Payments Instead of Fee-for-Service to Some Providers
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 … Read More
Charles Smith Retires, Cecile Young Takes Over As Another HHS Executive Commissioner Hit By Contracting Woes
In case anyone missed it, Charles Smith, the Executive Commissioner of Texas Health and Human Services retired at the end of May. The continuing saga of poor contracting practices at the state agency enraged legislators and Gov. Abbott. As the … Read More
A Texas health commission employee was fired. Then she received the private information of more than 100 clients.
Tracy Ryans pulls out client applications containing private information that was mistakenly sent to her from the Texas Health and Human Services Commission, on April 24, 2018. Pu Ying Huang for The Texas Tribune. By Marissa Evans, The Texas Tribune … Read More
‘Unacceptable’ errors spur Abbott to send aide to ride herd on Texas Health and Human Services
AUSTIN — Gov. Greg Abbott says he is alarmed by contracting mistakes at the Texas Health and Human Services Commission and is sending a top aide, former state Sen. Tommy Williams, to correct the problems. Abbott said through a spokesman … Read More
State auditor finds more contracting errors made by health agencies
Charles Smith of the Texas Department of Health and Human Services testifies Wednesday, Nov. 1, 2017, to the House Committees on Human Services and Public Health at the Capitol. Bob Daemmrich for the Texas Tribune. Texas HHS still hasn’t learned … Read More
DMO Request for Proposals Coming?
TDMR has been asked several times recently if we have any knowledge of an upcoming RFP (request for proposals) for dental management organizations. There have been rumors flying around for well over a year now that Texas Health and Human Services … Read More
Molina Healthcare Awarded Texas CHIP Contracts
LONG BEACH, Calif.–(BUSINESS WIRE)–Molina Healthcare, Inc. (NYSE: MOH) today announced that its Texas subsidiaries, Molina Healthcare of Texas, Inc. and Molina Healthcare of Texas Insurance Company, have been awarded contracts by the Texas Health and Human Services Commission (HHSC) for … Read More
The United States Dental Association Is Forming!
TDMR has been asked to inform its readers that a new association of dentists is in the process of being formed. The new association is to be called the United States Dental Association. Among the founding members of the new organization … Read More
Texas Dentists Misled by Xerox/TMHP on Orthodontic Prior Authorizations: Deposition
Yes, we know it is 2018. Sorry. But the truth about the late great Texas Medicaid orthodontic debacle (2007 to 2011) has been not fully been made public yet. So here is some more truth for those who were involved … Read More
Bye-bye Xerox, Hello Fuji
Two days ago, the iconic and troubled American corporation Xerox was sold to Japan’s Fujifilm for $6.3 billion dollars, ending its solo history in this country. Losing money, under pressure The new company will be known as Fuji Xerox and, … Read More
Texas House Speaker Joe Straus calls for investigation into state health agency contracting
Texas House Speaker Joe Straus is calling on House members to investigate the Texas Health and Human Services Commission after a state audit report revealed mishandling of a contract with a health insurance company. The State Auditor’s Office released a … Read More
“Truth Decay” One Year Later
In January of last year, Dr. Juan Villarreal’s long-awaited book “Truth Decay: How Government Corruption Caused a Political Scandal Victimizing Texas Dentists and How It Could Happen to You!” was released on Amazon.com. “Truth Decay” details Dr. Villarreal’s personal struggles … Read More
Federal government provides funding for temporary CHIP extension in Texas
AUSTIN – As lawmakers on Capitol Hill continue to discuss the future of the CHIP program, Texas is set to receive $135 million from the federal government to keep benefits in place thru February. CHIP, which stands for Children’s Health Insurance Program, … Read More
UPDATED: Say What? Medicaid Rates Change January 1, HHS Invites Providers to Comment January 11
UPDATE: After conferring with colleagues, this is not the major reimbursement changes that were discussed earlier this year but an annual update of codes with minor changes. Hope you are having a nice Friday afternoon, the Friday before the Christmas … Read More
UPDATED: Xerox Goes After Dentists to the Texas Supreme Court
UPDATE: Arguments in this case were heard by the Supreme Court on Wednesday, December 6. The 39-minute video of the oral arguments is here. The court’s decision is not expected until spring of next year. As a heads up for dentists … Read More





















