texas medicaid reform

HHS sent out this notice today. The 86th Legislature included a cost containment rider in the FY 2020-21 General Appropriations Act directing the Health and Human Services Commission to achieve $350 million in savings by focusing efforts on “increasing fraud, … Read More

Last Friday, HHSC sent out the following notice: If you’re interested in Medicaid managed care issues, you might be interested in being a member of the State Medicaid Managed Care Advisory Committee. The Texas Health and Human Services Commission executive … Read More

In 2012, Tanya Walker took the $200 her father loaned her to see a doctor. She was in the aftermath of a divorce and needed a prescription for antidepressants, she said. But her doctor in Texarkana found signs of hypertension … Read More

Nearly 20% of Texans under the age of 65 don’t have health insurance and most of them are working, according to a new analysis that could further pressure that state’s policymakers and politicians to expand Medicaid coverage for the poor. Texas has … Read More

It appears that Texas Office of the Attorney General (OAG) forgot to sue Xerox to recover over $133 million that the federal government determined it was owed because of the state’s lack of oversight over Xerox, its then-Medicaid claims administrator, … Read More

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

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

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 … Read More

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. … Read More

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

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

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

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

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

Recently the Health and Human Services Office of Inspector General issued a report A-17-17-52000-  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES MET MANY REQUIREMENTS OF THE IMPROPER PAYMENTS INFORMATION ACT OF 2002 BUT DID NOT FULLY COMPLY FOR FISCAL YEAR … Read More

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

TDMR is releasing the results of its 2017 Medicaid Provider survey today. Not much has changed Not much has apparently changed for Medicaid providers from 2016. per the 337 individuals who answered our anonymous, 6 question survey in October and … Read More

UPDATE: September 1, HHS announced this morning that it has put on hold the proposed rate changes per legislative sources. Original story: August 1, 2017 TDMR has received a copy of an email from the Texas Academy of Pediatric Dentistry … Read More

On August 9, the House Committee on Human Services held a public hearing. Part of the agenda was to hear testimony relating to the proposed dental Medicaid reimbursement rate cuts for many necessary codes that have been called “devastating” by … Read More

From the Texas Dental Association: ATTENTION TDA MEMBER MEDICAID DENTISTS: CALL TO ACTION Texas Health and Human Services (HHS) is moving forward with a devastating proposal that will significantly cut certain Medicaid dental reimbursement rates. The proposed cuts include dental codes that … Read More

From the Texas Dental Association: As a part of ongoing efforts to prevent potentially devastating “rebalancing” of  Medicaid dental fees, the Texas Dental Association (TDA) will meet with Health and Human Services officials in the coming weeks to discuss each … Read More

TDMR has received a statement from the Texas Dental Association about its position on the proposed upcoming cuts to dental reimbursement rates for Medicaid providers. Statement from TDA President Dr. Joey Cazares The Texas Dental Association (TDA) already voiced strong … Read More

A dozen years ago, Texas health care administrators hired a company to help determine when taxpayers should cover the cost of dental care for the state’s poorer residents, particularly children. The company, later acquired by the giant corporation Xerox, deployed … Read More

A dentist recently contacted TDMR with a problem that his practice, a group practice, has come across with the new requirements for placing Medicaid children under general anesthesia. Difficulty with multiple dentists doing treatment He wrote: The new general anesthesia … Read More

Stacey English has modest desires for her 7-year-old daughter Addison: Be able to eat without gagging and move both her arms. But since Addison’s occupational therapist went out of business this winter, the child with a rare genetic disorder has regressed in … Read More

Texas rejected billions in federal aid to expand Medicaid under the Affordable Care Act, calling the program “broken.” But now it’s asking the Trump administration to renew a deal that’s brought the state an additional $6.2 billion a year under … Read More

Insurance companies are a powerful voice in virtually any congressional debate over health care. In the case of the Senate health-care bill, some insurers didn’t even wait for the official release before expressing their concerns. This week, the heads of … Read More