A new document has come to light out of the lawsuit the state filed in 2014 against Xerox, its former Medicaid claims administrator, that shows Medicaid dentists were concerned as early as 2007 about Xerox’s prior authorization process and demanded to know how it worked.
In fact, it appears from the document that a policy review of the whole Medicaid orthodontic program was delayed for almost two years while the answers were compiled.
The document surfaced last month as an exhibit to a court filing Xerox made in response to a state motion to compel the company to produce more documents.
Court exhibit shows 2009 policy review of Medicaid orthodontic program
The exhibit in question is the final draft of a policy review entitled “Texas Health Steps Orthodontic Benefit Policy Development”, dated July, 2009. It is noted on the document that is “Confidential – Not Subject to Disclosure under FOIA.” It is the outline of a proposed change in the way Medicaid orthodontics was to be handled by the state, collaborated between staff from TMHP/Xerox, HHSC and HHSC-OIG.
The review was initiated in July, 2007 but put on hold September, 2007 for provider feedback and wasn’t taken up again until February, 2009.
Document shows Orthodontic stakeholders questioned prior authorization process in 2007
The document shows clearly that Medicaid dentists and orthodontists had been complaining to Dr. Linda Altenhoff, then Manager. Oral Health Group Texas Department of State Health Services, that they wanted to know who was doing and how the orthodontic prior authorizations were done.
In fact, the whole policy review was put on hold until the following questions were answered which was not until February, 2009:
- Who is involved in the review of orthodontic cases?
- What are the criteria for the review of orthodontic cases?
- What is the process when a difficult orthodontic case is presented?
- What is the level of understanding orthodontics by the providers who present orthodontic cases?
- What type of interceptive orthodontics is available for children in the age range of 6 to 7 years‘?
It is noted in the exhibit that “The following issues are high with Frew and Orthodontic providers” and that the questions are “to be researched and completed before Dr. Altenhoff can request a meeting and present to the Orthodontic Stakeholders.”
Dentists not given answers to questions
Dr. Altenhoff held a stakeholder meeting in January, 2009 but she did not present the answers to these questions per her meeting agenda. She did advise and seek feedback on proposed changes to provider qualifications and treatment plans for the orthodontic program. However, she told stakeholders, per her agenda, that:
All submitted orthodontic prior authorizations will be reviewed by a board certified Texas orthodontist through the Health and Human Services Commission claims administrator contractor(s) responsible for dental claims review and payment to determine if the case qualifies for orthodontic treatment as outlined by orthodontic policy.
Medicaid dentists were never told the answers to those questions.
But we now have them and it will the subject of the next article.