Medicaid managed care

June 24, 2019 – 1:00pm Health and Human Services Commission, Robert D. Moreton Building, Room M-1001,100 W 49th StreetAustin, TX 78756 Webcasting Available This meeting will be webcast. To access the webcast, go to https://hhs.texas.gov/about-hhs/communications-events/live-archived-meetings the day and time of the meeting and select … Read More

California made capitation payments after beneficiaries’ deaths. Of the 184 capitation payments in our random sample, 6 payments were correct. For the remaining 178 payments, California made unallowable payments totaling $433,948 ($302,755 Federal share). Despite California’s efforts to identify and … Read More

February 25, 2019 – 1:00pmHealth and Human Services Commission, Brown-Heatly Building, Public Hearing Room4900 North Lamar Blvd.Austin, TX 78751 This meeting will be webcast. To access the webcast, go to https://hhs.texas.gov/about-hhs/communications-events/live-archived-meetings the day and time of the meeting. Call to order Roll … Read More

FLORHAM PARK, N.J., Jan. 31, 2019 /PRNewswire/ — Conduent Incorporated (NYSE: CNDT), a digital interactions company, was awarded a $100 million, seven-year contract extension to provide third-party administration services for Gold Coast Health Plan (GCHP), a Ventura County, Calif.-based Medi-Cal … Read More

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

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 … Read More

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: 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

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 … Read More

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 … 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

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 … 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

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

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

By Marissa Evans June 27, 2018 Linda Badawo says she doesn’t know if managed care works or not — but it hasn’t worked for her family. Sitting with her son D’ashon beside her in his wheelchair, Badawo told legislators during … Read More

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

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

FORT WORTH, Texas (AP) — The largest assisted-living facility for Medicaid recipients in Texas is voluntarily shuttering after years of budget deficits and as residential developers clamor for real estate in the nation’s seventh fastest-growing city, the owner confirmed Friday. … Read More

WHITE PLAINS – A registered nurse from Yonkers was arrested and indicted Monday for allegedly submitting more than $390,000 in claims for services to two severely disabled patients that he did not provide. Attorney General Eric Schneiderman says over the course … Read More

Procurement Director Edward Armstrong must have a feeling of deja vu.Disclosure provisions in the state’s competitive bidding process have landed him in the hot seat again, this time as a defendant in a lawsuit filed last week by DSM USA … Read More

The Texas Health and Human Services Commission did not always claim Federal Medicaid reimbursement for managed care payments in compliance with Federal requirements. Of the 3,170 beneficiary matches in our review, 3,045 were assigned more than 1 Medicaid identification number. … Read More

Below are the results of our TDMR Medicaid Dental Maintenance Organization Followup Survey.  84 dentists responded to the survey which is not quite comparable to the 105 who took the first survey back in December 2016. Cautions on the results … Read More

Another bill affecting Medicaid providers of all stripes was introduced yesterday by state Rep. Sergio Muñoz Jr. from District 35 in the Rio Grande Valley.  Rep Muñoz, Jr. is a second term representative who was a member of the Government … Read More