The Texas Health and Human Services Commission (HHSC) plans to request $300 million from the state legislature to address extensive delays in processing Medicaid applications. This funding would facilitate hiring over 1,000 new employees and modernizing the outdated and heavily … Read More
In the Texas Health and Human Services Commission (HHSC) hearing held on November 12 about the proposed rate changes to the Medicaid dental fee schedule, eleven dental professionals, including a representative of the Texas Dental Association, testified, either in person … Read More
ACS State Healthcare and Conduent State Healthcare LLC have filed an appeal with the Texas Supreme Court, hoping to prevent a trial in which it must defend its flawed Medicaid prior authorization process, which rubber-stamped hundreds of millions of dollars … Read More
While DentaQuest limits its Medicaid network in Texas and threatens to boot over 100 providers from its network in urban areas, yesterday, its Canadian parent company, Sun Life Financial Inc., crowed about its share price reaching an all-time high, boosted … Read More
It is a common misconception that your voice does not matter in big government. Unfortunately, it is that misconception that allows big governments to continue in a state of blissful unawareness about the need for change in their policies and … Read More
In our last article regarding the HHSC Provider Finance department biennial review of Medicaid dental fees, we published a letter sent to HHSC by a dentist to complain about the lack of real increase in rates made. Hot issue We … Read More
Texas Health and Human Services Provider Finance quietly posted its much anticipated legislated biennial review of Medicaid dental fees early last week. Well, maybe it was earlier, but it was only noticed early last week. It was found tucked into … Read More
The Sunshine State now joins the growing list of states that have recently increased dental Medicaid rates. Florida’s commitment to “live healthy” for its citizens On October 1, several health care bills came into effect in Flordia called the ‘Live … Read More
REPUBLISHED FROM THE TEXAS TRIBUNE Texas officials acknowledged some errors after they stripped Medicaid coverage from more than 2 million people, most of them children. A ProPublica and Texas Tribune review of records shows that these mistakes and others were … Read More
It’s a bad week for DentaQuest. Yesterday, according to an article in the online publication The Center Square, Louisiana legislators ripped into DentaQuest at a hearing of the House Joint Budget Committee as the Louisiana Department of Health had recommended … Read More
Remember we wrote that Texas should beware of DentaQuest and its corporate behavior, which cost the company $11 million in fines in Louisiana for Medicaid contract violations, which was recently cited in a report by the Louisiana Legislative Auditor’s office. … Read More
A recent article published by Becker’s Dental Review using Department of Labor statistics revealed that Texas ranks at the bottom when it comes to the number of dental hygienists per capita in the country. New Hampshire ranks number one with … Read More
In July, the Louisiana Legislative Auditor’s office published a scathing audit review of DentaQuest’s performance as one of the two dental maintenance organizations with Louisiana Medicaid. It fined the company for its poor performance. FYI, Louisiana calls them dental benefit … Read More
This week, a federal judge in Tennessee found that an algorithmic system similar to the one in Texas and designed by the same company illegally denied Medicaid benefits to thousands of Medicaid-eligible individuals. The TennCare Connect system, developed by Deloitte, … Read More
More comments have poured in as a result of our last article containing remarks from dentists about the state of their Medicaid practices. Medicaid dentists are having difficulty grappling with the crushing weight of rising costs and woefully inadequate Medicaid … Read More
TDMR’s recent article on the financial challenges facing Medicaid dental practices in Texas has struck a chord with a number of providers who left comments. We don’t often receive a spate of comments after an article, but this one certainly … Read More
The Texas Medicaid dental landscape faces a dire financial paradox. While costs for essential supplies, staffing, and real estate have surged dramatically, Medicaid reimbursement rates have stagnated below 2007 levels. Dental supply costs have increased by up to 98%, staffing … Read More
The American Dental Association’s Health Policy Institute (ADA HPI) recently published its “Economic Outlook and Emerging Issues in Dentistry” report for the second quarter of 2024. This comprehensive survey offers valuable insights into the current economic conditions, staffing challenges, and … Read More
The Texas Tribune published a major story yesterday about the problems Texas and other states are having with Medicaid eligibility systems developed by global consulting firm Deloitte. The Kaiser Family Foundation researched and wrote the story. A few sentences summarize … Read More
In what can only be described as a bombshell decision, the Texas Supreme Court has sided with Dr. Richard Malouf and his legal team. The Court not only reversed the $16 million summary judgment against Dr. Malouf but granted his … Read More
This week, several media outlets, including KXAN, have reported on U.S. Rep. Lloyd Doggett‘s release of correspondence from the Centers for Medicaid and CHIP Services (CMS) to Texas regarding significant delays and backlogs in processing Medicaid program eligibility. These delays … Read More
In a surprising move, the Arkansas Department of Human Services (DHS) announced this week that it is ending its Medicaid managed care dental program and transitioning back to a fee-for-service model starting November 1, 2024. This move from contracting with … Read More
The National Conference of State Legislatures (NCSL) has published an online article that promotes the need for oral health for all citizens and highlights the strides some states have taken to improve access to dental care, including Medicaid. The article … Read More
TDMR has learned that Texas Health and Human Services Provider Finance will conduct its biennial review of the Medicaid dental fee schedule later this year. The review will be presented at a rate hearing in November, with a proposed implementation … Read More
This past week, TDMR came across the State Of Texas Medicaid Managed Care Dental Rate Setting reports on the Texas HHS Provider Finance web portal. These are the third-party actuarial reports compiled for Texas HHS to recommend the per-member, per-month … Read More
The Colorado Dental Association (CDA) announced at the end of April that Gov. Polis had signed the 2024/25 state budget, which includes $78 million in “meaningful reimbursement rate increases for Medicaid dental providers.” The increased fees schedule goes into effect … Read More
TDMR recently received the 2023 statistics of active and enrolled Medicaid dentists from a freedom of information request to Texas Health and Human Services. These statistics come from the THSteps Active and Enrolled Dental Provider Participation Report (downloadable PDF below), … Read More
Holy Healthcare, Batman, Walmart just announced it is getting out of the healthcare provider business by closing its 51 Walmart Health centers around the country, including three brand new locations opened only a few weeks ago in Pearland, Sugar Land … Read More
BY KAREN BROOKS HARPER, Texas Tribune APRIL 26, 2024 “State’s premature release of bid proposal info touches off new battle over $116 billion in Medicaid contracts” was first published by The Texas Tribune, a nonprofit, nonpartisan media organization that informs … Read More
TDMR has compared the fee schedules for TMHP THSteps Medical services from 2019 and 2024 to determine if doctors are being hampered by the same reluctance from Texas HHS to increase fees that have plagued Medicaid dentists over the last … Read More
REPUBLISHED FROM THE TEXAS TRIBUNE By Karen Brooks Harper, The Texas Tribune April 18, 2024 “Proposed changes to state Medicaid plans could shake up health coverage for 1.8 million low-income Texans” was first published by The Texas Tribune, a nonprofit, … Read More
Last July, Louisiana quietly and significantly increased its EPSDT Dental program fee schedule. According to online information, the increase came about because Louisiana Medicaid was using the Full Medicaid Pricing program to establish fees. Its creator, the Centers for Medicaid … Read More
TDMR has reported on a number of recent controversies regarding dental loss ratios and value-based care outside of Texas. Now, to address these issues nationally, a Massachusetts-based dental organization, the American Alliance for Dental Insurance Quality (AADIQ), has been formed … Read More
The latest OIG Quarterly report was released last month. It contains several important trends for dentists and trends in OIG investigations into dental practices. Firstly, OIG preliminary investigations into dentists and dental practices remain at their traditional level of 6%, … Read More
Yesterday, we received an OIG update that is valuable for Medicaid dentists. OIG has found concerns “about inappropriate administration of sedation and local anesthesia, discharging the patient before they fully recovered from anesthesia, and billing for sedation levels the provider … Read More
Since Massachusetts voters overwhelmingly voted in favor of Question 2, the “Patient Access to Affordable Dental Care Act” in November 2022, instituting the nation’s first dental loss ratio, there has been a push to get other states on board with … Read More
Over the last several months, TDMR has been receiving anecdotal comments from Medicaid dental providers that they have found themselves truly between a rock and a hard place at this time. Although we have reported on a number of negative … Read More
On February 7, the Nebraska legislature passed the first reading on a bill to increase Medicaid dental reimbursement rates by a whopping 25%. In the only state with one state legislative body, that legislative body passed the bill 35-0. Recognizes … Read More
The movement to set a dental loss ratio (DLR) for the dental insurance industry is fast becoming a national issue and is now on the agenda of a number of state dental associations as well as the ADA thanks to … Read More
Arizona, through its Arizona Health Care Cost Containment System (AHCCCS). the state’s Medicaid agency, has instituted a value-based healthcare initiative with its Differential Adjusted Payment (DAP) program, which has been running for several years. Value-based healthcare initiative Value-based healthcare focuses … Read More
