The St. Mary’s University Mu Psi Chapter of the Pi Sigma Alpha National Political Science Honor Society is holding The Texas Medicaid Fraud Issue Forum on Wednesday, November 5th, 2014 in San Antonio. The purpose of the forum is to … Read More
Also during the debate, Abbott proposed Texas seek and receive a block grant to reform the state’s Medicaid system. It is a proposal similar to the ones Patrick and Perry have laid out for how to deal with the state’s … Read More
Republican lawmakers in Florida and Texas snubbed the Affordable Care Act’s Medicaid expansion for adults, but their states did broaden the program this year — for school-age children. Those states were among 21 – including some big Democratic-led states, such … Read More
September 29, 2014 — Late last week, California Gov. Jerry Brown signed a bill that establishes standardized requirements for dental plans to disclose how they spend patient premiums. The bill, AB 1962 introduced by Assemblymember Nancy Skinner (D-Berkeley), puts the … Read More
AUSTIN – Call it the billion-dollar blame game. Six years after auditors discovered signs that some Texas orthodontists were putting unneeded braces on teeth of the state’s poorest children, an army of lawyers are battling over who is liable for … Read More
Erin Fair Taylor’s job isn’t easy. That’s because every day, she must figure out how to pay doctors. Taylor works for CareOregon, which is playing an active part in Oregon’s effort to overhaul its Medicaid system. As such, it’s her … Read More
The following is a writeup done by a dentist on the Medicaid orthodontic program. He previously wrote on his experience with the program. This is a discussion of the Medicaid Insurance Program that covered general dentistry and the specialty of … Read More
TDMR received the following from a Texas Medicaid dentist who wishes to tell his story about his history with the HLD scoring system and the current state of Medicaid for orthodontia. He asked to remain anonymous. When I began working with … Read More
by Alexa Ura, The Texas Tribune SAN ANTONIO — When Armando Rodriguez opened the front door of his home here on the city’s west side, Chris Ornelas of the Texas Organizing Project met him with one question. “What are some … Read More
Dr. Behzad Nazari of Houston testified before the House Human Services Committee on September 3rd on SB 1803 and due process rights for Medicaid providers. Nazari’s Antoine Dental clinics was put under a 100% payment hold for their Medicaid orthodontic … Read More
Signed into law in 1965, Medicaid ensures health coverage for nearly 60 million Americans today. Since the Medicaid program was established, the costs and responsibilities for administering it have been shared between the States and the Federal Government. However, a … Read More
Dr. Paul Dunn testified before the House Human Services Committee last week about his experiences with the Health and Human Services Commission Office of the Inspector General and SB 1803. Dunn testified last year before the same committee and more … Read More
This past Wednesday, the Texas House Human Services Committee held public testimony on the effectiveness of SB 1803 passed last session to put into legislation due process rights for Medicaid providers under investigation by the Health and Human Services Commission … Read More
This past Wednesday, the same day as the House Committee on Human Services hearing on SB 1803, HHSC sent out a notice that it had placed online a video for Medicaid providers about Office of the Inspector General investigations. This … Read More
WASHINGTON — If the 23 states that have rejected expanding Medicaid under the 2010 health care law continue to do so for the next eight years, they’ll pay $152 billion to extend the program in other states _ while receiving … Read More
September 1 marks latest expansion of Medicaid managed careAn additional 134,000 people who are elderly or have disabilities are now getting their Medicaid services through STAR+PLUS managed care. The switch came September 1 as HHSC continued its expansion of managed … Read More
The Texas House of Representatives Committee on Human Services has announced that it will be holding a public hearing on Wednesday, September 3rd, which will include hearing testimony regarding the effectiveness of SB 1803 and changes that should be made to the … Read More
Gov. Rick Perry of Texas is one of the least thoughtful and most damaging state leaders in America, having done great harm to immigrants, abortion clinics and people without health insurance during his 14 years in office. But bad political … Read More
The following is the testimony presented last week to the Texas Senate Committee on Health and Human Services by Jason Ray of Riggs Aleshire & Ray in Austin. Ray is an attorney for a number of Medicaid dentists who have … Read More
As part of its charge in its hearing last Thursday, the Texas Senate Committee on Health and Human Services looked into the state of the Texas State Board of Dental Examiners. The Executive Director Julie Hildebrand, the Director of Enforcement Lisa … Read More
Texas lawmakers are exploring ways the state could provide more access to health care for 1.9 million uninsured poor people without acquiescing to guidelines set under the Affordable Care Act, sometimes referred to as Obamacare. They’re calling it the “Texas … Read More
Three Medicaid dentists who are involved in HHSC-OIG cases will be testifying tomorrow before the Texas Senate Committee on Health and Human Services. Dr. Chad Evans of Smile Magic from Dallas, Dr. Vivian Teegardin of Harlingen Family Dentistry and Dr. … Read More
The Senate Committee on Health and Human Services has sent out public notice that it will be holding a public hearing at the Capitol in Austin on Thursday, August 14th. One of the charges the Committee will look into at … Read More
More than 80,000 additional Texans have enrolled in Medicaid or the Children’s Health Insurance Program since the rollout of the Affordable Care Act last fall despite Republican state leaders’ decision not to expand eligibility to poor adults, according to federal … Read More
Today, Health and Human Services Secretary Sylvia M. Burwell announced a new innovative collaboration with states to improve care for Medicaid beneficiaries by accelerating efforts in reforming their health care systems to improve health and care while reducing costs. The … Read More
GAO identified a gap in state and federal efforts to ensure Medicaid managed care program integrity. Federal laws require the states and the Centers for Medicare & Medicaid Services (CMS) to ensure the integrity of the Medicaid program, including payments … Read More
Work continues to move the Medicaid claims administration contract from Xerox to Accenture. HHSC is reviewing Accenture’s readiness to take over the contract, which also includes processing claims for the Children with Special Health Care Needs program and vendor drug … Read More
Michael McMillen, former Deputy Chief Counsel, Texas Health and Human Services Commission Office of Inspector General, is suing the HHSC for wrongful dismissal after reporting alleged violations of law within the agency. The nature of the alleged violations are not known. The … Read More
On May 7th, Dr. Kyle Janek, the Executive Commissioner of the Texas Health and Human Services Commission, issued his final order in the case of Antoine Dental Center of Houston. Upheld reversal of favorable SOAH ruling on Antoine Dental As expected, … Read More
June 19, 2014 — Colorado adults on Medicaid now have dental coverage, including an annual benefit of up to $1,000 in dental services. Previously, only emergency dental services were covered, according to Oral Health Colorado. The benefit enables adults age … Read More
Texas’ Republican leadership made sure the state didn’t expand its Medicaid program to poor, uninsured adults — an optional provision of the Affordable Care Act. But low-income parents here are increasingly getting covered by the joint state-federal insurer anyway — … Read More
June 6, 2014 — Illinois lawmakers have passed a bill to restore adult dental coverage for Medicaid patients after emergency room costs for dental problems mushroomed when the program was cut. The bill now goes to Gov. Pat Quinn for … Read More
Wednesday, TDMR received a notice that HHSC had put online a report from Deloitte Consulting LLP entitled, “State of Texas Medicaid Payment Reform – Market Assessment and Recommendation Analysis.” The report is dated March 31st, 2014 and is 51 pages … Read More
Of the eight acute-care hospitals in our sample, one hospital always reconciled patient accounts and refunded associated Medicaid overpayments to the Texas Health and Human Services Commission (State agency). However, the seven remaining hospitals in our sample did not always … Read More
Deloitte Report for Texas As market pressures continue to mount, states are not only looking to derive more value from their managed care programs but also seeking to use these programs to address CMS’ Triple Aim: better health, better quality, … Read More
HHSC yesterday sent out a notice that a new draft HHSC strategic plan has been issued to cover 2015 to 2019. They have invited public comment. Naturally, the report is 348 pages long and their first public hearing on the report … Read More
Texas has received federal approval to test an innovative idea that combines health services for people with both Medicaid and Medicare coverage into one plan, making it easier to get care and potentially saving money for the state and federal … Read More
May 27, 2014 — In the latest flurry of lawsuits in the Texas Medicaid scandal, eight dentists have filed suits claiming the state and attorney general (AG) “protected” Xerox because they feared a federal clawback for hundreds of millions of … Read More
May 20, 2014 — This year more than 181 million Americans won’t visit a dentist, nearly half of people older than 30 suffer from some form of periodontal disease, and about 1 in 4 children younger than age 5 already … Read More
TDMR filed an open record request a while ago to obtain the Texas dental Medicaid spending figures for the years from 2000 to 2005 and 2012, 2013. Texas Medicaid orthodontic spending from 2006 to 2011 has been heavily reported so we … Read More
