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
TDMR has written extensively on how the provisions of the Texas Medicaid Prevention Act may be used by apparently unscrupulous relators to seemingly blackmail honest dentists into hefty monetary settlements to avoid costly and lengthy litigation. Problems with TMFPA The … Read More
Inc. Magazine just published an article by Adam Levin, Chairman and Founder of CyberScout, with his take on the alarming increase in fraudulent claims within Medicare and Medicaid due to the proliferation of medical identity fraud. This figure now exceeds … Read More
Back in March, TDMR published an article on the number of active THSteps Enrolled Dental Providers obtained from an open records request filed with Texas Health and Human Services. Records since 1996 Texas HHS has been compiling these figures since … Read More
Looking for a fee increase for Medicaid services? Here is another opportunity to make your voice heard. We received this email notification for Texas HHS this week. The Texas Health and Human Services Commission is working on its Legislative Appropriations … Read More
Governor Greg Abbott announced yesterday that he has appointed Raymond C. Winter (“Ray”), former head of the Civil Medicaid Fraud division of the Office of the Attorney General, as the Inspector General for Texas HHS. He will replace Sylvia Hernandez-Kauffman, … Read More
Two weeks ago, TDMR reached out to Texas HHS to find out if a new dental director had been hired for the Medicaid CHIP program to take the place of Dr. Margaret Laccabue. And, yes, that has occurred. We were … Read More
NOTE: DentaQuest had contacted us and the fees used for comparison initially were their commercial fees, not the Medicaid fee schedule available to providers and not publicly available online. We did not receive the correct fees from DentaQuest. However, we … Read More
Last month, TDMR was told that Inspector General Sylvia Hernandez Kauffman was going to be leaving OIG sometime in September. Today, we received confirmation from an OIG spokesperson that Ms. Hernandez Kauffman will be leaving the position on October 2. … Read More
The Office of Inspector General has another proposed rule on the Texas HHS “Comment on Proposed and Draft Rules” webpage entitled – “Recoupment of Overpayments Identified by Retrospective Payment Review.” This one is another addition to the Texas Administrative Code … Read More
Last Friday, Texas Health and Human Services sent an email notification that OIG was proposing a new rule (bottom of page) concerning “recoupment of overpayments identified by inspection” and wants public feedback by August 11. Public feedback Public feedback? Well, … Read More
In our last article “ADA Says Dentists Need to Accept Value Based Care as “Inevitable,” we referenced an online discussion on the Dentistry in General YouTube channel held on June 13. This passionate discussion revolved around the JADA editorial advocating … Read More
REPUBLISHED FROM THE TEXAS TRIBUNE Neelam Bohra, The Texas Tribune For seven years, Maricela Delcid has guided Texans through the Medicaid application minefield, working past language barriers and documentation issues out of a community center in Houston. But her clients … Read More
A firestorm erupted last month with an editorial published in the Journal of the American Dental Association titled “Value-based care in dentistry – Is the future here?” by Marko Vujicic, the chief economist and a vice president of the ADA’s … Read More
On June 27, we reported that the Legislature would not be increasing the Medicaid fee schedule for dentists despite the overwhelming need and the record abundance of funds in the state coffers this legislative session. The reason cited was that … Read More
With the passage of the record $321.3 billion state budget by the legislature and recent certification by the State Comptroller, all hope for a fee increase for Medicaid dentists this legislative session has evaporated. Efforts unsuccessful Efforts to educate legislators … Read More
Texas Medicaid nursing providers received a rate increase this past weekend as the Texas legislature approved an extension to a COVID-era add-on until August 31 and a further $900 million general Medicaid rate increase as part of the state’s overall … Read More
Last week, TDMR filed a complaint with the Texas Health and Human Services Office of Inspector General over the continuing complaints received by TDMR about the unacceptable delays in the credentialing of Medicaid dentists, particularly relating to the need to … Read More
Back in March, Rep. Mike Simpson, D.M.D., R-Idaho, introduced federal legislation to reduce administrative barriers for Medicaid dentists. Simplify credentialing According to an ADA release, “H.R. 1422, the Strengthening Medicaid Incentives for Licensees Enrolled in Dental Act [SMILED Act], would … Read More
TDMR has learned that Dr. Margaret Laccabue is no longer the Dental Director, Office of the Medical Director, Medicaid and CHIP Services for Texas HHS. We have it on good authority that she was released from employment with HHS, but … Read More
Texas needs to attract more dentists to help serve the ever-increasing number of Medicaid-eligible children in the state. Medicaid dental provider statistics Back at the end of 2013, there were roughly 3.2 million Medicaid-eligible children with 3,468 Medicaid dental providers … Read More
TDMR received an email from a provider that a new problem had developed in credentialing a dentist that adds even more time to the process. No TPI in welcome letter Apparently, TMHP is no longer including the TPI (Texas Provider … Read More
This seems like a silly question because surely the agency that pays billions of dollars to DMOs and MCOs and keeps the Medicaid show on the road in Texas should know something—and perhaps should know everything– about the credentialing of their Medicaid dentists in Texas. You wouldn’t be … Read More
Over the last several months TDMR has been receiving an increasing number of complaints regarding credentialing for Texas Medicaid dental providers. There have been numerous fixes over the years such as PEMS, the Provider Enrollment & Management System, which is … Read More
The American Dental Association Health Policy Institute has reported that national spending on dental care has recovered from the pandemic and in 2021 was higher than pre-pandemic levels. Patients coming back and government funding The increase is attributed to patients … Read More
The Great State of Texas, a leader in so many other things, unfortunately, is not a leader in healthcare. United Healthcare Foundation, UnitedHealth Group This is according to America’s Health Rankings, an annual state-by-state survey of healthcare in the nation … Read More
TDMR received this letter highlighting the difficulty Medicaid dental providers are having in today’s current economic climate and the need for the legislature this session to take corrective action. We publish it in hopes that it will reach open and … Read More
Becker’s Dental & DSO Review published a list of things about dental care in Texas a while ago. Some of them are not very flattering to this great state. Many underserved areas While Texas has the second most number of … Read More
Texas Health and Human Services is looking for a dental policy analyst for its HHSC Medical and Dental Benefits Program. As they say, “If you enjoy researching, writing policy and remaining current with dental practices, and are interested in being … Read More
State Medicaid Director Stephanie Stephens, in a speech given on September 27 at the 2022 North Texas State of Reform Health Policy Conference, stated that an HHS priority for the upcoming legislative budget is Medicaid provider rates. Provider fees a … Read More
TDMR received an email from Texas Health and Human Services this week requesting everyone’s help to come up with ideas to save some dough. Apparently, the Texas Legislature directed HHS to figure out how to save $350 million for the … Read More
OIG recently published the following article on its website which we thought to republish here along with the PDF documents linked to in the article. Texas providers encouraged to self-report overpayments Providers continue to participate in the OIG’s self-report process, … Read More
According to a recent report entitled “Access to Oral Health Workforce Report, Part I” by the Pennsylvania Coalition for Oral Health, the state lost 13.5% of its dentists participating in its Medicaid program between the beginning of 2019 and the … Read More
The recent business headlines about Sun Life, the Canadian insurer that purchased DentaQuest earlier this year, and its Q2 financial results are quite bipolar – either dismal or glowing. Good Q2 or not for DentaQuest purchaser Several publications spotlight the … Read More
The American Dental Association has reported that dental services increased 1.9% in June, the highest single-month rise ever recorded since the Department of Labor started keeping track in 1995. Job Market Increases The increase is attributable in part, according to … Read More
The American Dental Association reports that 14 state legislatures have passed progressive legislation regarding Medicaid dental care this year, partly due to increased budget surpluses in those states. Connecticut, Georgia, Illinois, Maryland, Mississippi, Missouri, Nebraska, South Dakota, Tennessee, Vermont, and … Read More
Thanks to the excessive prices for oil products due to the attempted embargo of Russian oil to punish the country for its war on Ukraine, the Texas state budget will benefit to the tune of some $27 billion, according to … Read More
After our article about the need for a review of Medicaid dental fees was published in May, we received a number of comments from dentists about how the lack of a fee increase is impeding service to their clients and … Read More
TDMR has learned that a number of Medicaid dentists around the state have been receiving informal letters from the Office of Inspector General about their billings. Avoid formal process Apparently, OIG is looking to resolve billing situations informally rather than … Read More
Everyone remembers the Frew case back in 2004 when the Supreme Court forced Texas to provide basic healthcare services including dental care for Medicaid-eligible children. Reason for fee increase in 2007 For those that don’t remember, let’s recap. Linda Frew, … Read More
