Dental Medicaid Update (5/16/13)

Info Found on Louisiana Medicaid Website Related to Maintaining Provider Enrollment with Molina (5/16/13)

Source: https://www.lamedicaid.com/provweb1/recent_policy/ProviderEnrollmentOperations.pdf

Effective March 25, 2013, Molina Medicaid Solutions will resume all operations related to provider enrollment applications, inquiries and requests.
Molina Medicaid Solutions Provider Enrollment Contact Information:
Molina Provider Enrollment, P.O. Box 80159, Baton Rouge, LA 70898-0159
Ph: (225) 216-6370, Fax: (225) 216-6392
Further direction will be posted on http://lamedicaid.com as it becomes available.

So, for the time being, despite all the changes considered, planned for and communicated regarding dental Medicaid, NOTHING has changed to date and there is NOTHING any dentist currently enrolled in Medicaid has to do to continue seeing patients and getting paid. There probably will at SOME point be a new RFP let for a dental plan to administer the dental Medicaid program. The LDA is monitoring the situation and will email and post any instructions as we are alerted to new information. 

ALL Medicaid Providers Must Re-Enroll with PRISM for Claims Processing (2/25/13)

ALL Medicaid providers have been notified via letters from both the Louisiana Department of Health and Hospitals (DHH) and the PRISM system (Provider Recipient Integrated System for Medicaid) about the new claims processing system DHH is implementing for Louisiana Medicaid. PRISM is scheduled to totally replace the existing Medicaid claims system operated by Molina.  

DHH is still working with their actuaries and federal officials to allow the State to contract with a single prepaid dental benefit plan to administer Louisiana’s dental Medicaid program. The PRISM system re-enrollment is completely separate from the company that will eventually be selected to administer the dental portion of the Medicaid program. PRISM has nothing to do with being a preferred provider in a private plan that administers Medicaid. To be paid in 2014 by Medicaid, you MUST re-enroll by Dec. 31, 2013.

So, anyone enrolled in Medicaid as a provider, regardless of whether part of Bayou Health or fee for service/legacy Medicaid, will switch to the PRISM system. PRISM is replacing Molina as fiscal intermediary, and any dentist enrolled as a current Medicaid provider who is processing claims/getting paid by Molina will need to participate in re-enrollment to do claims/get paid through PRISM once the switch is complete. PRISM will host a number of provider training sessions in March throughout the state. For dates and registration information, visit http://prism.la.gov/Pages/ComingMarch2013.aspx.

Provider enrollment is the first part of PRISM that will be implemented. Beginning February 28, 2013, ALL Louisiana Medicaid Provider Enrollment activity (new enrollments, changes, re-enrollment of all existing providers) will be performed by contractors CNSI and Noridian Administrative Services. To comply with Medicaid provider enrollment requirements of the federal Affordable Care Act (ACA) and to receive Medicaid reimbursement after the 2014 transition to claims payments through PRISM, all currently enrolled providers must re-enroll in Louisiana Medicaid through the PRISM Portal by Dec. 31, 2013.

Each provider should expect to receive two additional letters with their login information. The first letter will have login information and, for security purposes, the second letter will have the provider’s password. These letters are sent out in groups and may not arrive until April or May. Again, providers have until December 31, 2013, to complete the re-enrollment.

If any dentists (or other provider types) have questions about re-enrollment or PRISM, they can email This e-mail address is being protected from spambots. You need JavaScript enabled to view it or call 1 (888) 780-7858. 

Update on Dental Benefit Plan Implementation from the Louisiana Department of Health and Hospitals (DHH) (1/31/13)

The following information was posted on the DHH website on Thursday, January 31, 2013. The LDA will continue to update members as we gather information.

http://new.dhh.louisiana.gov/index.cfm/newsroom/detail/2750

DHH is not announcing a winning proposal to operate the Medicaid Dental Benefit Plan (DBP) at this time. We are working with our actuaries and federal officials to ensure that we are able to move forward in a manner that is cost effective and compliant with applicable federal regulations. Therefore, DHH is postponing its planned March 1, 2013 implementation.  Once more information is available or an announcement is ready, it will be posted here at this web address. Please continue to direct any future questions related to this RFP to Medicaid procurement manager Gail Williams at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Medicaid Providers Should Stop Rendering Services to Pregnant Women Jan. 31 (12/18/12)

Louisiana Department of Health and Hospitals Secretary Bruce Greenstein announced mid-year reductions at the agency that will save $51.8 million in State General Funds for Fiscal Year 2012-2013. Included in these cuts is the elimination of dental benefits for pregnant women, an optional service for Medicaid recipients. The effective date for the mid-year cuts is February 1, 2013. According to DHH officials, all services have to be rendered prior to February 1, 2013.

After Jan. 31, 2013, Medicaid providers will NOT be paid for dental services to pregnant moms.

For a complete list of DHH’s midyear cuts, visit http://new.dhh.louisiana.gov/index.cfm/newsroom/detail/2727.

Update on Administration of LA’s Dental Medicaid Program (11/30/12)

Most of you are aware that, since originally learning in June of the Department of Health and Hospitals’ (DHH) plan to carve dentistry into Bayou Health, Louisiana’s Medicaid managed care program, the LDA has devoted considerable effort to educating officials at DHH regarding potential pitfalls and concerns about such a move. Thankfully, DHH Secretary Bruce Greenstein and his key advisors listened earnestly to the LDA.  Over several months and numerous meetings, the Department heard our concerns, and despite the necessity of substantially reworking complex plans, dropped the part of its plan that involved incorporating dentistry into the system of at-risk managed care health plans currently operating in Bayou Health.

All this has been reported previously by the LDA in publications, on the website, etc., as has the clear fact that there will be a transition to a privately administered dental Medicaid program.  However, many of the specific details of the transition may still be subject to some modification.  Following is the anticipated scenario going forward, based on the best available information at this time.

DHH is now seeking a waiver and necessary state plan amendments with the Centers for Medicaid and Medicare Services (CMS) that would allow the State to contract with a single prepaid dental benefit plan to administer Louisiana’s dental Medicaid program. DHH officials are confident in this course of action and will work diligently to secure necessary federal approvals.

Provisions of the contract will include a capitated reimbursement methodology for the plan, fee-for-service reimbursement for dentists of no less than the Medicaid reimbursement fee schedule set by DHH, and network adequacy requirements sufficient to allow for a level of access to care deemed sufficient by DHH.  The contracted plan will also be required to provide data to DHH so the department can monitor a wide array of performance metrics ranging from timeliness of claims payments to fraud prevention.

A Request for Proposal (RFP) will soon be released by DHH.  The RFP will outline the expectations and required content of any proposals to be submitted by dental plans seeking the contract.

DHH has targeted March 1, 2013, as the date on which administration of the dental Medicaid program will transition to the contracted private plan. That date is not set in stone as yet, though, and it may well depend on how quickly DHH can vet proposals and award a contract.

Though the Department has indicated it is not a MAJOR factor in determining which plan will win the contract, the RFP does require that proposals include an indication of a plan’s ability to build an adequate provider network prior to the March 1 “go live” date.  Accordingly, plans interested in submitting proposals have been contacting dentists who are currently enrolled as Medicaid providers and asking them to sign non-binding “letters of intent.”  These letters indicate the willingness of the signee to participate in a plan’s Medicaid network should that plan win the contract.  If you are a Medicaid-enrolled provider, you may well have already been contacted and asked to sign such a letter.

Whether a dentist does or does not sign one or more letters of intent is not especially significant from the dentist’s perspective.  The dentist is not committed to participation in that plan, because the letters are non-binding.  And, it is unlikely that any dentist not signing a letter of intent would be unable to enroll as a participating provider for that plan after the contract is awarded.  However, it is possible, though unlikely, that a plan could achieve network adequacy with only dentists that have signed letters of intent i and close their network in a particular area.  Given the current Medicaid network, this is very unlikely, and DHH is committed to ensuring that the plan provides the necessary access for Medicaid enrollees.
Any explanation of the letters of intent that differs substantially from the above is probably inaccurate.  This is especially true if, prior to the contract actually being awarded to a given plan, a dentist is told that he/she will not be able to continue seeing Medicaid patients if he/she does not sign with a plan immediately.  Any dentist being told this prior to the contract being awarded should report the incident to DHH by calling Cordelia Clay at (225) 342-4182.

Finally, it should be noted that the Dental Benefit Plan cannot mandate your participation in any commercial network they may have as a requirement to participate in the Plan’s Medicaid network.

Please note that this issue is still evolving.  There have been many changes already and more are possible, though additional major changes would appear unlikely. I urge all who are interested to monitor LDA’s website, Facebook page and emails for the latest information.

BREAKING NEWS: Dental Medicaid Carved BACK OUT of Managed Care (10/12/12)

It is a great week for LDA members and our association! The Louisiana Department of Health and Hospitals (DHH) has informed us that after reviewing the research and case studies we presented to them regarding the management of dental Medicaid, that it would be in the best interest of the state to follow the LDA’s recommendation and put all dental Medicaid benefits under the administration of a single dental plan under an Administrative Services Only contract (we were told a single plan design will require a waiver from Centers for Medicare and Medicaid Services (CMS), but that in worst case scenario, there would be two plans).

As many of you already know, dental Medicaid was to be carved into Bayou Health (Coordinated Care Networks/managed care) despite the many concerns of the LDA and dental Medicaid providers. The LDA and Secretary Bruce Greenstein (and his staff) of  DHH met many times to discuss details and work out a plan that would maintain the success that the program has attained over the last 10 years while adapting as well as possible to challenging fiscal conditions.

Stay tuned as information unfolds but we believe this is a win/win for Louisiana dentists and Louisiana children who are in most need of the services the dental Medicaid program provides.

Release from DHH Regarding the Dental Implementation Set for Early 2013 (9/27/12) 
Health Department Continues Dialogue with Dental Providers, Will Announce Final Dental Reforms in Coming Weeks

http://new.dhh.louisiana.gov/index.cfm/newsroom/detail/2644

The Louisiana Department of Health and Hospitals in June announced plans to include dental services as a benefit in some Bayou Health Plans managed care plans, and requested stakeholder feedback on enhancing Medicaid fee-for-service dental care.

Following a forum at the LSU School of Dentistry in July, DHH has held ongoing meetings with dental stakeholders about its plans to transform the Medicaid dental program, and will soon announce final plans on how dental care will become a part of Bayou Health as well as how legacy Medicaid dental benefits will be administered. DHH anticipates releasing its final dental reform concept in the coming weeks with a timeline for implementation in early 2013.

Regarding provider contracts with a Health Plan network, DHH will have to review both the Health Plans' contracts with their dental plans as well as the standard language of contracts the Health Plans will use to contract with dental providers before the Health Plans can begin contracting with dentists. At a minimum, dental providers' contracts must include the applicable language outlined in the Bayou Health provider checklists, which are available at www.MakingMedicaidBetter.com under the "Providers" section. DHH will give dental providers additional guidance when plans to move this benefit into managed care are finalized, including a timeline for approval of the contracts.

Providers are encouraged to visit the Bayou Health website, www.MakingMedicaidBetter.com. DHH updates this website frequently. Visitors to the site also can review information about Bayou Health, subscribe to DHH's newsletter for frequent email updates and submit questions or comments electronically. Stakeholders can also email any comments or questions to This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Update: Implementation Probably Moved Back (9/11/12)

Yesterday, in a meeting with the DHH Secretary's Policy Advisor, the LDA reiterated its opposition to the proposed carve-in of dental Medicaid into Bayou Health. However, as DHH almost certainly will not maintain status quo, the LDA re-stated a number of the recommendations we've been making. These included administering the program via an administrative services only (ASO) contract with a single dental plan, standardizing as much as possible policies and procedures among the various plans (if a single ASO model is not adopted), and delaying implementation of the carve-in to ensure better preparation and do more provider education. On the latter point, DHH is now conceding that an Oct. 1 effective date is too soon, and they will be pushing that date back (probably 2-4 months). Continue checking the LDA website for more details and new developments.

Also, it seems that most of the Bayou Health (Medicaid managed care) plans have already been trying to contract dentists to their respective networks despite having very little information to share. (Presumably, this is one reason DHH is no longer planning on Oct 1 as the effective date for carving dental Medicaid into Bayou Health.) We are looking for dentists who can share their experience(s) with one or more of the Bayou Health dental plans trying to recruit dentists to their network. Email This e-mail address is being protected from spambots. You need JavaScript enabled to view it or call the LDA and ask for Ward Blackwell or Annette Droddy. 

DHH Info to Answer Provider Questions about Bayou Health (Updated 8/15/12)

If you have questions or want to read more about Bayou Health, there is a large amount of info on the DHH website or you can participate in a weekly call where providers can ask dental questions. You can visit www.makingmedicaidbetter.com, click on the tab “Providers,” and then “Dental Services” for more info.  To participate in the DHH call and answer session for dental, call in any Tuesday (indefinitely) at noon: 1-888-278-0296, Access Code: 6556479#.

Even though the dental carve in to Bayou Health in our state’s Medicaid program is a moving target and details are almost guaranteed to change, the LDA feels that it is of utmost importance to keep our members educated with whatever info we have available.

As you may have read, there are two types of Bayou Health Plans:

1.      In the prepaid model (Amerigroup, LaCare and Louisiana Healthcare Connections) the health plans establish networks of a wide range of health care providers and receive a monthly payment for each member covered to provide core benefits and services. In this model, prior authorizations and claims payment are handled directly through the health plan. Plans have some latitude as far as negotiating specific contract provisions, but must reimburse at no less than the Medicaid schedule.

2.      The shared savings model (Community Health Solutions and United Healthcare) includes a network of primary care providers that receives monthly management fees for each member to provide enhanced care management services. The health plan is responsible to authorize most services and preprocess claims, and then Medicaid’s fiscal intermediary actually pays the claims according to the Medicaid reimbursement schedule.

The prepaid plans are doing provider enrollment right now, as these plans go live on Oct. 1. We have been told that two of the plans are already contracted with DentaQuest for administration. According to the info shared with the LDA, credentialing of plan providers will occur after the launch date.

Unfortunately, we have not been able to secure copies of provider contracts and cannot offer opinions but we would like to remind all members that the ADA offers a contract analysis service for members. To participate in this program, contact the LDA at (800) 388-6642 or email your contract to This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Regarding the shared savings plans, DHH will undergo a competitive procurement process (Request for Proposals) to select an entity that will coordinate dental care for recipients in those two plans. More than half of Medicaid recipients will continue getting their dental services through the shared savings plans, which is similar to the traditional Medicaid model we have been using and the claims will go through a claims administrator. To clarify, you do NOT have to join a network to be a provider and participate in the Medicaid shared savings plans.  The shared savings dental plan contract is slated to be awarded and effective by Nov. 1, though DHH has hinted this date might be postponed a bit.

We have tried to inform DHH that we view this strategy as less than optimal but the department sees the carve in as a big savings generator and a way to help future budget issues that could be looming. 

We are still negotiating options with DHH and they have agreed to continue discussions with us even though they are pressing forward with the carve in.

Letter from the LDA to DHH Secretary Bruce Greenstein Refferring to the LDA's View that a Carve In to Bayou Health is not Optimal (Updated 8/14/12)

Click here to download a pdf of the letter.

Louisiana Dental Medicaid Added to Bayou Health
DHH Lumps Dental into Managed Care Model (Updated 8/3/12)

As many of you may have read via LDA email alerts and/or in your local newspapers, the LA Department of Health and Hospitals (DHH) was forced to address the budget shortfall resulting from Congress’s action that resulted in a decrease to the state’s disaster-recovery Federal Medical Assistance Percentage (FMAP) rate.

DHH announced their budget reduction plan in which dental Medicaid has NOT been cut more than the 3.7% necessitated in the state’s 2012-2013 budget. Even though this is not a small amount, it is far smaller than what we had been warned to be prepared for in the budget shortfall caused by the FMAP rate.

However, in related news, DHH has projected that they will achieve additional savings by carving dental and pharmacy services into their managed care system (Coordinated Care Networks, CCNS) called Bayou Health.

Medicaid patients are roughly evenly divided between two parts of Bayou Health.  “Pre-paid” health care managed care organizations (MCOs), of which there are three, will receive payment from the State based on patient enrollment and have some flexibility in contracting/reimbursing dental providers (though Medicaid fee schedule will be the minimum).  “Shared savings” plans simply administer claims for which DHH still foots the bill as with current Medicaid. DHH will contract a single dental benefit plan for the dental portion of “shared savings.”  The target dates for implementation are October 1, 2012, for pre-paid plans and November 1 for the shared savings dental plan.

The LDA has pointed out to DHH that the experiences of other states has been that administering dental Medicaid through multiple health care MCOs usually has led to fewer dentists participating in Medicaid. This allegedly has been due to the MCOs lowering reimbursements (which DHH says won’t happen in LA) and frustration over the additional administrative burden of dealing with several MCOs instead of a single payor Medicaid system.  Such scenarios decrease access, which ultimately can mean increased costs overall as people unable to find a dentist who accepts Medicaid wind up in hospital emergency rooms with dental infections.

As the LDA also noted to DHH, the prevalence of managed care in dentistry is FAR less than in other areas of health care, and the willingness of dentists to enroll in a managed care network is likely to be far less than for other types of providers. 

DHH has made it clear they will not veer from their commitment to the carve-in nor the timeline for implementing it.  And, though it’s not the main justification, the issue is complicated by the fact some of the savings anticipated from the carve-ins are part of the DHH plan to address the FMAP shortfall.

DHH initially said they would host three forums to allow dentists to attend and ask questions related to the change. One forum was scheduled (at this time) and held in New Orleans at the LSU School of Dentistry. Due to protests unrelated to the dental issue (but rather in response to a mental hospital closing) there was a large number of attendees unrelated to the dental discussion.Ultimately, many questions were asked by dentist attendees. 

LDA’s effort to engage DHH and monitor developments on this issue is ongoing.  Members can expect updates via LDA’s e-publications, print publications, website and Facebook page. You can visit www.MakingMedicaidBetter.com, click on the tab “Providers,” and then “Dental Services” for more info.

If you are a provider and want to send DHH feedback/comments on the proposal, especially regarding specific provisions with potential adverse impact, email This e-mail address is being protected from spambots. You need JavaScript enabled to view it .