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Managed Care Dental for ABCD Coordinators

This overview provides background information on implementing managed care dental and special programs for ABCD coordinators. It also includes the timeline for implementation and contact information for providers.

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Managed Care Dental for ABCD Coordinators

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  1. Managed Care Dentalfor ABCD Coordinators February 2019

  2. Overview • Background • Implementing Managed Care Dental • Special Programs – ABC Dental • Apple Health Client Communication

  3. Managed Care Dental Background Information Overview for ABCD Coordinators

  4. 2017 Passage of SSB 5883Section 213 (1)(c) • Directs HCA to contract through a competitive procurement process with licensed dental health plans or managed health plans to provided managed dental care services. • This proviso creates a new program, Managed Care (MC) Dental.

  5. MC Dental Program Requirements • Client Choice: HCA must contract with at least 2 plans. Where only one is available, fee-for-service will remain. • Savings: • HCA must ensure the savings offered by dental plans are actuarially sound. • Additional dental program savings achieved by the plans beyond those assumed will be used to increase dental provider reimbursement rates.

  6. MC Dental Program Requirements • Increase Access: Plans must increase the dental provider network. • Oversight: Quarterly reporting requirements to include Medicaid utilization and encounter data by CDT code. • Innovation: Plans must demonstrate a commitment to retain innovative programs that improve access and care.

  7. MC Dental Program Requirements • Increase Utilization: • Managed Care Entities (MCEs) must have a plan to reduce dental related ER visits. • Quarterly reporting requirements to include Medicaid utilization and encounter data by CDT code. • A provision to ensure the contracting fee shall be sufficient to compensate county health departments and FQHCs for dental patient care.

  8. Implementing Managed Care Dental Overview for Providers

  9. Implementing MC Dental Managed Care Dental will be implemented July 1, 2019 • Statewide procurement • Three state-wide Apparent Successful Bidders have been announced: • Amerigroup Dental • Dentegra (Delta) • MCNA Dental • American Indian and Alaska Native populations will have an opt-in option (fee-for-service will remain)

  10. Implementing MC Dental Timeline Overview February 2019 Readiness Review AH Client MC Dental Webpage March 2019 Change Notification Letters Sent April 2019 HCA-Plan Contracts Finalized Network Milestone May 2019 AH Client Enrollment Letters Sent June 2019 AH Clients can change plans July 2019 MC Dental Program Begins

  11. HCA Provider Relationship • HCA values Apple Health providers • The intent of MC implementation is to (as defined by the legislation): • Increase Efficiency • Increase Access • Improve oral health outcomes • HCA hopes to build on the positive outcomes experienced by Apple Health clients enrolled in MC physical health plans

  12. Provider Credentialing • Be sure that you are a participating provider with Apple Health and have gone through the Health Care Authority’s credentialing process. • Once you decide on which, if any, MC plan you are contracting with you will need to go through the MC plan’s credentialing process as well.

  13. General Information for Providers • Access ProviderOne for: • Client Plan Assignment • Verification of benefits • Claims submitted by the provider for that specific client • Work directly with the MC plan for: • Service limitations • Provider Assignment • Prior Authorizations

  14. HCA and MC Plans HCA MC Plans Contract and pay providers Maintain and grow provider networks Process prior authorizations Adjudicate claims Adjudicate grievances Conduct fair hearings • PM/PM • Pay Service Based Enhancements (SBE) • Regulate minimum benefit package offered by the MC plans • Provide guidance for Prior Authorizations • Oversight and monitoring of MC plans

  15. Providers and MC Plans HCA will not be giving providers direction on how they communicate with their clients which MC plan they have decided to sign contracts with; that is the provider’s sole discretion. • Decide which, if any, plan to sign a contract with • Negotiate terms of contracts with MC plans • Communicate with your existing Apple Health clients

  16. Provider Networks A minimum of 2 MC plans must be available in a county. In counties where 2 MC plans aren’t available then Fee For Service will remain. • 2 plans available- most clients will be auto-enrolled into a MC Plan • Less than 2 plans available- there will be no auto-enrollment; this is referred to as a voluntary county • Clients in voluntary counties can opt in to Managed Care

  17. Access to Baby and Child Dentistry (ABCD) Overview for Coordinators

  18. ABCD • 0-5 year olds • Providers w/indicators receive enhanced reimbursement for certain services • Enhanced reimbursement part of PM/PM • HCA will continue to hold and manage coordinators contracts • MC plans will work with coordinators

  19. Managed Care Contact Information

  20. Client Communications Overview for Providers

  21. Client Communication • Change Notification Letter • Apple Health Clients eligible for dental services will receive an informational letter in March telling them about the move to managed care.  This letter: • Does not assign them a managed care plan • Provides information regarding the differences between the current Fee For Service system and managed care • Provides them with an online resource with additional information

  22. Client Communication • Enrollment Letter • In May, Apple Health Clients, who are eligible for dental services, will be automatically enrolled into one of these 3 managed care plans: • Amerigroup • Dentegra • MCNA Delta • The letter also provides client’s with: • Their plan’s website and phone number • How to change plans (clients can change plans once a month)

  23. Client Communication Client Specific Webpage A Managed Care Dental webpage will be added to the HCA website in February. This page will contain information specifically for our Apple Health clients. Community Outreach and Stakeholders The Managed Care Dental implementation team will work with existing stakeholders to provide informational forums.

  24. Resources • Clients will be able to change plans by: • Calling Apple Health Customer Service at 1-800-562-3022. • Requesting a change online at: https://fortress.wa.gov/hca/p1contactus/client_webform/ Select the topic “Enroll/Change Dental Plans.” The Health Benefit Exchange is not available for MC Dental program. • Information for Providers and Stakeholders: • https://www.hca.wa.gov/about-hca/apple-health-medicaid/apple-health-dental-moving-managed-care

  25. Questions? Contact the Managed Care Dental Team at: HCAMCDentalInfo@hca.wa.gov For More Information: https://www.hca.wa.gov/about-hca/apple-health-medicaid/apple health-dental-moving-managed-care

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