June 14, 2023
Even with compelling testimony in front of the Health Committee Senators and waves of NDA members contacting their Senators, the budget approved by the Legislature only called for increases of 3% and 2% in the next two fiscal years, but Pillen vetoed the second year increase, leaving funding for that year flat.
Questions Regarding Changes to Nebraska Dental Medicaid to Review with Nebraska Dentists
- What will be transitioning in terms of NE Dental Medicaid Program?
The contract with MCNA will be ending December 31, 2023. Nebraska Medicaid opted to go in a new direction with medical and dental plans being integrated. Therefore, the three medical managed care organizations (MCOs) will be responsible for the dental plans through their dental dental partners. The three new dental contractors are Envolve (NE Total Care), Skygen (Molina), and United Dental Partners (United Health Care.) They will take over January 1, 2024.
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Did the NDA have any notice these changes were coming by Nebraska Medicaid and Long-Term Care (MLTC)? No. NDA found out in a HHS bulletin that provides updates.
- Why did the plan change from a stand-alone plan of MCNA to an integrated dental/medical plan?
Nebraska Medicaid believed that having dental and medical more integrated would be more beneficial to patients and cost savings in the long run. For example, a patient that seeks relief of dental pain in the hospital emergency department is likely not to get treatment for the dental problem. They would be seen by a medical provider who would likely prescribe an antibiotic and narcotic, thus spending resources and never getting resolution of the dental problem.
- Is the NDA concerned that “dental” could be lost in a larger “medical plan?”
Yes. That’s why NDA leaders have been meeting proactively with the MCO’s to assure dentists’ concerns are addressed. There will likely be a period of time where the new plans will have to address the pent up needs of the Medicaid population’s dental disease. However, a certain percent of the population who hopefully stay dentally healthy and go into recall. There will another subset that is higher risk for dental disease that we hope will get more attention through better MCO planning.
- When does the new contract (changes) start?
Officially, the new plans will start January 2024. However, the dental and medical MCO leaders have been meeting with the NDA leadership to explore what is or is not working well under the current MCNA contract.
- Can I sign up for one plan or do I need to sign up for all three?
A dentist can sign up for one, two, or three plans. The dentist must first get credentialed by each plan, review each plan’s provider agreement/contract, and then will be ready to see patients and send in claims in January. The Medicaid patient population has open enrollment in November where they will choose the plan that best fits their family’s needs.
- If there are 3 separate Medicaid plans, will there be 3 sets of provider contracts, 3 fee schedules, and 3 provider manuals?
Yes. However, the NDA has asked the MCO’s and NE Medicaid to streamline the credentialing process into one common application. In addition, NDA is working with the plans to coordinate benefit limits and prior authorizations to be as similar as possible across all three plans.
- Can the new 3 managed care plans change the benefits available to patients or the fees?
The MCO’s can’t offer benefits or fees less than what NE Medicaid has already approved (what we know exists now). They can offer additional benefits (called value added benefits) or higher fees for some procedures. However, the MCO assumes the financial risk, not NE Medicaid.
- What if I have a question about a particular plan, benefit, or rule?Whom do I contact?
Each MCO’s dental plan partner will have provider reps available to answer questions. NDA will get a list of the provider reps and place on the members’ only section of the website.
- Are there any changes you know of that will impact my patients or major changes to the plans?
Yes. The adult annual cap will go away in the new contract (as of Jan 2024). That means you can treatment plan for all the patients’ needs and provide them without an annual limit of $750The elective extraction of all wisdom teeth will be added back in as a covered service. A 10% fee increase was issued in July 2022.
- What happened with the legislative bill (LB 358) that NDA proposed this past session for a 25% increase in fees? The bill was assigned to Appropriations Committee.They transferred it to the HHS Committee.It made it out of committee but it did not go to the floor for debate due to a lack of time.Appropriations then included a 3% increase for the next fiscal year, followed by a 2% increase the following year.This made it out of committee but the governor vetoed the second year increase.It passed with a 3% increase which will take effect on July 1st, 2023.The NDA will continue to work with NE Medicaid and the MCO’s on better fees.Our 25% increase bill is still out of committee and on General File and will be taken up next year.
- What if I have an interest in bringing change to a specific benefit (dental service), benefit limit (such as prior authorization or frequency of a service), or I’m having a concerns related toMedicaid policy?
Like is the case now with MCNA, each of the plans will have Dental Advisory Committees. These act as a liaison between the dental community and Nebraska’s dentists who are Medicaid providers. Proposals from dentists come through the DAC and are discussed at meetings. Many changes to MCNA’s plan were made through this route.
- I’ve read that a number of people who received Medicaid during Covid will phase out.How will I know if my patients still qualify?
Correct. During Covid, the federal government extended Medicaid benefits temporarily to many more Americans with small incomes. This is being phased out. Your dental team should check all Medicaid patient’s eligibility status online prior to the day of their appointment to assure they have coverage.
- As a dental Medicaid provider, do I need to be worried about audits?
Because Medicaid is a state and federal program that is supported by tax payer dollars, just like school districts, county governments, and government contractors (which include Medicaid providers) are subject to audits. Audits can come from the federal government, the state government, or the MCO. About 10 years ago and up to about 5 years ago, Nebraska dentists were heavily impacted by audits from the state. The NDA helped passed two laws that changed how audits can be conducted. Audits that came from MCNA, tend to be spot checks. Essentially, MCNA would ask a dentist to send in a list of 5-10 patients, their diagnosis, and treatment. Basically, they were matching up what the dentist billed for is what the patient both needed and received. Often these smaller audits identify problems whereby the dental contractor can help the dentist understand the problem and get it corrected before it becomes a bigger audit or problem. The NDA is not aware of any large pending audits to Nebraska dentists at this time.
- Will the new MCO’s be holding informational sessions about all these upcoming changes and what dentists need to do to get ready for them?
Yes. They have already held three. These are available on demand.
- How do I stay up to speed on changes with dental Medicaid? There are four ways: 1) Read your NDA newsletter and website (this has summaries of changes as well as call to actions when NDA is working making improvements like the recent fee increase effort), 2) read your ADA News monthly (this describes what the ADA is doing to improve Medicaid as well as alerts when to contract your members of Congress about Medicaid bills and actions), 3) sign up for the Nebraska Medicaid Provider Bulletin (where state changes are often announced that impact all Medicaid providers), and 4) subscribe to your MCO’s provider announcements (this is up for MCNA but not yet for new contractors.
Here is how you sign up for the NE Medicaid bulletins. https://dhhs.ne.gov/pages/Medicaid-Provider-Bulletins.aspx
April 5th - LB 358 Advances to General File!
Now is the time to email Senators on the Appropriations Committee!
Here are the Appropriations Committee Members that should receive our emails.
- Sen. Robert Clements, Chairperson (Elmwood)
- Sen. Christy Armendariz (Omaha)
- Sen. Myron Dorn (Beatrice/some of South Lincoln)
- Sen. Robert Dover (Norfolk)
- Sen. Steve Erdman (Bayard)
- Sen. Loren Lippincott (Central City)
- Sen. Mike McDonnell (Omaha)
- Sen. Tony Vargas (Omaha)
- Sen. Anna Wishart (Lincoln)
Example Language to email Senators:
Dear Sen. _________________
I am writing to ask you to incorporate the dental Medicaid fee increase bill – LB358 – into the state budget bill.
With the current reimbursement rates from Medicaid being approximately 40% of our average office fees, it has become incredibly difficult to provide quality dental care to those on Medicaid. It has never been dentists’ intent to make a large profit from Medicaid patients; however, one cannot expect dentists to lose money and continue to be able to take Medicaid.
LB358 would place Medicaid fees closer to market rates. While it would still be the lowest payer for dental insurance, it would help assure that more Nebraskans who rely on Medicaid are seen.
With only a small number of dentists still accepting Medicaid patients, hundreds of patients are forced to seek relief for their dental pain in the Emergency Room. Unfortunately, the hospital physician can’t treat their dental problem, only prescribe them a pain killer. This only exacerbates the problem and drives the costs up ever further.
Investing in sound Medicaid dental fees is good for our state and will help get more kids back in school and adults back to work. Without this increase, many of us won’t be able to afford to keep taking Medicaid patients, leaving hundreds more without a dental home.
Thank you for including this fee increase in the Appropriations bill.
Senator Walz agreed to carry a bill requiring a 25% increase to the current DHHS Medicaid Fees. LB 358 will be heard in front of the Health and Human Services Committee on February 16th at 1:30 p.m.
LB 358 is scheduled for a committee hearing in the Health Committee on Thursday, February 16th. Please submit a written comment online in support of LB 358 by Wednesday, February 15th at Noon.
Read All Three Steps Below First
STEP 1: CLICK HERE to access the LB 358 webpage on the legislature’s website.
STEP 2: Click “Submit Comments Online For LB 358” in the center of the page.
STEP 3: Select “Yes” under “Include Comment in Hearing Record,” fill out the form, and submit your comment as a “proponent.” You will receive an email asking you to confirm your comment.
Comments must be submitted
by Wednesday, February 15th at 12:00 PM (CST)
At the beginning of December, Senator Lynne Walz’s office reached out to Matt Schaefer, our lobbyist with Mueller Robak.
Senator Walz stated that constituents (Fremont / Valley area) were having trouble finding dentists that accept Medicaid recipients. The Senator asked to meet with the NDA to discuss these issues and if there was potential for legislation. As with Medicaid, low fees are always an issue and one we could address legislatively.
In preparation for the meeting, we created a spreadsheet that compared the 2021 NDA Fee Survey fee with private insurance and the current DHHS Medicaid fees. One column allowed entering an overall percentage increase to see how that would affect the comparison to NDA Survey fees. Senator Walz asked to also see the fees from surrounding states Kansas, Iowa and South Dakota.
We informed Senator Walz that some NDA members were leaving Private Insurance 1, so any increase would have to move the percentage compared to NDA Survey fees close to Private Insurance 1 fee percentage.
That increase would equal a 25% to the current DHHS Medicaid Fees.
After that meeting, Senator Walz agreed to carry a bill requiring a 25% increase to the current DHHS Medicaid Fees.
LB 358 will be heard in front of the Health and Human Services Committee.
Please email the Senators linked below, asking for their support of LB 358.
Sen. Ben Hansen, Chair
District 16 (Blair, West Point)
bhansen@leg.ne.gov
Sen. Beau Ballard
District 21 (NW Lincoln, Blair, Malcom)
bballard@leg.ne.gov
Sen. Machaela Cavanaugh
District 6 (Central Omaha)
mcavanaugh@leg.ne.gov
Sen. Jen Day
District 49 (LaVista, Papillion)
jday@leg.ne.gov
Sen. Brian Hardin
District 48 (Scottsbluff, Gering, Kimball)
bhardin@leg.ne.gov
Sen. Merv Riepe
District 12 (SW Omaha)
mriepe@leg.ne.gov
Sen. Lynne Walz (LB 358 sponsor)
Fremont, Valley
lwalz@leg.ne.gov