The Louisiana Department of Health and Hospitals (DHH) has announced plans to renew its efforts to contract with a single Dental Benefits Manager (DBM), to be procured through a new competitive Request for Proposals (RFP) process, to provide dental healthcare benefits and services to Louisiana Medicaid and LaCHIP recipients statewide. DHH will solicit proposals from qualified DBMs this fall, with a start date for services expected in April 2014.
The anticipated savings from this move to managed dental care prompted DHH to modify its proposed reductions in dental benefit rates, moving from a 3% rate reduction to 1.5%. Those rates are effective as of August 1, 2013. However, DHH plans to establish its initial rate floor for the DBM based on those rates in effect prior to the August 1 reduction. Once the DBM begins administering the program, dental rates will be no less than those rates in effect prior to August 1, 2013.
The DBM will manage the dental health care services for all Medicaid recipients who are eligible to receive dental benefits, whether they receive other health care services through fee-for-service (legacy) Medicaid or Bayou Health Shared Savings and Prepaid Health Plans. Proposers will be required to have a comprehensive network of dental providers, to be verified in a DHH readiness review of network adequacy, prior to the go live date.
While some program details are still being determined, several basic principles have been established:
The DBM RFP is in the final stages of development, and DHH anticipates announcement of the recommendation for contract award in early 2014. The following dates are tentative, pending approval from state contracting authorities and the federal government. More detailed timeline information will be made available once the RFP has been released.
Single DBM Contractor
Pending approval from the Centers for Medicare and Medicaid Services (CMS), DHH intends to award one contract to a single DBM entity for coverage statewide.
Benefits and Services
The DBM will be required to offer the full range of required core benefits and services currently available to Medicaid and LaCHIP recipients, as outlined in the Louisiana Medicaid State Plan. Additional benefits above and beyond that core may be offered at the DBM's discretion. Due to the limited nature of the benefit, the DBM will not administer the adult denture program, which will continue to be managed by the state.
Dental Providers contracted with the state-selected DBM will be reimbursed at a rate no less than the Medicaid fee-for-service fee schedule. The initial rate floor will be established based on rates in effect on July 31, 2013. Payments to the DBM will be actuarially sound and established based on historical claims data prior to the August 1, 2013 reductions.
The winning proposer for the DBM contract will be required to demonstrate that they can develop a robust dental network across the state. This network must meet adequacy requirements based on mileage and distance from where members live. Dental providers can anticipate contacts from potential DBM proposers relative to joining their network.
Dental providers are free to contract, or express an intention to contract, with any and all potential proposers. To simplify this process, DHH has drafted a standard letter of intent (LOI). Potential DBMs will be required to use this standard form, though they can customize the form to reflect their branding and additional details about their company. Dental providers can complete the LOI to show their intention to contract with a particular proposer's network, should that proposer be successful in securing a DBM contract with DHH. Providers that commit through the LOI should be prepared to provide services by the DBM launch date.
A copy of the LOI can be found in the dental portal at www.MakingMedicaidBetter.com. While the form will be standardized, interested providers should complete the LOI that is supplied to them by the proposer. Providers must turn in the LOI directly to the potential proposer not DHH. LOIs that have previously been completed should be replicated using this standard form.
Potential proposers cannot require that dental providers commit to their DBM exclusively. A dental provider may choose to only contract or commit to one potential DBM, at their discretion, but not
because of influence from the potential proposer. Similarly, a dental provider may choose to contract with the winning DBM to also provide services to non-Medicaid patients covered by that DBM's private plans. However, no dentist can be compelled to contract with the DBM to provide care to non-Medicaid patients as a condition of participating in their Medicaid network.
Stay in Touch with DHH
You can learn more about DHH's plans for implementing managed care for dental benefits by visiting MakingMedicaidBetter.com and clicking on the "Dental" tab. DHH will provide answers to frequently asked questions, RFP information and any dental related news to this site.
DHH is also available to answer any questions and provide assistance through this process. You can email any questions or comments to firstname.lastname@example.org and staff will respond. DHH is typically able to provide an answer within one business day, but please keep in mind that the program is in development and some questions may require additional time for response. Providers should also sign up for the Bayou Health electronic newsletter to receive any email updates on the dental program. Providers can sign up at www.MakingMedicaidBetter.com and use the "Subscribe to newsletter" button on the homepage, or e-mail email@example.com and request to be included on the newsletter email list.
DHH also plans to have a series of dental provider-specific conference calls in the near future to discuss program plans and answer any questions. DHH will promote these calls through the Making Medicaid Better website and will send a notice out through the newsletter e-mail list.