Medicaid Payment Issues On Table

May 14, 2019

Representatives from a number of different health-care provider groups took part in a meeting Monday at the state Agency for Health Care Administration to discuss a proposed rule that contains Medicaid payment rates. And while improving payments often translates to increased funding, that wasn’t the crux of the comments the agency received during the meeting. 

Douglas Manning, Florida executive director of DentaQuest, said the agency is proposing billing codes that involve outdated standards of care, and therefore, should be changed.

DentaQuest is a Medicaid managed care dental plan that has a contract with the state. As an example, Manning said the agency is proposing to reimburse for dental X-rays once every three years. But Manning said the standard now is to take X-rays once every five years unless patients have specific dental issues or problems.

He also noted that there is a separate billing code for oral hygiene instruction that reimburses dentists $1.92.

“Ethically, that is what they are supposed to do, how to take care of your teeth.” he said, noting there are no standards around “oral hygiene” other than telling patients to brush and floss. And while $1.92 isn’t big money, it can add up, he said. “Twice a year that adds up to millions of dollars,” Manning said.

The payments in the proposed rule are for Medicaid fee-for-service rates. While most Medicaid patients are treated by managed-care plans, some continue to receive care in which providers are paid on a fee-for-service basis.

Fee-for-service rates also are important because they are the benchmark that Medicaid managed-care contracts use when reaching agreements with providers. The proposed rates have retroactive application to Jan. 1 and will be effective through June 30, and beyond, unless the Legislature specifically includes rate increases in the fiscal year 2020-2021 budget.

Interested parties have until the end of the day Tuesday to submit written comments to the agency on the proposed rule.