July 2, 2021: Informational Letter 2241-FFS-D: Transition of Children's Medicaid Dental Benefit to Pre-Ambulatory Health Plans (PAHPs)
June 7, 2021, Sample Welcome To DWP KIDS Letter (Español)
February 26, 2021, Dental Provider Training: Presentation
March 24, 2021, Important Children's Medicaid Dental Update (Español)
Please send additional questions regarding this transition to imedental@dhs.state.ia.us.
What is happening?
The administration of children’s Medicaid dental benefits is switching from Fee-for-Service (FFS) to Managed Care. Parents and guardians will have the opportunity to choose a dental carrier for their child’s benefits, either Delta Dental of Iowa or MCNA Dental.
When will this happen?
It is anticipated that this change will be in place by July 1, 2021, but this is subject to change.
Who does this affect?
This transition includes Medicaid enrolled children from age 0 to 19. Once a member turns 19, they become assigned to the Dental Wellness Plan.
The following will be excluded from this: members of the Health Insurance Premium Program (HIPP), children enrolled in the Hawki program, members receiving benefits through presumptive eligibility, and medically needy members.
Who will administer the children’s Medicaid dental benefits?
The two current dental carriers for the adult population - Delta Dental of Iowa and MCNA Dental - will also administer dental benefits for children.
Does this affect the Hawki program?
No. Hawki children will not be impacted. Hawki children will continue to be enrolled with and receive dental benefits through Delta Dental of Iowa.
Does this affect the I-Smile program at all?
The goal is to keep the current I-Smile infrastructure throughout this transition.
Will the children’s dental benefit be changing as part of this transition?
No, the children’s Medicaid dental benefits will remain the same.
Will the fee schedule for providers change as part of this transition?
We anticipate the fee schedule will remain relatively the same as it currently is under FFS.
Will children now be subject to an annual benefit maximum (ABM) as adults enrolled in the Dental Wellness Plan are?
No, there will not be an ABM for children.
Will there be an annual or monthly premium?
No. (Families receiving dental benefits for their children through the Hawki program may still have to pay a monthly premium in accordance with Hawki program rules.)
Will children be required to complete Healthy Behaviors?
No, children will not be required to comply with any Healthy Behavior requirements
If a dentist is already enrolled with Iowa Medicaid, do they still need to enroll with Delta Dental or MCNA if they want to see Medicaid children?
Yes. If a dentist is not credentialed with either Delta Dental or MCNA, they would need to complete that process in order to receive payment for services provided to Medicaid beneficiaries.
Why did the IME decide to move children to managed care?
The IME believes that all Iowa Medicaid members deserve high quality dental coverage and care. The transition of children to dental managed care will help provide a more effective care management system and efficient administration of services, benefiting both families and dental providers. Children will now have a choice in a dental plan, allowing all family members to have the same dental benefit administrator. This will eliminate confusion for members and streamline administrative processes for providers.
What does this transition mean for providers?
Essentially, this transition is a change in administration. The processing of prior authorizations and claims will now be the responsibility of the dental plan administrators. The benefit package will remain the same. However, it will require providers to be enrolled with one or both dental plans in order to receive reimbursement. The dental plan administrators will determine their own reimbursement rates.
Will the benefit change when children transition to dental benefit administrators?
The benefit package will stay the same. While this program will be referred to as Dental Wellness Plan (DWP) Kids, there will be no annual benefit maximum or any Healthy Behavior requirements that apply to the adults enrolled in DWP.
How will members be made aware of this change to their dental benefit?
The Department is finalizing its plans for member outreach. The Department plans to notify all families by mail of their dental plan assignment for July 1, 2021, in June 2021. Members will be assigned to either Delta Dental of Iowa (DDIA) or Managed Care of North America Inc. (MCNA) Dental effective July 1, 2021, and will have until September 30, 2021, to switch dental plans if they want.
Starting October 1, 2021, a member must meet “good cause” criteria (determined by the IME) in order to switch to a different dental plan. Members also have the opportunity to change dental plans for any reason during their annual choice period.
Will members be informed if their current dentist is not enrolled with MCNA or DDIA?
The IME will not be notifying members if their current provider is in network with the dental plan they have been assigned to. Providers may notify members which dental plans they will be participating in but Federal law prohibits “steering” a member (making recommendations for or against enrollment with a specific dental plan).
Can providers choose which dental plan administrator(s) to participate with?
Yes, providers can choose to participate with one or both of the dental plan administrators.
Can providers limit the number of members they accept into their practice? Along the same lines, can providers only accept adults or children or must they now accept all members?
Providers can limit the number of members they accept into their practice. While providers are held to a non-discrimination obligation, it does not require a provider to accept every Medicaid patient seeking services. Providers have the ability to make decisions to sustain their businesses. There is no state or federal law that requires a practice to take every patient that seeks their services.
Will existing FFS prior authorizations (PAs) be honored by the dental plan administrators?
Yes. To ensure continuity of care for members, PAs will be honored by both dental plan administrators for the first 90 days of the transition (July 1, 2021, through September 30, 2021.) The codes requiring a PA have been streamlined across all Medicaid programs and can be found on the Department’s website.
Will claims be honored if a member receives services by a provider not enrolled in the dental plan the member is assigned to?
For the first 90 days (services received July 1, 2021, through September 30, 2021), all claims will process as “in network” for both dental plan administrators. Following the end of the 90-day continuity of care provision, providers may not receive reimbursement if not enrolled with the member’s assigned dental plan administrator. An exception would be non-enrolled providers who see a Medicaid member in an emergency. These services will be reimbursed at the plans established rate(s).
Are training sessions scheduled for providers to learn more about this transition and ask questions?
Yes. The IME has a virtual training session for dentists scheduled for February 26, 2021, where the upcoming transition will be discussed in more detail. The IME is currently scheduling an additional training session for this spring.
How will providers check a member’s eligibility and plan assignment?
The IME offers two options for providers to confirm member eligibility and plan assignment, a web portal and a phone line. The Eligibility Verification System (ELVS) is available 24 hours a day, 7 days a week:
- Portal
- Telephone: 1-800-338-7752 (toll free) or 515-323-9639 (local Des Moines)
In addition, DDIA and MCNA have similar resources to verify member information:
- Delta Dental: deltadental.com/dwp/ or by calling Provider Services at 1-888-472-2793
- MCNA: portal.mcna.net or by calling Provider Services at 1-855-856-6262
|
Iowa Medicaid Member Services (Monday to Friday from 8 a.m. to 5 p.m.) 1-800-338-8366 (Toll Free) 515-256-4606 (Des Moines Area) 515-725-1351 (Fax) For telephone accessibility assistance if you are deaf, hard-of-hearing, deaf-blind, or have difficulty speaking, call Relay Iowa TTY at 1-800-735-2942.
Llame al 1-800-735-2942, a Relay Iowa TTY (teléfono de texto para personas con problemas de audición, del habla y ceguera) si necesita asistencia telefónicamente.
|