American Dental Association settles antidiscrimination charges for $1.95M

 

BY TDMR 

The ADA has agreed to pay almost $2 million to settle two discrimination charges filed against the association.

The U.S. Equal Employment Opportunity Commission (EEOC) investigated charges that the association fired two employees in retaliation for complaining to its board of directors about potential violations of the Americans with Disabilities Act, the Age Discrimination in Employment Act, and other antidiscrimination laws. The ADA will pay $1.95 million to resolve the charges, according the EEOC.

The former employees who were discharged were the association’s former chief legal counsel and the former director of human resources.

Source: ADA settles antidiscrimination charges for $1.95M  Dr Bicuspid

 

Why Texans' Health Care Ranks Among the Worst

 

Texas is known for being an alluring place to live: a can-do attitude, economic growth, robust cities with expansive opportunity, and vast outdoor adventures are but a few of the reasons so many Americans choose to become Texans.

However, the luster of the state quickly vanishes if you’re a family of six with a child living with a chronic condition that requires extensive use of healthcare services, or even if you’re the average Texan who experiences low back pain (LBP), the second most common cause of disability in U.S. adults, which amounts to $100 to $200 billion in total costs annually. A portion of direct costs associated with LBP stem from expenses incurred from medical imaging, like MRI, which has been shown to be of little to no utility in the treatment of people living with chronic LBP.

 

Article by TDMR April 17, 2017

First Dental Home for Texas Medicaid

There have recently been a lot of questions, from Texas Dental Providers, regarding the First Dental Home forms and when they should be completed.  The following information should be of assistance to you, in your efforts to comply with the Texas Department of State Health Services First Dental Home policies.  You can find each of these forms on the DSHS First Dental Home (FDH) Materials page. 

The First Dental Home Certification Request Form. This form only needs to be completed once. Once a provider is certified, there is no end date to their status.  If there are any new TPI's issued to the provider, their status will automatically update with the certification code.  

The First Dental Home Visit Documentation. This form must be completed for every visit, maximum of ten, for those patients in the age range of six (6) months to thirty-five (35) months of age. 

The First Dental Home Oral Health History Questionnaire.  This questionnaire must be completed at the very first appointment.  Thereafter, ask if they have any updates to their history (i.e., new fillings, crowns, extractions, etc.).

The First Dental Home Dental Risk Assessment Questionnaire.  This questionnaire must be completed at the very first visit. Thereafter, ask for updates for each family member. 

The First Dental Home Caries Risk Assessment Tool. This tool must be completed for every visit, only if there has been a change in the parent/caregiver status.   

IMPORTANT UPDATE on Medicaid Provider Re-Enrollment Application Deadline

The Health and Human Services Commission has updated their previous notice stating that as long as Medicaid provider re-enrollment applications have been received by the Texas Medicaid and Healthcare  Partnership on or before September 24, those providers will not face immediate dis-enrollment from Medicaid because the application has not been processed.  This is good news for late filers.

The notification said:

As a requirement of the Patient Protection and Affordable Care Act, providers must have their enrollment re-validated by state Medicaid programs by September 24, 2016. In accordance with the law and upon the direction of the Texas Health and Human Services Commission (HHSC), TMHP will accept completed provider re-validation applications received by September 24, 2016. There will be no immediate dis-enrollment actions taken on providers meeting this submission date. Providers must continue to respond to all application deficiencies in a timely manner to remain enrolled.

There is a links to a PDF article from TMHP.  You can download it here.   The copy is below:

Deadline Approaching: Avoid Medicaid Provider Disenrollment Information posted August 31, 2016

As a requirement of the Patient Protection and Affordable Care Act (PPACA), providers must have their enrollment revalidated by state Medicaid programs by September 24,

  1. In accordance with PPACA and upon the direction of the Texas Health and Human Services Commission (HHSC), TMHP will accept completed provider revalidation applications received by September 24, 2016. There will be no immediate disenrollment actions taken on providers meeting this submission date. Providers must continue to respond to all application deficiencies in a timely manner to remain enrolled.

Note: The federal deadline to revalidate is September 24, 2016, which is a Saturday. TMHP offices will be closed. Providers will not be able to physically bring their paper applications to TMHP on that day. Applications submitted electronically through the Provider Enrollment on the Portal (PEP) on or before September 24, 2016, will be accepted and processed as having met the deadline.

Disenrollment Process for Providers that Miss the September 24, 2016, Deadline

TMHP, under the direction of HHSC, will begin the disenrollment process for any provider that does not submit a completed revalidation application received by September 24, 2016. The disenrollment process will include, but is not limited to the following:

  • TMHP will send a notice of termination of the HHSC Medicaid Provider Agreement to the provider.
  • TMHP will notify Medicaid clients that they must choose a new provider if they have open prior authorizations from a provider that does not meet the deadline.
  • TMHP will transfer all open prior authorizations for clients who choose a new provider.

The disenrollment process will begin shortly after September 24, 2016; however, a final disenrollment date has not yet been determined. Final disenrollment may occur as early as November 2016. Providers that do not meet the submission deadline should inform their Medicaid patients to begin seeking a new provider.

Revalidation Applications Received After the September 24, 2016, Deadline

Revalidation applications received after September 24, 2016, will be processed. Receipt of a completed revalidation application after the September 24, 2016, submission deadline will not cease disenrollment actions. If a revalidation application received after September 24, 2016, has not completed processing by the final disenrollment date, the provider will be disenrolled and have a gap in enrollment from the final disenrollment date until the application is approved and finalized. Additionally, disenrolled providers will not be eligible to participate as network providers in Medicaid managed care organizations (MCOs) or dental maintenance organizations (DMOs).

This revalidation requirement applies to providers that participate in Medicaid Fee for

Service (FFS), Medicaid managed care, the Texas Vendor Drug Program (VDP), the Children with Special Healthcare Needs (CSHCN) Services Program, and in long term care (LTC) services administered through the Texas Department of Aging and Disability Services (DADS).

To avoid disenrollment, and a disruption in claims payment, providers should submit a revalidation application to the state or TMHP immediately.

Information for Acute Care and Pharmacy/Durable Medical Equipment (DME) providers re-enrolling through TMHP:  

Information for Long Term Care (LTC) only providers with a DADS Medicaid contract re-enrolling through DADS: 

Information for Vendor Drug Program (VDP) providers reenrolling through VDP: 

Information for Medicaid MCO Long-Term Services and Support (LTSS) Provider:

There is a separate enrollment process for LTSS providers that bill MCOs and do not have an active DADS Medicaid contract and do not have a Texas Provider identifier (TPI) for the same provider type to bill TMHP for acute care services. These providers are required to re-enroll through the Medicaid MCO LTSS provider re-enrollment process. LTSS providers that are unaware of their DADS contract status may contact DADS at Texas.Medicaid.Enrollment@dads.state.tx.us to verify contract status and establish next steps.

For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHPCSHCN Services Program Contact Center at 1-800-568-2413.

Medicaid Providers Not Re-enrolled by September 24 Will Automatically be Disenrolled on the 25th

 

Texas Medicaid established an application submission deadline of June 17, 2016 which ensured providers of continued enrollment if a complete application was submitted by that date. Providers that missed the application submission deadline may still be able to complete the revalidation process by the federal deadline of September 24, 2016. While there is no guarantee that an application submitted now will complete the process by the September 24, 2016 deadline, submitting an application now provides the best possible chance of meeting the deadline.

If the application is not processed by September 24, 2016, the provider will be dis-enrolled from Texas Medicaid with an effective date of September 25, 2016.

To avoid disenrollment on September 25, 2016, and possible disruptions in claims payment, providers should submit a revalidation application to the state or TMHP today.

 

New Non-Discrimination Regulations Taking Effect Could Cost You Big

 


The Office of Civil Rights (OCR) issued Section 1557 which prohibits health care entities that receive federal financial assistance from certain types of discrimination. It will go into effect July 18, 2016. This includes discrimination against age, race, color, nationality, disability or gender. On the surface it seems to be common sense but within this regulation is the requirement for assistance of patients who have limited English proficiency.  

If you participate with CHIP or Medicaid then this applies to you. It is still unclear if providers that take Medicare Advantage plans are included in this, but I’m willing to bet that it does. You may not realize that you take dental Medicare Advantage, but should check into this as United Healthcare, Delta Dental, Aetna and others offer dental plans as part of their Medicare Advantage.

 

Compliant offices will need to provide the following items on their website and in their office:

  • A posting of a non-discrimination policy by October 16, 2016 (I’ve attached a copy to this email)
  • A notice of the top fifteen non-English languages that are spoken in your state. You will need to indicate that your office will provide language assistance services – free of charge. (I’ve attached a sample copy to this email)

The compliance piece of this is that you are now required to provide language assistance for fifteen non-English languages. This includes vetting a translator (because you are responsible for their competency) or contracting with a translation service. And your practice must cover the cost. You have the option of claiming that this will cause an undue financial burden but it up to you to pursue and prove your case. I’ve included links at the bottom of this article so that you can read up on it. Being unaware is not an excuse for on-compliance.

The dental insurance industry is in a state of regulatory change and dental providers do not have a choice but to be compliant. You’ll need to be compliant or risk large fines. I have contacted one of my old colleagues at the Texas Department of State Health Services with some questions I have about translation services.  As soon as I get a response, I will pass this information on to you.  The American Dental Association and most state dental associations/societies will also be posting guidance on their websites.

 

http://www.hhs.gov/civil-rights/for-individuals/section-1557

http://success.ada.org/en/practice/operations/section-1557/section-1557-the-basics-on-what-you-must-do

http://www.hhs.gov/about/news/2016/05/13/hhs-finalizes-rule-to-improve-health-equity-under-affordable-care-act.html

http://www.hhs.gov/civil-rights/for-individuals/section-1557/translated-resources/index.html