1. Managed Care Dental for ABCD Coordinators
February 2019

2. Overview Background Implementing Managed Care Dental
Special Programs – ABC Dental
Apple Health Client Communication

3. Overview for ABCD Coordinators
Managed Care Dental Background Information
Overview for ABCD Coordinators

4. 2017 Passage of SSB 5883 Section 213 (1)(c)
Directs HCA to contract through a competitive procurement process with licensed dental health plans or managed health plans to provided managed dental care services.
This proviso creates a new program, Managed Care (MC) Dental.

5. MC Dental Program Requirements
Client Choice: HCA must contract with at least 2 plans. Where only one is available, fee-for-service will remain.
Savings:
HCA must ensure the savings offered by dental plans are actuarially sound.
Additional dental program savings achieved by the plans beyond those assumed will be used to increase dental provider reimbursement rates.

6. MC Dental Program Requirements
Increase Access: Plans must increase the dental provider network.
Oversight: Quarterly reporting requirements to include Medicaid utilization and encounter data by CDT code.
Innovation: Plans must demonstrate a commitment to retain innovative programs that improve access and care.

7. MC Dental Program Requirements
Increase Utilization:
Managed Care Entities (MCEs) must have a plan to reduce dental related ER visits.
Quarterly reporting requirements to include Medicaid utilization and encounter data by CDT code.
A provision to ensure the contracting fee shall be sufficient to compensate county health departments and FQHCs for dental patient care.

8. Overview for Providers
Implementing
Managed Care Dental
Overview for Providers

9. Implementing MC Dental
Managed Care Dental will be implemented July 1, 2019
Statewide procurement
Three state-wide Apparent Successful Bidders have been announced:
Amerigroup Dental
Dentegra (Delta)
MCNA Dental
American Indian and Alaska Native populations will have an opt-in option (fee-for-service will remain)

10. Implementing MC Dental
Timeline Overview
February 2019 Readiness Review
AH Client MC Dental Webpage
March Change Notification Letters Sent
April HCA-Plan Contracts Finalized
Network Milestone
May AH Client Enrollment Letters Sent
June AH Clients can change plans
July MC Dental Program Begins

11. HCA Provider Relationship
HCA values Apple Health providers
The intent of MC implementation is to (as defined by the legislation):
Increase Efficiency
Increase Access
Improve oral health outcomes
HCA hopes to build on the positive outcomes experienced by Apple Health clients enrolled in MC physical health plans

12. Provider Credentialing
Be sure that you are a participating provider with Apple Health and have gone through the Health Care Authority’s credentialing process.
Once you decide on which, if any, MC plan you are contracting with you will need to go through the MC plan’s credentialing process as well.

13. General Information for Providers
Access ProviderOne for:
Client Plan Assignment
Verification of benefits
Claims submitted by the provider for that specific client
Work directly with the MC plan for:
Service limitations
Provider Assignment
Prior Authorizations

14. HCA and MC Plans HCA MC Plans PM/PM
Pay Service Based Enhancements (SBE)
Regulate minimum benefit package offered by the MC plans
Provide guidance for Prior Authorizations
Oversight and monitoring of MC plans
Contract and pay providers
Maintain and grow provider networks
Process prior authorizations
Adjudicate claims
Adjudicate grievances
Conduct fair hearings

15. Providers and MC Plans
HCA will not be giving providers direction on how they communicate with their clients which MC plan they have decided to sign contracts with; that is the provider’s sole discretion.
Decide which, if any, plan to sign a contract with
Negotiate terms of contracts with MC plans
Communicate with your existing Apple Health clients

16. Provider Networks
A minimum of 2 MC plans must be available in a county. In counties where 2 MC plans aren’t available then Fee For Service will remain.
2 plans available- most clients will be auto-enrolled into a MC Plan
Less than 2 plans available- there will be no auto-enrollment; this is referred to as a voluntary county
Clients in voluntary counties can opt in to Managed Care

17. Overview for Coordinators
Access to Baby and Child Dentistry (ABCD)
Overview for Coordinators

18. ABCD
0-5 year olds
Providers w/indicators receive enhanced reimbursement for certain services
Enhanced reimbursement part of PM/PM
HCA will continue to hold and manage coordinators contracts
MC plans will work with coordinators

19. Managed Care Contact Information
Name
Plan
Donnell Barnett
Amerigroup
Heather Knaplund
Delta WA, Delta CA & Arcora Fdtn)
Shannon Hays
MCNA Dental
Get update from Becky

20. Overview for Providers
Client Communications
Overview for Providers

21. Client Communication Change Notification Letter
Apple Health Clients eligible for dental services will receive an informational letter in March telling them about the move to managed care.  This letter:
Does not assign them a managed care plan
Provides information regarding the differences between the current Fee For Service system and managed care
Provides them with an online resource with additional information
See handout

22. Client Communication Enrollment Letter
In May, Apple Health Clients, who are eligible for dental services, will be automatically enrolled into one of these 3 managed care plans:
Amerigroup
Dentegra
MCNA Delta
The letter also provides client’s with:
Their plan’s website and phone number
How to change plans (clients can change plans once a month)
Provide handout

23. Client Communication
Client Specific Webpage A Managed Care Dental webpage will be added to the HCA website in February. This page will contain information specifically for our Apple Health clients. Community Outreach and Stakeholders The Managed Care Dental implementation team will work with existing stakeholders to provide informational forums.

24. Resources Clients will be able to change plans by:
Calling Apple Health Customer Service at
Requesting a change online at: Select the topic “Enroll/Change Dental Plans.” The Health Benefit Exchange is not available for MC Dental program.
Information for Providers and Stakeholders:
dental-moving-managed-care

25. Questions?
Contact the Managed Care Dental Team at: For More Information: health-dental-moving-managed-care