Enhanced Dental Benefit Started July 1 – What You Should Know

“Eligible adults enrolled in Colorado Medicaid now have access to more comprehensive dental services which builds upon the basic preventative services that became available on April 1, 2014. The new dental benefit provides Medicaid adults, age 21 and over, up to $1,000 in dental services per state fiscal year (July 1 – June 30) and includes the following services: basic preventative dental exams, diagnostic and restorative dental services (e.g. x-rays, fillings), extraction, root canals, crowns, partial dentures, complete dentures, periodontal scaling, and root planning. *Please note that partial and complete dentures are not subject to the $1,000 cap per state fiscal year.

The Department has contracted with DentaQuest as its Administrative Services Organization (ASO) to help manage the benefit and provide a customer service center for Medicaid dental questions. The ASO will also help the Department grow its dental provider network. Clients may search for dental providers in their area by visiting the ASO’s website. Additional information, including frequently asked questions about the new dental benefit, can be found here.” [Source: HCPF]

Dental Benefits Collaborative Updates - Including Date Change

“Complete Denture Benefit
The Department is presenting an emergency rule at the Medical Services Board (MSB) Friday, June 13th to authorize coverage of complete dentures once every 7 years, upon prior authorization, for adult clients age 21 and over. As mentioned previously, if the MSB approves the rule, this new denture benefit will appear in rule separate from the adult dental benefit effective July 1, 2014 and will not be subject to the yearly $1,000 adult dental limit. Note: Although the Complete Dentures Benefit will not be subject to the $1,000 annual adult dental limit, complete dentures will be subject to a set Medicaid allowable rate.

Children’s Dental Benefit

• In the last few weeks the Department has continued to receive insightful feedback on the proposed Children’s Dental Benefit Coverage Standard. Because the Department is committed to implementing a benefit that promotes the health of children, is evidence based and sets reasonable limits upon services, we are looking into this most recent feedback presently.
• As a result, the Department has decided not to take the Children’s Dental Rule to the MSB for initial reading on June 13th as originally planned. We hope to take the rule for initial reading in July and will provide further updates as soon as they become available.
• New Target Date of Friday, July 11 (9am-12pm) – Planned initial reading of Children’s Dental Rule in front of MSB.” [Source: HCPF]

Dental Benefits Collaborative Update

“Adult Dental Benefit:

• You may view the final version of the Adult Dental rule, which outlines the more comprehensive adult dental benefit that will become available as of July 1, 2014.
• The Department is pleased to report that the Joint Budget Committee authorized additional funding for complete dentures in the state’s 2014-15 budget. This new denture benefit will appear in rule separate from the adult dental benefit effective July 1, 2014 and will not be subject to the yearly $1,000 adult dental limit.
• A revised version of the Dental Listening Log has been posted to reflect the proposed denture policy.

Children’s Dental Benefit:

• All comments received as part of the 45 Day Public Comment Period for the revised Children’s Dental Benefit are now posted to the Dental Listening Log.
• In the meantime, a revised draft of the Children’s Dental Benefit Coverage Standards, which includes many changes as a result of the feedback we received, can be found on the Benefits Collaborative website.” [Source: HCPF]

Adult, Children and Orthodontia Dental Benefits Updates

"Adult Dental Benefit

• Here are resources that describe this interim benefit, including an addendum to the Dental Fee Schedule and the path to the revised Dental Provider Billing Manual.
• Last Friday, the Medical Services Board (MSB) approved the rule that defines the more comprehensive dental benefit to follow.

Children's Dental Benefit
Due to the large volume of stakeholder feedback and the need to properly process that input and consider changes to the draft policy, we have pushed this date back by two months. The Children’s Dental Benefit will go before the MSB on June 13th for first reading.

Important dates related to the Children’s Dental Benefit are as follows:

• Tuesday, May 27 (9am) – Public Rule Review Meeting
• Tuesday, May 27 (9am) – Public Rule Review Meeting
• Friday, July 11 – Tentative: Second reading for final adoption of Children’s Dental Rule in front of Medical Services Board (MSB).

Children's Orthodontia Benefit

• The revised Children's Orthodontia Benefit will not go to the MSB at the same time as the revised Children's Dental Benefit.
• We have asked Oregon Health Science University's Medicaid Evidence Based Decisions Project (MED) team to independently review the research and data provided to us by the various Benefits Collaborative participation before making further policy decision."  [Source: HCPF]

Update on Adult Dental Benefit and Childrens Dental Benefit

“Adult Dental Benefit

• As previously announced, the Adult Dental Rule will go before the Medical Services Board for initial adoption on March 14, 2014.  As a reminder, rule adoption is generally a multi-month process.
• A revised version of the Dental Listening Log – which contains comments and questions received as part of the Dental Benefits Collaborative – has been posted online.
• Policy update: while full dentures will not be a covered benefit as of July 1, the Department has decided to cover adjustments & relines for those who have dentures.  We will update the Adult Dental Benefit Coverage Standard and Adult Dental rule accordingly.

Childrens Dental Benefit

• The draft Childrens Dental Benefit Coverage Standard has been posted online for a 45-Day Public Comment Period.”  [Source:  HCPF]

Dental Benefits Collaborative Update

“If you did not get a chance to attend the last Dental Benefits Collaborative meeting and if you would like to listen to a recording, please dial 888-203-1112 and enter replay code 190464146.  An updated copy of the Adult Dental Benefit Coverage Standard and an updated version of the Listening Log is posted on the Benefits Collaborative Meeting Schedule.

Next Steps:  The Dental Policy Team will take the complete Adult Dental Rule (which will include those services that require prior authorization and will be available July 1st, 2014) to the Medical Services Board (MSB) for initial approval on March 14, 2014.  Prior to MSB Hearings there is always a Public Rule Review Meeting (PRRM), which for the Adult Dental Rule will be held Monday, February 24th at 9am in the 1st Floor Conference Room of 225 E 16th Ave.  If initially approved, the Department will take the Adult Dental Rule back to the MSB for final adoption on April 11, 2014.  The Department tentatively plans to take the Children’s Dental Rule to MSB for initial approval on April 11, 2014.”  [Source: HCPF]

Final Dental Benefits Collaborative Meeting Feb. 13

“The last Dental Benefits Collaborative meeting will be held Thursday, February 13, 2014 10:00am – Noon in the Mile High Conference Room at COPIC | 7351 E. Lowry Blvd. | Denver, CO 80230.  To attend by telephone, dial 877-820-7831 and enter the participant code 423066. In this meeting the issues that were identified for future discussion through the process and placed on the “Parking Lot List” will be revisited.  Please click here to view the agenda.”  [Source:  HCPF]

Notice: Revised Adult Benefit Coverage Standard

“The Department posted an official 45 Day Public Notice inviting the greater public to comment on the revised Adult Dental Benefit Coverage Standard.  Both the notice and the revised standard can be viewed here. The public comment period closes January 19th, 2014.

If you were unable to attend the Dental Benefits Collaborative meeting on December 6th concerning pediatric dental care, including hospital-based care, you may listen to a recording of the meeting by dialing 719-457-0820 (or toll free 888-203-1112) and entering replay code 445324000.”  [Source:  HCPF]

Dental Benefits Collaborative Meeting

“The next Dental Benefits Collaborative meeting will be held on Friday, December 6th, 2013 from 9:00am-12:00pm at the Lowry Conference Center, 1061 Akron Way, Bldg. 697, Denver 80230.  Please review the meeting agenda and PowerPoint presentation.  The topic under discussion will be pediatric dental care, including hospital-based care.

To attend the meeting by telephone, dial 1-877-829-7831 and enter the passcode 423066.  If you have questions please contact Kimberley.Smith@state.co.us or call (303) 866-3977.”  [Source:  HCPF]

Benefits Collaborative Oct. 25 Meeting Follow-Up

"Minutes from the October 25th Benefits Collaborative meeting are now posted on the Benefits Collaborative web page. You may listen to an audio recording of the meeting by dialing 1-88-203-1112 and entering the replay code: 313369983.

If you click on the link provide above, you will notice - in the column labeled Handouts - a copy of the Colorado Modified HLD form and minutes from the previous Orthodontic Benefits Collaborative meetings of 2012. We have also posted - to the Listening Log column - two articles Dr. Oesterle sent for the Department's consideration.

If you have any questions, place contact Kimberley.Smith@state.co.us or call (303) 866-3977."  [Source: HCPF]

Request for Review from HCPF on Medicaid RFP

“The Colorado Department of Health Care Policy and Financing (Department) is responsible for administering the Colorado Medicaid program. On October 11, 2013, the Department released a draft of its Medicaid Adult Dental Coverage RFP Package for review and comment.

The Department is requesting Vendors and Stakeholders to send any comments, no matter how minor, to the Department. Vendors and Stakeholders are encouraged to address text in the draft RFP that is repetitive, and/or confusing, as well as requirements that are incomplete or unclear. In addition, Vendors and Stakeholders are encouraged to review the requirements to advise the Department if any requirements are too broad or restrictive which will inadvertently cause a significant cost increase or cause a Vendor to make a no-bid decision.

The Draft RFP is posted for vendor comments on the Colorado BIDS website.

Responses are required no later than Monday, October 28, 2013.

The instructions for what questions to respond to and how to respond are contained in the RFI Release Announcement document under the “Specification Details/Attachments” section.” [Source: Oral Health Colorado]

October 25th Dental Benefits Collaborative Meeting

The next Dental Benefits Collaborative meeting will be held:

Friday, October 25, 2013
9:00am – 12:00pm
Lowry Conference Center
1061 Akron Way, Bldg. 697, Denver 80230

Click here for the meeting agenda. Topics under discussion will include proposed changes to the Children’s Services Policy and the Orthodontic Services Policy for the Medicaid Dental Benefit.

Also, meeting minutes from the September 20th meeting are on the Benefits Collaborative webpage. Information on how to access audio recording of the September 20th meeting and the October 4th meeting (related to dental services in the Developmental Disability waivers) can be found by scrolling to the bottom of the webpage. If you have questions, please contact Kimberley.Smith@state.co.us or call (303) 866-3977. [Source: HCPF]

Dental ASO Decision Letter

“Please take a moment to read the letter, which informs and explains the Department’s decision to pursue an Administrative Service Organization (ASO) model to manage both the adult and children’s Medicaid dental benefits. The letter also includes a timeline for the competitive procurement of a Vendor to be the ASO.

We are currently developing a Request for Proposals (RFP) for the ASO and welcome your continued feedback with regard to the development of the RFP.

This process does not impact the ongoing discussion related to the appropriate amount, scope and duration of dental services to be offered.”  [Source: HCPF]

Location of Dental DD Waiver Discussion

“A location has been identified for the information public meeting concerning dental benefits in the DD waivers. The meeting will be held:

Friday, October 4, 2013
11:00am – 2:00pm
Lowry Conference Center
1061 Akron Way, Bldg 697, Denver, CO 80230

Click here for the meeting agenda. If you have questions, please contact Kimberley.Smith@state.co.us or call (303) 866-3977.” [Source: HCPF]

Dental Benefits Stakeholder Opportunities - Next Meeting September 20

"The Colorado Department of Health Care Policy and Financing is hosting a series of Dental Benefit Collaborative meetings to define the coverage standards for our newly approved limited adult dental benefit (SB13-242) and the children’s dental benefit. We welcome all stakeholder input.  For a meeting schedule and any additional information, please visit our benefits collaborative web page.

This is a reminder that the next Dental Benefits Collaborative meeting will be held Friday, September 20 from 9:00am – 12:00pm, at the Developmental Disabilities Resource Center | 11177 W. 8th Avenue, Lakewood, CO 80215.  Click here for the meeting agenda. You may check for agenda updates, read past meeting minutes and access the Dental and Network & Delivery Systems listening logs by visiting the website. The purpose of the September 20th meeting is to further discuss design of the Adult Dental Benefit, specifically:  endodontics, periodontics, prosthodontics; and oral surgery.

To attend the September 20th meeting by telephone: dial 1.877.820.7831 and enter the passcode 423066 and then wait to be added to the conference.  Please mute your phone when you are not speaking by dialing *6*.

A recording of each of the Dental Benefit Collaborative Meetings will be made available for those who cannot participate.  To access the recording of the Aug. 23rd meeting:  dial 1.888.203.1112 and enter replay passcode 312363153." [Source:  HCPF]

Dental Benefits Collaborative

"Thank you to all attendees who participated in the second Dental Benefits Collaborative meeting, either in person or on the phone.  The updated meeting schedule may be found here.  The general Dental Listening Log and a special Dental Service Delivery and Network Option Listening Log may also be found on the Benefits Collaborative website.

Important note: All materials the Department has received in reference to the choice of a dental service delivery model and/or network option will appear directly below the corresponding listening log. We plan to use this log to continue the conversation around service delivery model and network options. Please send further comments, responses and/or questions to Kimberley Smith using the contact information below. I will update the listening log with your feedback."  [Source:  HCPF]

August 23rd Dental Benefits Collaborative Meeting

The next Dental Benefits Collaborative meeting will be held Friday, August 23, 2013 from 9:00am-12:00pm in the COPIC Building, Mile High Conference Room, 7351 E Lowry Blvd, Denver, CO 80230.

The purpose of this meeting is to discuss design of the Adult Dental Benefit, specifically:

• Preventive services;
• Diagnostic services; and
• Restorative services.

Please view the August 23rd meeting agenda and the presentation.

To attend the Aug. 23rd meeting by telephone:  Dial 1-877-820-7831 and enter the passcode 423066 and then wait to be added to the conference.  Please mute your phone when you are not speaking by dialing *6*.

A recording of each Dental Benefit Collaborative Meeting will be made available for those who cannot participate.  To access the recording of the Aug. 9th kick-off meeting:  Dial 1-888-203-1112; and enter replay passcode 31331261.  [Source:  HCPF]

Dental Collaborative Meeting Materials

The initial Dental Benefits Collaborative kick-off meeting was held Friday, August 9th.  Recordings of these meetings will soon be made available on the Benefits Collaborative website.  Please see the documents below that were discussed at the first meeting:

• Benefits Collaborative Ground Rules
• The Benefits Collaborative Process
• Guiding Principles
• Delivery System Options

The next Dental Benefits Collaborative meeting is August 23, 2013 from 9:00am-12:00pm.  Please visit the website for more information and the meeting agenda.

Invitation to Dental Benefits Collaborative Meeting

"The Department of Health Care Policy and Financing is convening a series of stakeholder meetings in response to:

• The passage of SB13-242 by the Colorado General Assembly, which adds preventative dental services for adults to the list of optional services provided under Medicaid; and
• The Department's desire to resume the Benefits Collaborative discussion of the Children's Orthodontia benefit; and
• Authorization through Senate Bill 13-230 (the Long Bill) to fund the creation of a Dental Administrative Service Organization (ASO) and the associated reprogramming of the MMIS system to manage dental benefits; and
• The Department's goal of enhancing the Children's Medicaid Dental Benefit package.

The initial Dental Benefits Collaborative kick-off meeting will be held:  

Friday, August 9, 1:00-3:00p.m.
COPIC Building, Mile High Conference Room.
7351 E. Lowry Blvd, Denver, CO 80230

Meeting Objectives:

• Define the stakeholder role in the development/re-development of each benefit
• Review the benefit design and implementation process, including future Benefit Collaborative meeting dates and the general benefit areas to be discussed at each meeting
• Provide background on authorizing legislation
• Review potential service delivery model

Click here for more information including the agenda, presentation, meeting schedule, and information on how to attend the meeting via telephone.  All members of the public are welcome to attend."  [Source:  HCPF]