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Toolkit can help states negotiate Medicaid contracts

June 09, 2015

By Kelly Soderlund

Dr. Hoffman
A new ADA-produced toolkit provides state dental associations with elements to consider when working with their respective state Medicaid program administrators on contracts that could ultimately benefit the Medicaid program and dental patients.

"Medicaid: Considerations When Working with the State to Develop an Effective RFP/Dental Contract" covers a number of topics state dental society leaders could consider when working with state officials on Medicaid programs and contracts. It was sent to all state dental society executives for consideration when they discuss the dental aspects of their state's Medicaid contract.

"The toolkit provides guidelines for program elements that should ideally be addressed in a Medicaid contract," said Dr. Charles Hoffman, chair of the ADA Council on Dental Benefit Programs, which developed the kit.

A large part of the toolkit covers the key elements to enforce through a dental program contract. This includes assuring an adequate network; continuity of care; fee schedules and reimbursement; claims processing and appeals; and the role of peers in resolving issues, among other topics. The document also discusses the need for a dentist to be the state Medicaid dental program director.

CDBP members and staff reviewed requests for proposals and Medicaid contracts from a number of different states when developing the toolkit. They took a number of suggestions from the Texas Dental Association, which negotiated a Medicaid contract in 2011.

"For us, these elements were absolutely instrumental in ending up with a contract that has helped establish a reasonable managed care Medicaid program," said Dr. William Steinhauer, chair of the TDA's Committee on Access, Medicaid and CHIP.

Other states are already looking forward to referencing the toolkit as they enter into negotiations with their particular states.

Florida doesn't have a state dental director, which makes it difficult to obtain a seat at the table when the state's Medicaid contract is being discussed, said Casey Stoutamire, lobbyist for the Florida Dental Association. Florida's Medicaid contract was just solidified for another five years but Ms. Stoutamire said the ADA toolkit will be useful when it's up for renewal.

"It's great to have as a mental checklist, to fill in the gaps for what was an wasn't included in the contract," Ms. Stoutamire said. "Even though our contract is already done, there were things we weren't able to get into the contract so it's nice to have something to refer back to when we're talking to our Medicaid officials and legislators."

For more information on the toolkit, email dentalbenefits@ada.org.