BITES&BRIEFS
Dental Medicaid Increase Great News for Existing and Potential Providers
O
n Friday, July 1, Governor Parson signed the budget which included a historic dental Medicaid increase. Why was this historic? Because we have not seen a rate increase like this in 30+ years (maybe more) in our state. And just what is the increase?
Reimbursement rates for MO HealthNet dental providers for the 2023 Fiscal Year will be 80 percent of the 50th percentile of 2022 UCR rates, which means 80 percent of the average 2022 fees for codes in a particular area.
So, what does that mean to the average member, in plain speak? This is an incredible win for dental professionals, but truly for all Missouri citizens. Dentists have told us over the years that if the reimbursement rate got to even 65 percent of UCR, they would certainly consider providing services for the Medicaid population. So, this does create an opportunity for pro- viders to consider the choice to become a Medicaid dental provider.
We’re also hearing from current Medicaid dental providers that the increases provide them a higher reimbursement than most private insurance companies. But it is more than that: If provider enrollment can increase, so can needed access for patients, delivery of care out- side of emergency room visits and the hope to provide more preventative dental services to patients in need. This is a huge victory for dentistry in Missouri. It was built on decades of members’ persistence and advocacy. We can’t thank each of you enough, as well as the many oral healthcare advocates who’ve supported this.
IF YOU ALREADY ARE A MEDICAID PROVIDER
The provider bulletin published July 1 states effective for dates of service on or after July 1, 2022, the MO HealthNet Division (MHD) will increase the fee-for-service maximum al- lowable amount for the services listed in the June 30, 2022 public notice posted on the MO HealthNet website: FY23 Rates for Services Receiving Rate Increases (dental codes begin on page 64). Providers may and should begin billing based on these new codes as of July 1.
When any state changes their Medicaid reimbursement rates or methodology, they must submit what is called a “state plan amendment” to the federal government/CMS. This is more of a notification process than it is an application. Once CMS approves the state plan amend- ment, MO HealthNet will reimburse you for the difference between the new codes/old codes. If you do not bill based on the new codes, you are not eligible for that reimbursement. Again, you can begin billing for these codes effective July 1.
IF YOU ARE NOT A MEDICAID PROVIDER
If you are interested in becoming a Medicaid provider, the Missouri Department of Social Services has a Provider Enrollment page with information. The MDA is working diligently with the Department to provide resources to help members (and their dental office team) en- roll and onboard more efficiently, and to give more direction to the many links and resources available. Until we know more about that process, the first step is to apply to be a Missouri Medicaid Provider. We are in continual conversation with the Department and will share ad- ditional information and resources as soon as possible.
Find referenced links and additional information/resources/updates at
modental.org/medicaid. 12 focus | JUL/AUG 2022 | ISSUE 4
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