DRAFT
April 17, 2008 Health Access Washoe County 1055 S. Wells Avenue Reno, NV 89502 1. The meeting was called to order at 5:45 pm by Dr. Mark Rosenberg, Chair. 2. Roll call. In attendance were: Maria Brannum: CSA Head Start Carrie Fritz: Doral Jake Hatzenbuhler: Doral Mike Johnson: Saint Mary’s Michelle Kling: Washoe County District Health Department Lisa Lottritz: Washoe County District Health Department Dr. Mike Rodolico: Health Access Washoe County Community Health Center Dr. Mark Rosenberg: Private Citizen John Whaley: Nevada Division of Healthcare Financing and Policy Chris Wood: Nevada State Health Division In attendance via telephone conference line: David Blackman: Anthem Blue Cross Blue Shield Dr. Robert Talley: Nevada Dental Association 3. Report/discussion with Anthem, Doral, and the Division of Health Care Financing and Policy (Taken out of order). David Blackman - Doral is the new third party administrator for Anthem Blue Cross Blue Shield. As such, they handle claims, coding errors, preauthorization approval and other routine administrative matters. Dr. Rosenberg - Per a phone call he received from Small Smiles, due to the recent reductions in reimbursement instituted by Doral, as of April 1 they are no longer treating patients who are enrolled in Doral. Mark asked if this is a concern since Small Smiles is one of the largest Medicaid providers in the state. Carrie Fritz - Doral has made a conscious decision to exclude certain providers. A reduction in the number of providers could be beneficial for providers as it means there will be more enrollees per provider. David Blackman - Anthem fully intends to meet contract deliverables (ratio of providers to clients) and he firmly believes members will continue to have good access. Due to budget issues, this will be a very difficult year for both Anthem and providers. Rate cuts had to be implemented across the board. The rates cuts were implemented because there has been a large increase in medical utilization and Anthem is experiencing large losses on the medical side. John Whaley - Even with the recent rate cuts, Anthem is still paying more than Nevada Care used to pay. Doral’s reimbursement is now more in line with Nevada Care’s. The contract with Medicaid allows for a maximum 3 percent profit. They are currently at 261 percent of the
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minimum contract requirements for access to dental services. The contract requires one provider for each 1,500 enrollees. They currently have 2.61 providers per 1,500 enrollees. As an FYI, Medicaid looked at the 2002 Medicaid reimbursement schedule and the 2007 schedule. The 2007 rates are lower than the 2002 rates so they decided to use the 2002 rates. Dr. Rosenberg - A well run dental practice has an overhead of around 65 percent. The new reimbursement rates don’t even cover overhead. Providers are losing money. The new rates might motivate providers to provide more services that are unnecessary. John Whaley - Medicaid and Doral run monthly reports to monitor provider claims. The reports will red flag providers who are providing services that are out of the norm. Mike Johnson - Saint Mary’s is a not-for-profit hospital. It has provided dental services for 1012 years. Their clients are enrolled in Medicaid or they are self-pay. No private insurance is accepted. The self-pay fees are based on the amount of income received from Medicaid; if Medicaid reimbursement goes down, self-pay clients must be charged more. In addition, Saint Mary’s costs are higher because they must comply with hospital accreditation standards. John Whaley - He understands but unless Medicaid’s budget is increased, they do not have any funds to support an increase. David Blackman - Anthem does not negotiate rates with providers; Doral does. That said, Anthem does not want to see provider erosion due to excessively low reimbursement. Dr. Robert Talley - Who negotiates the per enrollee reimbursement rate for Doral? David Blackman - Doral does not negotiate the rate. John Whaley - The federal government requires states to pay based on actuarially determined rates. These rates are based on historical data from the states. Dr. Robert Talley - How can we get the per person rate increased? John Whaley - There is a form on the Division of Health Care Financing’s website that can be completed and submitted to the rates department. John has submitted a request for a rate increase but no one is submitting formal complaints so there is no data to support the need for a rate increase. Formally complaints can be submitted individually or multiple individuals / organizations could all sign onto one complaint. Providers can also contact policymakers about concerns. Action - John will send the link to Chris and she will distribute to coalition members. Mike Johnson - Can Saint Mary’s petition for a higher reimbursement rate? Carrie Fritz - A negotiated rate is unlikely at this time as rates have just been established but Mike may wish to follow up with her or John Whaley sometime in the future. John Whaley – The exception to Doral’s ability to pay whatever rates they can negotiate is with Federally Qualified Health Centers (FQHC) and Rural Health Centers (RHC). FQHCs and RHCs are reimbursed based on the fee-for-service reimbursement schedule and Doral can not negotiate these rates down. Carrie Fritz - Doral runs monthly reports and the State monitors these reports. If Doral sees a drop in the number of providers, they will take steps to address it. In terms of over utilization, Doral will be monitoring this by comparing utilization with the providers past history. Mike Johnson - The reimbursement issue is very significant for Saint Mary’s. It has really jeopardized the future of all Saint Mary’s dental programs. If Saint Mary’s closes its dental programs, they will not come back anytime in the near future. Small Smiles was probably the largest Medicaid provider in the state. HAWC is second. Saint Mary’s is probably the third. If Medicaid loses both Small Smiles and Saint Mary’s it will be losing a large portion of their capacity. Dr. Mark Rosenberg - The business model for the Northern Nevada Dental Health Program (NNDHP), which is a partnership between Saint Mary’s and the Northern Nevada Dental Society, is that income from treating children who are enrolled in Medicaid helps support a case manager. The case manager refers uninsured children to providers who treat the uninsured children at no charge. The case manager also refers children who are insured by Medicaid to specialists who are not enrolled as Medicaid providers. These providers treat the children at no charge. They do
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not have a financial incentive to undergo the credentialing process yet again. The providers who volunteer for NNDHP recently completed WellPoint credentialing applications. Now they are being asked to submit Doral credentialing applications. In the past over 80 percent of the members of the Northern Nevada Dental Society participated in NNDHP. Can’t Doral accept the WellPoint credentialing process? David Blackman - If a provider completed the standardized (“long form”) mandated by the Nevada Insurance Commissioner, to credential with Wellpoint or HPN, they can photocopy the application and simply submit it with a new front and back page and original signature. Mike Johnson - The problem is that originally Wellpoint credentialed providers using a nonstandard (“short form”). None of the providers who were credentialed with the short form, re credentialed with the long form. Carrie Fritz - Would it help if Doral assisted providers with completing some parts of the long form? Mike Johnson - No. NNDHP already provides some help. The problem is that some of the questions ask for information only the provider would have. Currently only six providers have re-credentialed with Doral and there are 160 more who need to. Carrie Fritz - Carrie would like to see a copy of the short form to see if Doral can come up with any innovative ideas about credentialing these providers with Doral. Action - Mike Johnson to send Carrie a copy. John Whaley - Individuals can also file a complaint with the Insurance Commissioner. David Blackman - Individuals with concerns may call him at 702-669-5182. 4. Approval of minutes Mike Rodolico noted the omission of a statement by Jaime Collins from Anthem Blue Cross Blue Shield regarding the credentialing of providers; she had stated no provider would have to recredential, which turned out not to be correct, Doral has asked all providers to re-credential. Mike also noted that on page 3, under announcements, the minutes should say, “Shriners Hospital will be coming to HAWC twice a year,” rather than “once a month.” Michelle Kling asked if two times a year meets HAWC’s needs. Mike stated it does. Action - Michelle to share information about Shriners services with the Craniofacial Clinic at UNR. The minutes of the February 2008 meeting were approved as revised. 5. Announcements Mike Rodolico HAWC is discontinuing its program to provide dental treatment in hospital/surgery centers. The reimbursement they are receiving from Medicaid does not cover the actual costs. o Action - John Whaley will request an analysis on the number of pediatric dentists enrolled in an HMO who provide care in hospitals/surgery centers. o Action - Carrie Fritz will contact the Nevada State Board of Dental Examiners to inquire about the number of Nevada licensed dentists who have requested approval to utilize a “traveling” anesthesiologist to provide anesthesia services in their private offices. HAWC was recently awarded a $150,000 grant from the Trust Fund for Public Health. The funding will support the provision of dental services to uninsured children and adults over the age of 55. The grant is effective July 1, 2008. HAWC is hiring a new dentist for the dental clinic in south Reno. This will bring the number of dentists at HAWC to 4.5 FTE and the number of hygienists to 2.8 FTE.
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Chris Wood - The deadline for submitting comments on the 2008 State Oral Health Plan is Friday, April 18. The final draft will then be submitted to Health Division Administration for final approval and publication. John Whaley The expansion of the HMOs into five additional counties has been delayed until September or October. Doral is not offering a benefit previously provided by WellPoint (one free adult cleaning per year). Medicaid is very concerned about the high percent of Medicaid appointments where the patient is a no-show (30%-40%). He noted that Saint Mary’s no-show rate is down to 8%. When asked how they achieved this, they were told it was through the use of “scolding.” (Mike Johnson shared that Saint Mary’s uses the “promatora” approach with one-on-one counseling). Leah Bennett contacted several providers to try to get their input as to why Medicaid patients say they fail appointments but she did not have great success obtaining feedback. o Action - John to have Leah call Chris to see if she can help. 6. Old business Fluoridation and Washoe County: Dr. Rosenberg presented a policy brief on maintaining the current population level at which community water fluoridation is mandated. The policy brief was developed by the State Oral Health Advisory Committee, Legislative Subcommittee. The policy brief explains why all policy makers, not just those from counties that have recently met the current population threshold, should support maintaining the current population level at which fluoridation is mandated. It could be used by all six of the regional oral health coalitions to secure support from the policy makers representing the counties served by each coalition. A motion to approve the policy brief was approved unanimously. 7. New Business Dr. Rosenberg asked for approval to write a letter of support for a grant application the Oral Health Program will be submitting to the Centers for Disease Control and Prevention (CDC). The CDC grant that currently provides 80 percent of the funding for the State Oral Health Program will end on June 29, 2008. This application, if funded, would allow the program to maintain current infrastructure and capacity. A motion to provide a letter of support was approved unanimously. Action - Dr. Rosenberg will draft a letter and Chris will disseminate to coalition members for their review and comment. 8. Next Meeting - The next CUSP general membership meeting was set for Thursday, June 26, 2008 from 5:30 PM- 7:30 PM at Health Access Washoe County (HAWC) Community Health Center in Reno. 9. The meeting adjourned at 7:25 PM
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