MCAC MEETING MINUTESdhcfp.nv.gov/uploadedFiles/dhcfpnvgov/content... · Helping People -- It's Who...

Nevada Department of Health and Human Services

Helping People -- It's Who We Are And What We Do

STEVE SISOLAK Governor

RICHARD WHITLEY, MS Director

SUZANNE BIERMAN, JD, MPH Administrator

DEPARTMENT OF HEALTH AND HUMAN SERVICES DIVISION OF HEALTH CARE FINANCING AND POLICY

1100 East William Street, Suite 101 Carson City, Nevada 89701

Telephone (775) 684-3676 • Fax (775) 687-3893 http://dhcfp.nv.gov

MCAC MEETING MINUTES

Date and Time of Meeting: January 15, 2019 at 9:00 AM

Place of meeting: Public Utilities Commission

1150 E. William Street, Hearing Room B

Carson City, Nevada 89701

Place of Video Conference: Public Utilities Commission

9075 W. Diablo Drive, Suite 250

Las Vegas, Nevada 89148

Teleconference: (775) 687-0999

(702) 486-5260

Access Code 43606

Attendees

Board Members (Present)

Rota Rosaschi, Chairperson

June Cartino, Board Member

Dr. Ryan Murphy, Board Member

Dr. Ihsan Azzam, Board Member

Peggy Epidendio, Board Member

Kimberly Palma-Ortega, Board Member

Board Members (Absent)

Dr. Stephanie Ingrey, Board Member

Dr. David Fiore, Board Member

Sharon Chamberlain, Board Member

Carson City

DuAne Young, Division of Health Care Financing and Policy (DHCFP)

Andolyn Johnson, Deputy Attorney General (DAG)

Joan Hall, Nevada Rural Hospital Partners (NRHP)

Heather Fitzgerald, SilverSummit Health Plan (SSHP)

Joanna Jacob, Nevada Dental Association (NVDA)/Ferrari Public Affairs (FPA)

http://dhcfp.nv.gov/



Lea Cartwright, Nevada Psychology Association (NPA)/Guardian Transportation

Emily Whipple, Nevada Academy of Pediatric Dentistry (NVAPD)

Jeanette Belz, Nevada Psychiatric Association (NVPA)

Allyson Hoover, Anthem Blue Cross/Blue Shield (Anthem)

Lisa Jolly, Health Plan of Nevada (HPN)

Maggie Fording, DXC Technologies (DXC)

Aaron Dieringer, University of Nevada Reno (UNR) Family Medicine

Jared Davies, DHCFP

Beth Slamowitz, DHCFP

Holly Long, DHCFP

Shauna Tavcar, DHCFP

Cody Phinney, DHCFP

April Caughron, DHCFP

Jay Dee Fredricksen, Paratek

Michelle Mays, Summit Surgery Center

Larry Hurst, NVDA/FPA

Elise Gronhagen, Summit Surgery Center

Briza Virgen, DHCFP

Kirsten Coulombe, DHCFP

Jaimie Evins, DHCFP

Lynne Foster, DHCFP

Veronica Alegria, DHCFP

Jennifer Shaffer, DXC

David Escame, Anthem

John Zabukovel, Conduent

Coy Barnson, Guardian Transportation

Mark Rosenberg, DDS, MPH

Las Vegas

Robert Talley, DDS

Stuart Weichers, MD, Sun Valley Surgery Center

Andrea Brown, First Med Health & Wellness

Ysenia Ayala, Absolute Dental

Devau Seawright, HPN

Shawna De Rousse, HPN

Gina Hernandez, Sun Valley Surgery Center

I. Call to Order

Chairwoman Rota Rosaschi called the meeting to order at 9:05 AM.

II. Roll Call

Chairwoman Rosaschi asked for roll call. A quorum was established.

III. Public Comment

Ms. Joanna Jacob with Ferrari Public Affairs and acting on behalf of the Nevada Dental

Association said that this past summer, Ferrari Public Affairs brought to the attention of

Nevada Medicaid access to care problems as a result of a dental rate realignment in 2016

that affected ambulatory surgery centers (ASC). This realignment brought the rates in line

with Medicare rates. One of the impacts included the ASCs not scheduling pediatric dental

procedures, which would give the recipients only the option of going to the emergency

room for care. Ms. Jacobs stated that she did not think it was an appropriate response or

even the best setting for pediatric dental patients and those present today will continue to

collaborate with the Division for a resolution.

Ms. Rosaschi asked Dr. Mark Rosenberg to speak next as she had changed her mind

regarding the order of the agenda, so the committee can use all of the information provided

in the discussions.



Dr. Rosenberg mentioned that he had last provided information to Nevada Medicaid about

10 years ago when the same subject surfaced and the Center for Medicaid and Medicare

Services (CMS) wanted to align services between Medicaid and Medicare. Dr. Rosenberg

provided his background, including being involved in dental public health since 1978 and

serving 26 years as a Commissioned Officer with the United States Public Health Service.

Dr. Rosenberg’s last assignment was directing the Indian Health Services dental programs.

Dr. Rosenberg was recruited by the State in 1999 to be on the Oral Health Advisory

Commission, which turned into the Advisory Committee on the State Program for Oral

Health (AC4OH), with which he had served 15 years. The DHCFP also asked Dr.

Rosenberg to start a Dental Care Advisory Committee, which lasted two years. Dr.

Rosenberg semi-retired in 2004 and was recruited by St. Mary’s Regional Medical Center

to start a hospital dentistry program because it was taking about a year for children to get

the care they needed. Dr. Rosenberg tried to retire again two years ago but his current

position is working as the Chairman of Oral Health Nevada.

Last April, Dr. Rosenberg was notified by pediatric dentists and multiple administrators of

surgery centers and hospitals and that the reimbursement rate for oral rehabilitation Current

Procedural Terminology (CPT) Code 41899 was going to be decreased by almost 50%.

This affects young children, developmentally disabled adults, those with cerebral palsy,

muscular dystrophy and other complex medical issues. Dr. Rosenberg was told that Nevada

Medicaid and Medicare rates were going to be aligned once again according to the

American Medical Association’s (AMA) CPT Code. According to CMS, the entire

Medicaid dental budget is only 3 – 5% of the total expenditures. The vast majority of

pediatric care took place in dental offices, not in surgery centers.

Dr. Rosenberg said that he testified at the AC4OH in May. The Committee asked for help

from Mr. Jack Zenteno, Chief of Children’s Services with Nevada Medicaid. Dr.

Rosenberg has not heard back.

Dr. Rosenberg mentioned that in 2009, the DHCFP’s Administrator, Mr. Charles Duarte,

had said the Division was encouraged by CMS to align the surgery center and the

anesthesiologist’s fees. The anesthesiologist’s fees went from approximately $600.00 per

case to approximately $200.00 per case, where it remains today.

Dr. Rosenberg said that the alignment of fees makes sense on the surface, but realistically

Medicare fees are only appropriate for adults. Medicare also does not provide dental. The

Division understood this in 2009 and the ASC fee was reinstated to its original rate. Several

years later, Mr. Duarte testified in front of the MCAC. Mr. Duarte was Chief Executive

Officer (CEO) of Community Health Alliance when he asked to have the anesthesia rate

reinstated but was unsuccessful. The fee remains for rural areas and Carson County. HPN

and Anthem negotiated higher fees for Clark and Washoe counties to decrease the access

to care issue. The Fee-for-Service (FFS) rate, which affects rural Nevadans and special

patients, is still at the reduced rate. Anesthesiologists are not interested in seeing FFS

recipients because they get paid so little. It costs more to see FFS recipients than what the

anesthesiologists get paid for.

Mr. Zenteno told Dr. Rosenberg that there was a 40% annual turnover rate for the Division

and most of the people Dr. Rosenberg previously worked with were either retired or had

moved on.



Dr. Rosenberg continued by stating that oral rehabilitation means taking a patient and doing

everything they need while they are under general anesthesia. There could be up to 30

different billable dental codes involved. Dr. Rosenberg and others asked the AMA to create

codes specific to dental procedures but was told that the CPT coding system was not to be

used for dental procedures. Dr. Rosenberg explained how difficult it is using anesthesia in

children versus adults. Dr. Rosenberg said the number of ASCs in Reno has decreased from

five when he started his career to there being only one today. Dr. Rosenberg reported that

Las Vegas only has one ASC left for over two million people.

Dr. Rosenberg claimed that due to the decrease in rates, many procedures are now being

done in dental offices, which will eventually lead to more and more problems.

Ms. Rosaschi thanked Dr. Rosenberg then asked for additional comments.

Dr. Emily Whipple, a pediatric dentist, provided two letters for the record. One letter was

written by Congresswomen Dina Titus and Jacky Rosen regarding access to care in ASCs

for Medicaid children. The second letter was from the Nevada Academy of Pediatric

Dentistry.

Ms. Rosaschi asked Dr. Whipple to paraphrase the letters as the Committee had not seen

them.

Dr. Whipple told the Committee that the lack of ASCs in the state is forcing the recipient

children to seek care in hospitals and emergency rooms adding to considerable costs. Dr.

Whipple mentioned that emergency rooms only treat the pain or infection then refer the

recipients to seek definitive care elsewhere. The care a recipient receives in a dental office

is usually under non-ideal conditions. Recipients will make multiple trips to the emergency

room with no definitive care. Dr. Whipple read from the letter that in 2015 32% of

Nevada’s children received Medicaid or coverage under the Children’s Health Insurance

Program (CHIP). That number has increased to 42% within the last few years.

Dr. Whipple summarized the letter and stated the Congresswomen are requesting the rate

be reinstated to the prior rate. The letter was dated June 7, 2018.

Dr. Stuart Weichers, owner of Sun Valley Surgery Center said his clinic sees about 250 –

300 pediatric dental patients per month. Other surgery centers in the Las Vegas area closed

their doors to pediatric dental patients and the cut in the reimbursement rate has

disproportionately affected poor groups of people. The community would have about

10,000 pediatric dental patients who would not be provided the level of care needed unless

the prior rate is reinstated. Dr. Weichers said that according to Nevada Revised Statute

(NRS) 449.443, it is against the law for an anesthesiologist or nurse anesthetist to provide

sedation in a dental office. Only a dentist can provide sedation.

Dr. Weichers noted that there is only one dental anesthetist in all of Southern Nevada who

does not accept Medicaid. Dr. Weichers explained that the pediatric dental recipients have

no place else to go besides a hospital or ASC. Access to care is the main issue for the

recipients. There are a couple of surgery centers that will do a limited number of cases, but

it is only about 10 – 20 per month. One surgery center has stated that one sinus surgery

case is more profitable than one whole month of pediatric dental surgeries. Dr. Weichers



said that his clinic was having to pay the anesthesiologists because the reimbursement rate

is not enough for the anesthesiologist to want to provide the service for Medicaid recipients.

Dr. Weicher’s clinic had to stop paying the anesthesiologists when the Medicaid cut to the

reimbursement rate went into effect.

Dr. Weichers concluded that the only solution is to have the prior rates reinstated as the

pediatric dental recipients do not have anywhere else to go.

Ms. Rosaschi asked if anyone else wanted to comment. Nobody came forward and Ms.

Rosaschi continued with the next item on the agenda.

IV. For Possible Action: Review and Approval of Meeting Minutes from the previous

meeting held on October 16, 2018

Dr. Ryan Murphy motioned to approve the minutes and Ms. Peggy Epidendio seconded

the motion. The minutes were approved.

V. Administrator’s report, State Plan Amendments and Medicaid Services Manual

Updates By: DuAne Young, Deputy Administrator

Mr. DuAne Young began with staffing updates. Mr. Young announced Ms. Suzanne

Bierman as the new Administrator. Mr. Young mentioned that Ms. Cody Phinney has

returned to her duties as the Deputy Administrator.

Ms. Rosaschi asked Mr. Young to provide more information about Ms. Bierman.

Mr. Young said that Ms. Bierman is the former Deputy Administrator for the Medicaid

program in Arkansas. Ms. Bierman most recently was employed with the Guinn Center in

Las Vegas. She has a juris doctorate (JD) and a master degree in public health (MPH) and

has 20 years of experience in the healthcare field. Mr. Young expressed his excitement in

being able to work with someone who has a lot of experience in Medicaid policy.

Mr. Young also mentioned the addition of Mr. Vincent “Budd” Milazzo as the new Chief

Financial Officer (CFO) who was formerly in the Director’s office as the Administrative

Services Officer (ASO) IV. Mr. Young announced the promotion of Mr. Zenteno to Social

Services Chief III over Program Integrity and said the Division is hoping to fill Mr.

Zenteno’s previous position over Children’s Services in the coming weeks.

Mr. Young provided updates regarding the State Plan Amendment (SPA) and the Medicaid

Services Manual (MSM). There were two SPAs that went into effect on November 29,

2018. One of the SPAs dealt with the Health Insurance Premium Program (HIPP) to align

language with CMS and the other SPA updated language and methodologies to the state

plan for Third Party Liability (TPL) as there have not been any updates in about 20 years.

The last SPA was for Medication Training and Support qualification changes, which went

into effect December 28, 2018 and removed Qualified Mental Health Professions (QMHP),

Licensed Clinical Social Workers (LCSW), Licensed Marriage and Family Therapists

(LMFT) and Clinical Professional Counselors (CPC) from administering medication

training. Mr. Young explained that this was done to improve mental health services



throughout the state as this service should be limited to a higher-level practitioner such as

a pharmacist or Registered Nurses (RN).

Mr. Young mentioned changes to the MSM that went into effect on November 5, 2018 that

included Radiology Services and clarification to certain prescription drugs. There were

changes to mental health that went into effect on October 26, 2018 that included rescinding

requirements for psychotherapy restrictions that were previously imposed. The changes

that went into effect December 1, 2018 included changes to Private Duty Nursing (PDN).

At the conclusion of the Administrator’s Report, Ms. Rosaschi asked for any public

comment regarding the report to which she received no response.

VI. Presentation of Marketing Materials by the Managed Care Organizations (MCO)

Ms. Allyson Hoover, Director of Provider Solutions with Anthem Blue Cross/Blue Shield

began her presentation by introducing Mr. David Ascame, who will be taking over and

running all of the marketing communications for Anthem. Mr. Ascame will be replacing

Ms. Hoover at the MCAC meeting.

Ms. Hoover gave an overview of the marketing materials by reminding everyone that

Amerigroup was re-branded as Anthem and has taken on some challenges with the

providers and the membership.

Ms. Hoover stated that Anthem is all about choice with their membership, whether it is

services that are provided in the doctor’s offices or the services offered in their value added

benefits (VAB). Ms. Hoover said their membership is happy with the services and will

oftentimes ask to come back to Anthem after they have dropped Medicaid, which proves

they have high quality doctors and valuable benefits.

Ms. Hoover mentioned that Anthem has increased access to care through their open

enrollment and part of that is the access to behavioral health (BH) services. Well Care is

the BH provider for Anthem. Well Care is now offering a variety of services related to

patients who have been exposed to violence or violent episodes. Anthem has social

services, housing and other options available to their BH members.

Ms. Hoover said that Crossroads is a new vendor with Anthem and bedside delivery is a

new service that will be offered for all their members. This will allow the members to leave

the hospital with medications rather than a prescription that will need to be filled. This

service will remove the stress of the recipient having to find an open pharmacy or worrying

about how they are going to pay for it after being discharged from the hospital. The

recipient will receive the medication and the training at the time they are discharged from

the hospital.

Ms. Hoover also said that Anthem has been very successful in offering their members

identification cards. The Department of Motor Vehicles (DMV) is opening a window two

days a week that will specifically be for Anthem members to allow them to have an

identification card replaced. This service will be offered at locations in both northern and

southern Nevada DMVs.



Anthem also assists their members in obtaining their birth certificates in order for them to

be seen at their primary care doctor or social services office.

Ms. Hoover talked about Anthem’s relationship with a provider who will be providing

telemedicine services. Many specialties have limited access in both the north and the south,

so this will help recipients connect with providers who may not usually be readily available

to make an appointment with.

Ms. Hoover concluded by saying Anthem is looking forward to the start of open enrollment

in April and in working with the other MCOs and the community.

Ms. Rosaschi asked Ms. Hoover to talk about the housing fees.

Ms. Hoover said that Anthem Medicaid provides short term housing and options for the

recipients when they end up in the emergency department and need relief from weather, if

they have lost their medications or if they need opportunities to get their feet back on the

ground.

There were no other questions or comments for Ms. Hoover.

Ms. Rosaschi requested that Health Plan of Nevada (HPN) begin their presentation.

Ms. Lisa Jolly, Director of Operations for HPN, began her presentation of the marketing

materials with the 2019 open enrollment materials. This year, HPN’s campaign is titled

“Discover the Difference” and it highlights the value they bring to their members. Ms. Jolly

said that in past years, HPN’s campaigns were lighthearted and fun but this year HPN is

focused on presenting the information in a way that the members and potential members

can easily understand to make the best healthcare decisions.

HPN will be using a couple of different key messages this year. The key messages of the

campaign include “Discover the difference”; “Coverage you need. Benefits you deserve.”;

“Benefits at 100% coverage.” and “No cost extra benefits.” The materials Ms. Jolly

provided are in a simplified format, so it is easy to see what HPN is using and the ways in

which the materials will be used.

Ms. Jolly said HPN will be putting together television and radio advertisements and will

utilize mobile texting, on-hold messaging, social media and other strategies in their

campaign. HPN wants to educate people on Medicaid, open enrollment and the recipient’s

choices. Ms. Jolly explained that the website is full of information that the recipients can

use to find a provider or find out how to get to the providers. The education includes what

the recipient gets with Medicaid as well as what they get as a value-added benefit.

Ms. Rosaschi asked for questions, of which there were none, then asked for the presentation

from SilverSummit Health Plan (SSHP).

Ms. Heather Fitzgerald, the Marketing and Communications Manager for SSHP, said the

2019 campaign is titled “It’s All Part of My Plan.” SSHP plans on using outdoor boards

for messaging and will use a website that will track the advertising efforts that are specific

to the campaign by directing the members to a vanity URL. SSHP plans on using digital



media, posters, social media and other means of advertising for the open enrollment

campaign.

Ms. Rosaschi asked Ms. Fitzgerald to share what she can regarding SSHP’s dental

program.

Ms. Fitzgerald said they provide standard dental benefits to members aged 21 and older

and pregnant women at a Federally Qualified Health Center (FQHC).

Ms. Rosaschi asked if SSHP provided Early and Periodic Screening, Diagnostic and

Treatment (EPSDT) services.

Ms. Fitzgerald said she will have to get back to Ms. Rosaschi about that. At that time,

someone on teleconference jumped in and said that SSHP does provide that service. (The

name was unintelligible).

Ms. Rosaschi asked what difficulties in treatment SilverSummit has if a recipient is referred

to a dentist by a Primary Care Physician (PCP).

The SilverSummit representative via teleconference answered that SilverSummit has not

encountered any of the barriers that the pediatric dentists presented earlier.

Dr. Ryan Murphy clarified that Liberty Dental Plan took on all of the dental benefits for

Washoe and Clark County as of January 2018. The rural areas are still providing dental

through FFS Medicaid. The issues discussed earlier with the ASCs are still funded through

the medical plans of the MCOs. The MCOs have not had an impact on the dental program.

Liberty Dental still pays the dental claims that the pediatric dentists bill for. The pediatric

dentists don’t bill for the facility or the anesthesiologists. The MCOs are reimbursing the

anesthesiologists and the facility. Dr. Murphy reiterated that the MCOs are not providing

the dental benefits and are unable to address Ms. Rosaschi’s questions.

Ms. Rosaschi asked if the MCOs can be a part of the solution.

Dr. Murphy responded that the MCOs can be part of the solution because the issue is the

reimbursement rate. Dr. Murphy commented that one of the MCOs stopped payments to

the last surgery center in Northern Nevada that was seeing pediatric dental recipients last

December.

Ms. Michelle Mays, the Administrator for Summit Surgery Center came forward and

responded by saying that multiple hospitals and surgery centers are no longer accepting

pediatric dental recipients. Summit Surgery Center is the only facility in the northern region

that is accepting these recipients even though it is a loss to the facility. Summit Surgery is

a multi-specialty facility that has to employ a certain skillset and that creates a financial

burden on the facility. Ms. Mays listed many other barriers that Summit Surgery Center

has encountered that has made it difficult to operate and handle the financial impacts of

treating pediatric dental recipients.

Ms. Rosaschi said to think about how the MCOs can be part of the solution for when the

discussion continues.



Dr. Murphy motioned to accept the marketing material and Ms. Epidendio seconded the

motion. The marketing materials were approved.

Ms. Rosaschi moved on to the Medicaid Management Information System (MMIS)

presentation and introduced Ms. April Caughron as the Manager of the Business Process

Management Unit (BPMU). Ms. Jennifer Shaffer and Ms. Maggie Fording joined Ms.

Caughron.

Ms. Caughron provided information regarding the MMIS replacement project and said the

Division is on schedule to go live with the February 1, 2019 release date. The Division

successfully completed the CMS review in early December 2018 as part of the go live

requirements. All testing of the MMIS system has been completed and all training of the

DHCFP and DXC staff is complete. The provider training is currently in process. Ms.

Caughron said that paper claims are no longer accepted effective January 11, 2019 and the

final data conversion is scheduled for January 27, 2019. A web page has been set up for

providers who want more information which can be accessed through the provider web

portal. Ms. Caughron also mentioned that a command center has been set up for pre- and

post-go live help that includes the decision makers that will be able to roll out any fixes

that may arise from providers, recipients, staff or the MCOs. The command center will be

available through March 2019.

Ms. Shaffer provided more information regarding the paper claims and said that the cutoff

includes claims, appeals filed by email or mailed in and provider enrollment applications.

She mentioned that prior authorizations (PAs) must also be entered through the web portal

as of January 29, 2019.

Ms. Rosaschi asked what kind of feedback the providers have given.

Ms. Caughron indicated that there has not been a lot of feedback from the providers. A

public workshop was held on December 27, 2018 which generated a lot of support and the

providers seemed to be on track with the changes. Ms. Caughron stated that she has not

come across any negative feedback. Provider training is still ongoing and if a provider

needs additional help, the Division and DXC will be there to provide any help possible.

Ms. Shaffer said that the website shows that registrations for provider training are closed

but the providers can still attend the training. Ms. Shaffer stated the providers would only

need to call the DXC Customer Service line and the representative will provide them with

a list of the webinar or in-person training information.

VII. DHCFP Reports

• Electronic Visit Verification (EVV)

By: Kirsten Coulombe, Social Services Chief III

Ms. Coulombe stated that she had presented before the MCAC in October. There will be a

visit verification system being implemented for Personal Care Services (PCS) by January

1, 2020 and Home Health Agency (HHA) services by January 1, 2023. Ms. Coulombe said

First Data, who is coming on board in April, will be the vendor for the Division. PCS



services are provided in the home for people who need assistance with activities for daily

living. EVV will verify that those services are truly rendered. The next step is outreach

with recipients and case managers. Ms. Coulombe said that it is important to get the case

managers on board as they have a more direct relationship with the recipients. Ms.

Coulombe said that one of her staff, Ms. Stephanie Robbins, is currently training the case

managers with the Aging and Disability Services Division (ADSD) and will be providing

training to the Medicaid District Offices (DO) so they can support the DHCFP with

implementation efforts. Ms. Coulombe plans on holding a teleconference with recipients

to provide them with information on how this will affect them and what their role will be

in the implementation of the program.

Ms. Rosaschi asked if the Personal Care Attendants (PCA) will have a tablet that the

recipients will use to verify the visit.

Ms. Coulombe replied that recipients in rural areas may not have Wi-Fi service so there is

a call-in number that the PCA can check into upon arrival then check out of when the job

is done. There will also be an app that can be downloaded onto a phone. The EVV will

verify who was receiving the service, what type of service was being performed, who

performed the service, the date and the location. Ms. Coulombe indicated that Medicaid

will have far better monitoring of the program to catch any fraudulent activity that may be

occurring. The implementation for the HHAs will be much smoother because the Division

and the agencies will already have the experience of the implementation with the PCAs.

• Discussion on non-emergency transportation (NET) in rural areas

By: Kirsten Coulombe, Social Services Chief III

Ms. Coulombe reminded the Committee about the plans from the October meeting to have

a “rural road show” to conduct town hall meetings. Ms. Briza Virgen was introduced as

the policy specialist who helped conduct the town hall meetings all across rural Nevada.

The current vendor for NET services is MTM, whose contract will be expiring soon. The

purpose of the town halls was to gather feedback from those who utilize NET services to

find out what the recipient’s preferences were and to find out if there were any current

practices within the Division that may need to be updated or changed in any way. Ms.

Coulombe said that in the coming weeks, the Division will work on waiving the minimum

authorization requirements for transportation services over 100 miles.

Ms. Coulombe commented that the Division will be looking at working with the MCOs to

provide NET services in urban areas as the MCOs have indicated they would like to have

more information.

Ms. Coulombe also discussed the possibility of working with the Nevada Department of

Transportation (NDOT) to see where services overlap and how the two divisions can work

together to meet the needs of the community.

Dr. Azzam asked what feedback was received regarding the people of MTM.

Ms. Coulombe answered that when MTM first came on board, the transition did not go as



smooth as everyone had hoped. The Division established contacts in the rural counties that

provided valuable feedback regarding the concerns in the rural communities that the urban

areas would not be familiar with.

Ms. Rosaschi asked for any public comment before moving the conversation on to the

dental procedures and ASCs and invited Ms. Shauna Tavcar to give her presentation.

• Discussion on dental procedures in ASCs

By: Shauna Tavcar, Social Services Program Specialist III

Ms. Tavcar said the purpose of her presentation was to explain the situation with the ASCs

as the Division understands it and solicit feedback from community stakeholders to ensure

the recipients are not impeded in obtaining access to care.

Ms. Tavcar said there were previously nine billing groups and each procedure was

associated with one of those groups. This was based on the prior Medicare methodology

for reimbursing same-day surgery. The current methodology is based on the current

Medicare system for reimbursing using an ambulatory payment classification system. This

increases the number of groups and allows Nevada Medicaid to set more appropriate rates

in outpatient surgery and ASC settings. Ms. Tavcar explained that this brought the rate

down from $1,194.00 to $595.75.

Ms. Mays commented that Medicare does not even pay for CPT Code 41899 so there is

nothing to compare it to.

Ms. Tavcar pointed out that CPT Code 41899 is not encouraged for use by Medicare as it

is a “dump code,” so this will be part of the conversation the Division wants to have to

come up with alternatives for reimbursement.

Ms. Tavcar said there was a public workshop in October 2016, a public hearing in

December 2016, then a second workshop in March 2017. The Division received formal

approval from CMS for changes to the SPA in May 2017 for an effective date of the rate

change in January 2017. The MMIS system was updated with the new rate in March 2018.

Dr. Rosenberg commented that he had heard that there were takebacks because of the new

rate.

Mr. Young replied that there was an initial realignment that was going to allow for a

takeback, but it was suspended under the authority of the previous administrator, Ms. Marta

Jensen.

Ms. Tavcar said that the Division has looked at what other states are doing and those that

are using CPT Code 41899 are using either grouper systems or individual rates. Ms. Tavcar

explained that 23 states are not using the code at all or are manually pricing it. Those using

individual rates are reimbursing anywhere between $35.12 in Hawaii to $1,980.94 in

Montana.

Ms. Tavcar said the Division is open to suggestions for a viable solution to ensure the



recipients have access to care and this is the opportunity for the Division to solicit feedback

from the committee and community stakeholders.

Dr. Murphy said that since he began about 15 years ago, there have always been issues

with anesthesia and with surgery center reimbursement. There has previously been talk

about realigning the dental rates. Dr. Murphy said that there is always a temporary fix to a

permanent problem. As the cost of doing business goes up and the reimbursement

continues to go down, it has to be understood that at some point, the providers will not be

able to take care of these patients. The reality is that a lot of these children will end up in

the hospital or they are going to attempt to be sedated in the dental office instead of getting

the proper care. A medical anesthesiologist cannot go into a dental office and sedate a child

or put them under general anesthesia. A dentist can sedate children for multiple reasons.

Dr. Murphy summed up an article regarding children under the age of 21 who had died

after receiving sedation in dental offices, ASCs and hospitals. He concluded that most

deaths occurred in children between two and five years of age in a dental office setting. Dr.

Murphy asked the audience where they would want their child to be taken care of if they

needed dental work that required them to be sedated.

Dr. Murphy said that whatever needs to happen to ensure the needs of the children in this

state are met, he wants to move forward and get it done.

Ms. Rosaschi asked why CPT Code 41899 is used and if other codes can be used instead.

Ms. Tavcar responded that CPT Code 41899 is the only code available for the ASCs to use.

Ms. Mays stated that there have been many requests for a CPT code to be added and it has

all fallen on deaf ears with the AMA. The AMA has failed to add an appropriate code. Ms.

Mays has also tried to find other codes that may be appropriate but has not found anything

that would not constitute fraudulent billing.

Ms. Epidendio asked if the one state is not using CPT Code 41899 at all, how they are

getting reimbursed and what they are being reimbursed for.

Ms. Tavcar replied there are different methodologies that those states are using. California

uses Level 3 Healthcare Common Procedure Code (HCPC) codes which are local codes

that were approved by CMS, but they are not nationally recognized codes. If the DHCFP

went that route, we would have to get CMS approval before we could implement it.

Dr. Azzam asked what California’s rate of reimbursement was for the equivalent code.

Ms. Tavcar replied that the first half hour of operating room use was reimbursed at $101.90

and each additional half hour, up to two, was $40.77. Use of the recovery room was

reimbursed at $18.22 and no reimbursement for CPT Code 41899.

Ms. Mays said that she would be interested in learning what types of supplies they are

utilizing.

Dr. Weichers commented that he has called pediatric dental offices in almost every state



and asked them where they do their general anesthesia cases. He found that Utah, Colorado,

Montana and Wyoming all reimburse over $1,000.00 for CPT Code 41899. Some states

did not reimburse for that CPT code. Dr. Weichers said that Nevada is unique in that we

do not allow general anesthesia in an office setting. Recipients are not going to surgery

centers in states that have low reimbursement rates. The recipients are going to hospitals

or dental offices instead. California has mobile anesthesia where the dental

anesthesiologists go to the dental offices to perform anesthesia.

Ms. Rosaschi asked Dr. Weichers if he had found any state that was parallel with Nevada.

Dr. Weichers replied that some states did pay lower, but those states have other options

like he previously mentioned. Oklahoma used to pay over $900.00 but when they cut the

rate, access to care became a major issue and patients had to wait over a year and a half to

get in for general anesthesia. This caused Oklahoma to reinstate the old rate.

Ms. Rosaschi asked how those other states pay higher reimbursement rates than Nevada.

Ms. Tavcar replied that they do not necessarily pay a higher rate. Colorado uses the grouper

system. Ms. Tavcar shows that Colorado reimburses $782.70 and Wyoming reimburses at

80% of the charges.

Ms. Rosaschi asked how grouper charges work.

Ms. Tavcar responded that Nevada was previously using the grouper system and had nine

different groups and each code was classified under one of those nine groups. The Division

now uses the ambulatory payment classification system which increased the number of

groups but brought the rate down.

Ms. Epidendio asked why we do not go back to the other nine groups.

Mr. Young replied that in a rate realignment, several rates across the spectrum of rates

readjust. Some of those rates will go up and others will go down. Nevada had not had a

rate realignment in about 10 years.

Mr. Jared Davies corrected Mr. Young’s statement to say it had been closer to 20 years

since the last rate realignment.

Ms. Rosaschi said that the concern is that it has now developed into a crisis.

Mr. Davies replied that the previous grouping system was over 20 years old. The amounts

assigned to those groupers were between $400.00 and $2,200.00. Those rates did not come

near meeting any of the other surgery codes that are provided in an ASC setting. The

Division changed to mirror the CMS methodology which gave the Division about 200

groupers ranging from $75.00 to $23,000.00. All those different groups gave us a lot more

flexibility reimbursing surgeries provided in that setting.

Dr. Rosenberg commented that the previous system had a set of ASC payment levels where

depending on the complexity of and the time needed to complete the surgery, different

procedures or groups of procedures were put into those levels. Dr. Rosenberg recalled that



the oral rehabilitation piece was at level seven out of eight or nine levels.

Ms. Rosaschi asked if the Division can reinstate the old system.

Mr. Davies replied that there are no quantifiable methodologies with those levels any

longer. Those methodologies were abolished somewhere around 2005. CMS has a vested

interest in how we reimburse these rates and since they are required to pay the federal share,

they require specific methodologies for how state Medicaid agencies set the reimbursement

levels for the procedure codes.

Ms. Rosaschi asked if anyone has talked to CMS about how this is creating a crisis in

Nevada and what their response to this issue is.

Mr. Young replied that what has been beneficial has been to hear other opinions. Previously

the Division only spoke with Dr. Capurro, the state’s Dental Officer, to track utilization

and access to care issues. The Division checked in with the executive team monthly on this

issue so this is the first time the Division is hearing from other surgery centers and dentists.

The Division Administration has not received a copy of the letter that was dated June 2018.

Mr. Young said that had this issue been brought up by other providers as it is today, the

Division would have known that it is much more of a crisis than what had initially been

demonstrated. Mr. Young said to keep in mind that when you are responsible for 687,000

lives, those decisions are made across the spectrum. The conversation today is very

beneficial to the Division as we hear from other partners and other perspectives.

Ms. Rosaschi summarized by saying she hears the Division is willing to listen to the

provider community and maybe form a workgroup that will involve some of the providers

that spoke today.

Mr. Young said he felt the Division is in a better position to find a solution with the new

legislature beginning their session next month.

Ms. Mays made the offer for Division leadership and staff to visit and tour her facility in

order to get a broad understanding of all that is required to handle a pediatric dental patient.

Ms. Rosaschi said she would like to have continued conversations on this subject matter as

the literature shows that a dental office is not the safest place for parents to bring their

children for surgical procedures.

Ms. Mays replied that she does not want to see kids draining the services in emergency

rooms for infection or pain because it is very costly to the taxpayers.

Ms. Rosaschi asked Dr. Weichers if he would be willing to open his facility for tours to

Division staff.

Dr. Weichers replied that he would be willing to open his facility for tours and that Ms.

Jensen had previously toured his facility, but he is not sure how much longer he can keep

his doors open. Dr. Weichers does not want this problem to be ignored once the meeting is

over.



Ms. Rosaschi agreed that it is an urgent matter.

Dr. Rosenberg reminded everyone that this only applies to FFS and not the reimbursement

rates from the MCOs. The MCOs have their own reimbursement levels. Dr. Rosenberg

asked if the committee can force the MCOs to hold their current rate.

Ms. Rosaschi responded that the committee does not have the authority to force them not

to change their rates.

Dr. Rosenberg replied that he is trying to make everyone aware that there are four different

rates here. Each of the MCOs have their own rates then Medicaid FFS is a separate rate.

He would like to see the MCOs hold their rates at the previous rate until the situation gets

worked out.

Mr. Davies said that he believes the MCOs have adjusted their rates to mirror the FFS rate.

Dr. Murphy said that around 2009 to 2010, the anesthesiologist group he was working with

cancelled all of their cases due to a rate realignment. That resulted in a backlog of about

two to three months and nobody was being seen. Those children slowly started going to

the emergency rooms. That made the problem get noticed and finally something was done.

Ms. Mays said the anesthesiologist group she uses is starting to feel the effects and this has

caused her to start mixing in more profitable cases to balance it out and make it worth their

time. The anesthesiologists are becoming more vocal saying they are not going to work the

dental cases because of the reimbursement rates. Ms. Mays said they do not want to work

for $23.00 a day. Ms. Mays has also looked into having a Registered Nurse First Assistant

(RNFA) but aside from the RNFA not being able to do these cases, she does not want that

level of a provider for a child.

Ms. Phinney said she is hearing the DHCFP has a good opportunity to work with Ms. Mays

and Dr. Weichers on not only the services they provide but also on how much it is costing

them to find a rate that is at least covering the cost of treating the children to make them

safe. Ms. Phinney also mentioned the urgency she heard from Dr. Weichers and suggested

immediately setting up a workgroup that would include Ms. Mays, Dr. Weichers, Dr.

Murphy or any other provider that would be interested, along with CMS, to find an urgent

mechanism to address ASC reimbursement rates.

Dr. Murphy mentioned that this issue comes up every couple of years and suggested

including the anesthesia providers in the workgroup. Dr. Murphy warned again that as the

cost of business keeps rising and the reimbursement rate keeps dropping, it will not be long

before the anesthesiologists stop providing services to Medicaid recipients. Dr. Murphy

recommended having everyone that is involved in a pediatric dental case in the workgroup.

Ms. Phinney thanked Dr. Murphy for his recognition of everyone involved and said the

urgency is disturbing. Ms. Phinney expressed concern for the data issue that makes the

CPT Code 41899 vulnerable because it is a “dump code.” Ms. Phinney said that as people

and practices change, this mechanism gets vulnerable to this type of reaction and the

Division needs to make sure that a long term solution is found.



Ms. Rosaschi recommended that, with the new Governor saying that health is one of his

priorities, the Division consider getting the Governor’s office involved. Ms. Rosaschi

stated that kids will be in jeopardy if it is not resolved.

Ms. Jacobs said that when concern was expressed about the rate realignment last summer,

there was already a natural kind of partnership between anesthesiologists, the American

Academy of Pediatric Dentists (AAPD) and facility partners so the stakeholder group was

something that had already been discussed. If the Division can get the relevant stakeholders

together, the issue can be addressed, and a resolution found. Ms. Jacobs said the point Dr.

Murphy made is a cumulative impact on the various changes that have been made over the

years. Ms. Jacobs expressed a commitment to participate towards a resolution and said

there are a lot of concerned members that would also like to work towards that goal.

Ms. Mays said that she has been able to offset the rates because the facility is multi-

specialty but is not immune because the facility takes a loss on dental days. Ms. Mays

advised the committee that Dr. Murphy is always booked and has been scheduled for one

day a week. Ms. Mays also indicated that Dr. Rosenberg has a long wait list and pointed

out that Dr. Weichers does nothing but pediatric dental cases at his facility so the urgency

for a resolution is greater.

Dr. Azzam said to keep Dr. Weichers and Ms. Mays facilities operating, he wants to be

sure that the other facilities that stopped seeing pediatric dental cases because of the low

reimbursement rates will start accepting them again if the rate is increased acceptably. Dr.

Azzam acknowledged that access is very important and the Division needs to make sure

that every child has access to these much needed services.

Ms. Mays agreed it would be helpful because she was trying to say that it has been difficult

for her facility to take on every case in Northern Nevada because nobody else will. Ms.

Mays is hoping they will re-open their doors, so the cases can be absorbed by other facilities

in the region.

Dr. Azzam responded that those other facilities need to be involved in the discussion to

find out if what works for one would work for another.

Dr. Whipple added that the most important thing for Northern Nevada would be to get

recognition from Renown Hospital. Dr. Whipple mentioned that St. Mary’s Hospital does

not accept any dental cases, so the only option for higher level care in the region is Renown.

The children who have the most severe health conditions are having to wait because the

one hospital is overwhelmed with other cases.

Ms. Epidendio suggested involving St. Mary’s in the conversation.

Dr. Whipple agreed it would be good if they wanted to start seeing dental cases again. St.

Mary’s took them in the past but have now completely stopped.

Ms. Mays said the CEO of St. Mary’s had said that dental cases will not be done in that

hospital’s operating room.

Ms. Epidendio asked if Northern Nevada Medical Center (NNMC) accepts dental cases.



Ms. Mays said she also spoke with the CEO of NNMC and was told that they are not

interested in taking on pediatric dental cases. Ms. Mays said NNMC only takes on ortho

cases and they make a ton of money in that realm.

Dr. Whipple said that any child in Northern Nevada who needs a higher level of care than

what they can get at an ASC can only be seen at Renown.

Ms. Rosaschi asked if Carson Tahoe accepts dental cases and was told they do not.

Ms. Mays replied Carson Tahoe should be invited to the conversation, but many people do

not realize how expensive it is to sterilize an operating room. She said that just bringing a

patient in then taking them out is a high financial cost. Ms. Mays compared it to going to

have a filling done at a dentist and said it is significantly different. She does not see a lot

of private insurance patients and when she does, she bunches them up. Ms. Mays said it is

primarily Medicaid patients that utilizes these services.

Dr. Whipple said she is unaware if any hospitals in the Las Vegas area are willing or able

to take some of the dental cases. When Dr. Whipple completed her residency four years

ago, University Medical Center (UMC) was accepting these cases but even then, it was

difficult for kids with severe health conditions to get dental care done.

Dr. Weichers commented that Sunrise Hospital and UMC are the only two hospitals that

will do dental cases, but it is very limited. UMC mainly does the dental school patients but

the dentists have expressed to Dr. Weichers that it is not safe. He continued saying that

UMC does not do a lot of dental as the anesthesiologists are not familiar with pediatric

nasal intubation and they have had some near misses. The dental cases are not priority, will

get bumped for emergencies and the turnover is very long. The kids have to fast for 8 hours

and will often be scheduled for a 1:00 PM start time. Dr. Weichers will do 250 – 300 cases

a month. His facility does special needs and very sick children and he does it with

experienced staff. The staff can do it well, very quickly and the turnover is very quick. Dr.

Weichers was able to pay a small stipend to the anesthesiologists to help them want to

come in and do these dental cases.

Ms. Mays remarked that Renown’s product is Hometown Health Plan (HHP), which is

everywhere. To get into a Renown operating room is almost impossible because so many

people carry HHP insurance. Ms. Mays is in contract negotiations with Renown to take on

their overflow and she does not understand why they would accept Medicaid as a payor

when they cannot even do the profitable cases right now.

Ms. Rosaschi noted that the offer is on the table and the Division is ready to take immediate

action.

Mr. Young said that the Division will set up the workgroup and will work with the State

Dental Officer, Dr. Capurro, who currently has a survey circulating in the dental

community regarding access to care issues. The Division will take all of the comments

from today and the results of the survey and discuss them in the workgroup.

Ms. Rosaschi asked when the workgroup is scheduled for.

Mr. Young replied that it can be scheduled within the next week.

Ms. Phinney stated that the Division will reach out to CMS immediately to see what options

the DHCFP has regarding an emergency mechanism to address this.

Ms. Epidendio suggested that the information obtained be addressed in the next MCAC

meeting.

Dr. Whipple asked if a pediatric dentist could also be invited in the workgroup because

even though she is the State Dental Officer, Dr. Capurro does not work with kids and does

not have surgery center privileges.

Mr. Young replied that the Division will work with Ms. Jacobs as she can provide them

with names of dentists that will be interested in joining the workgroup.

VIII. Public Comment

There were no other public comments.

IX. Adjournment

Chairperson Rosaschi adjourned the meeting at 11:10 AM.



State of Nevada

Department of Health and Human Services

Division of Health Care Financing & Policy

Non-Emergency Transportation

Non-Emergency Transportation (NET)

Program Overview NET services are provided to Nevada Medicaid recipients to access medically necessary Medicaid covered services. Non-emergency transportation is arranged by the Medicaid NET broker using various transportation providers and transportation modes throughout Nevada. For more information, please visit the Division of Health Care Financing and Policy webpage at www.dhcfp.nv.gov or send us an e-mail at [email protected].

Am I Eligible for NET Services? Medicaid Fee-for-Service (FFS) and Managed Care Organizations (MCO) recipients ae eligible to receive NET services. Nevada Check Up, Qualified Medicare Beneficiaries (QMBs) and Specified Low Income Medicare Beneficiaries (SLMBs) recipients are not eligible for NET services. To see if you are eligible for NET services, please call Medicaid’s NET broker customer care center at 1-844-879-7341.

Did You Know… Did you know you can get transportation services to routine doctor visits and urgent doctor visits? Routine medical appointments may require up to five (5) business days notice. Urgent trips, such as hospital discharges or urgent care visits, do not require five (5) business days notice.

Did you know you can also get transportation and accommodations, as necessary, for out-of-area medical appointments? For prior authorized medical appointments 101 miles or more away from home, the NET broker must be notified 14 days before the travel date. You may also qualify for lodging as necessary. The recipient is required to make use of any low-cost accommodations available, such as Ronald McDonald houses. If the recipient does not have access to any low-cost accommodations, the NET broker will arrange for lodging. The most cost-effective lodging is arranged and paid for by the NET broker prior to travel. Meal reimbursement may also be available.

Did you know Medicaid has different modes of transportation? Nevada Medicaid requires the NET broker to provide the appropriate and most cost-effective mode of transportation

based on the recipient’s medical condition. The most cost-effective mode may vary based on the recipient’s location in

Nevada and where they need to be transported. The modes available in Nevada include:

• Fixed route bus service or ADA paratransit (door-to-door) where available

• Gas mileage reimbursement

• Sedan/van transportation

• Wheelchair capable vehicles, including vehicles with a ramp or hydraulic lift

• Community Drivers Program

• Stretcher vehicles

• Airline services

• Greyhound bus

• Amtrak rail services

How Do I Schedule My Transportation? Nevada Medicaid’s current NET broker is Medicaid Transportation Management (MTM). You can schedule trips by

calling MTM’s customer care center at 1-844-879-7341.

http://www.dhcfp.nv.gov/

mailto:[email protected]

May 1, 2018

Mr. Richard Whitley Director Nevada Department of Health and Human Services 4126 Technology Way, Suite 100Carson City, Nevada 89706-2009

Ms. Marta Jensen Medicaid Administrator Division of Health Care Financing and Policy 1100 East William Street, Suite 101Carson City, NV 89701

Dear Mr. Whitley and Ms. Jensen:

On behalf of the Nevada Academy of Pediatric Dentistry and the American Academy of Pediatric Dentistry (AAPD ), we are writing in regards to Medicaid funding for facility fees when children are treated for dental caries in operating rooms under the applicable state regulation adopted in 2003. We are concerned that recently imposed reductions fu. reimbursement rates for facility fees threaten access to medically necessary dental care - and the oral health of children.

Tooth decay is the most common chronic early childhood disease in the United States, affecting four in ten children. Further, two in ten financially disadvantaged children have untreated dental problems.1 The pain from tooth decay hinders many children from eating, speaking, learning, and even getting a good night's sleep. Infection in the mouth can make a child more susceptible to infections in other parts of the body, such as the ears, sinuses and brain. Relationships have been found between oral infections and diabetes, heart disease and strokes. 2

Early intervention and preventive services are critically important to preventing dental disease and are the focus of pediatric dentists. However, when denta1 disease occurs, it is not always possible or practical for a child to be treated in a private dental practice. Some cases must be treated in a hospital-based or ambulatory surgical center (ASC) setting.

Who are the children requiring care in these settings? They are over-represented by the very young, the very poor-, and those with special health care needs who may not have the ability to comprehend or stay still for treatment in a traditional office setting. They are fr uently in pain, with serious decay in virtually all of their teeth. While the percentage of these patients

eq

may seem minimal, if it is your child, the need is 100 percent.

1 Centers for Disease Control and Prevention, National Center for Health Statistics, National Health and Nutrition Examination Survey, 2015-2016. 2 American Academy of Pediatric Dentistry. State of Little Teeth .Report. 2014. http:/ /www.aapd.org/assets/1/7/State_of_Little_Teeth_FinaLpdf. Accessed Aug. 12, 2017.

Page Two, Nevada Academy of Pediatric Dentistry, American Academy of Pediatric Dentistry

As pediatric dentists, we are on the front lines of care for patients with severe health disparities. We can guarantee that their dental problems worsen without treatment, becoming more debilitating and expensive. Without access to services provided under anesthesia in the hospital or ASC setting, families often seek relief in hospital emergency departments, adding considerable costs to state budgets.

Findings from other states clearly demonstrate that maintaining Medicaid fees fosters· participation by dentists and dental care utilization by patients, thus reducing unmet dental needs and dispatities in children's oral health.3 4 s The same principle applies to those fees necessary to maintain access to oral health care for children needing treatment in hospital or ASC settings.

Dr. Owen Sandel'S President Nevada Academy of Pediatric Dentistry

Sincerely,

JameS D. Nickman, DDS, MS President

About the American Academy of Pediatric Dentistry

The American Academy of Pediatric Dentistry (AAPD) is the recognized authority on children's oral health. As advocates for children's oral health, the AAPD promotes evidence-based policies, best practices, and clinical guidelines; educates and informs policyma:kers, parents and guardians, and other health care professionals; fosters research; and provides continuing professional education for pediatric dentists and general dentists who treat children. Founded in 1947, the MPD is a not-for-profit professional membership association representing the specialty of pediatric dentistry. Its 10,000 members provide primary care and comprehensive dental specialty treatments for infants, children, adolescents and individuals with special health care needs. For further information, please visit the AAPD website at http://www.cumd.otg or the AAPD's consumer website at http:/fwww.mychildrensteeth.org.

3 Beazog1ou T, Douglass J, Bailit H, Myne-Joslin V. Baker, P. Impact of fee increases on dental utilization rates for children living in Connecticut and enrolled in Medicaid. JADA 2015:146(1): 52-60. 4 Nas.5eh K, Vujicic M. The impact of Medicaid reform on children's dental care utili7.ation in Connecticut, Maryland, and Texas. Health Ser Res. 2014;50(4):1236-1249.

s Decker SL Medicaid payment levels to dentists and access to dental care among children and adolescents. JAMA. 2011;306(2.):187-193.

atnn9re11s nf tlJe 1lbtiteb Sfateslillasl1ingtnn, il<tt 20515

June 7, 2018

The Honorable Brian Sandoval Ms. Marta Jensen Governor Administrator State of Nevada Division of Health Care Financing and Policy Grant Sawyer State Office Building Nevada Department of Health and Human 555 E Washington Avenue, #5100 Services Las Vegas, NV 89101 1100 East William Street, Suite 10 I

Carson City, NV 8970 I Mr. Richard Whitley Director Nevada Department of Health and Human Services 4126 Technology Way, Suite 100 Carson City, NV 89706

Dear Governor Sandoval, Director Whitley, and Administrator Jensen:

It has been brought to our attention that Medicaid reimbursement rates for dental surgery cases at ambulatory surgical centers (ASCs) and hospitals have been cut by as much as half in Nevada. In addition to significantly decreasing access to care to children receiving dental Medicaid benefits, this will also drive up costs to other parts of the program.

In 2015, 32 percent of the children in Nevada were receiving Medicaid or CHIP coverage.' Since then., that number has increased. Forty-two percent of young children (infant up to preschool) and 34 percent of children with special health care needs commonly receive Medicaid coverage for medical and dental services. These children historically have a higher rate of dental decay leading to pain, infection, and swelling which can become severe enough to require hospitalization.

Historically, the Medicaid reimbursement has been sufficient, albeit lower than other insurance rates.,

for pediatric dental providers to safely treat these children who otherwise cannot handle treatment in office due to behavior, extent of treatment, or fear in an ambulatory surgical center setting. Cutting this reimbursement rate has already decreased access to care for these children because a number of ASCs have had to cut dental from their services. Another impact of this decision is that children with pain and infection due to oral disease will be driven to the emergency room., thus potentially increasing healthcare costs. Furthermore, dental neglect will increase due to inability to pay for treatment in surgical centers for patients who cannot be treated safely in office.

1 "Nevada Snapshot ofChildren·s Coverage", Georgetown University Health Policy Institute, American Academyof Pediatrics, (2015). Available at: https://ccf.georgetown.eduiwp-content/uploadst20 l 7 /02/Nevada-MedicaidCHIP-new-vl .pdf

PRINTS) ON REC'rCLeo PAP£R

We ask you to consider reinstating previous reimbursement rates to ambulatory surgical centers and hospitals for dental procedures, so that pediatric dentists in the state of Nevada can continue to take care of the children most in need. Please consider the future implications of this decision on the health of children with already limited access to care in Nevada.

Sincerely,

Dina Titus Member of Congress

Electronic Visit Verification

Frequently Asked Questions

What is the EVV system?

The Electronic Visit Verification System is an electronic scheduling, tracking, reporting and

billing system for in-home care providers. This paperless, web-based system also provides

real-time access to information needed for member services management. In Nevada, it is

known as AuthentiCare®.

The system:

• Uses GPS-enabled mobile devices or recipient’s phone Caller ID to track visits

• Is web-based and paperless

• Allows the provider to review claims before confirming them for submission

• Generates claims automatically

• Gives providers the ability to create reports and report templates

• Provides real-time service information to providers and care coordinators

• Requires access to the internet (a high-speed broadband internet connection is

recommended)

System benefits for providers:

• Reduction in paper records and/or timesheets

• A scheduling component providers can use to schedule workers who provide

services

• Billing process for immediate electronic claims submittal

• Method to view and monitor personal care attendants’ activities in real time

• Ability to create automated and ad-hoc reports

How does the EVV system work?

1. When a service is authorized for a member, a schedule can be entered into

AuthentiCare.

2. The provider agency employee (PCA) arrives at the member location to provide a

service.

3. The PCA checks into the AuthentiCare system using the following:

▪ The PCA’s mobile device to log the visit using the AuthentiCare® app (or the

recipient phone will be utilized to dial into the Interactive Voice Response

(IVR) system as the authorized back-up method).

▪ The PCA enters their worker ID, selects the recipient and the service they are

going to perform.

4. Using GPS technology, the location from which the service is rendered is validated.

5. The system verifies that the PCA is appropriate to provide the prior authorized

service for the member and advises the PCA that he/she is checked in.

6. After the PCA performs the service, they check out using the same process and

indicates specific tasks performed.

7. Claims will be available for the provider’s review via the AuthentiCare website in

real-time.

8. After the provider’s review, the provider should confirm the claim.

Proprietary and Confidential Information of First Data Government Solutions, LP

© 2018 First Data Corporation. All Rights Reserved. All trademarks, service marks and trade names referenced in this material are the property of their respective owners

Page 1 of 4





Page 2 of 4

9. Once confirmed, claims are automatically submitted for payment.

How can providers prepare for the EVV implementation?

Participate in the one-day training session, and plan to have at least one PCA responsible to

teach the rest of your office staff and PCAs

• Communicate to your office staff and PCAs about the AuthentiCare system.

• Assess your internal processes as the system is being implemented.

• After training, ensure that your office staff and PCAs are ready and able to use the

system.

• If applicable, download the AuthentiCare application for your or your staff’s mobile

device.

Who is Nevada’s contractor for the EVV system?

Nevada has contracted with First Data to deliver the EVV system as well as to provide

training to providers and ongoing system support.

Where do I get training to use AuthentiCare® Nevada?

▪ Agency staff will be trained prior to implementing the system. Each agency will be

responsible for training their staff.

▪ A Train-the-Trainer Kit, Training IVR, and a Training website will be provided.

▪ These are designed to help agencies train new PCAs to use the IVR and new agency

staff to use the website.

How will providers receive their initial login to the website?

First Data will assign the first Administrator user login and password for each provider. The

first Administrator will then assign other web users at the organization.

What is the preferred method and options of check-in/check-out for

EVV?

▪ The preferred method is to use the mobile device application. It is easy to use, and

does not require use of the member’s phone line.

▪ The AuthentiCare® app is compatible with Android phones, Apple (iOS) iPhones, and

Android tablets.

If the mobile app is used, what if there is no cell phone coverage

available?

The check-in and check-out information will still be captured and stored locally on the

phone. Once the phone connectivity is reestablished, the visit details will be forwarded to

the AuthentiCare® database.





Page 3 of 4

How do I use the AuthentiCare® Mobile App?

▪ First, register the mobile phone/device on the PCA record in AuthentiCare®. When

doing this, you will set the PCA up with a password.

▪ The PCA can download the AuthentiCare® app from the appropriate Store (Google

Play Store for Android or App Store for iOS (Apple iPhone)).

▪ Using their worker ID and assigned password, the PCA can log in and complete the

check-in/out process.

▪ Enter the Production Setup Code.

▪ A complete guide for using the Mobile app is covered in the User Manual.

What if no EVV method is available?

The following can be done to log the service: The PCA will call the supervisor, give the

supervisor the service start time, what the service was, what the activity and observation

code was, and the service end time. The provider will enter the information on the

AuthentiCare® website. This functionality will be monitored and restricted as deemed

appropriate.

Will AuthentiCare® Nevada integrate with our current time tracking

system?

No. The AuthentiCare® system is not intended to integrate with agency back-end time

tracking/payroll systems. However, AuthentiCare® offers multiple claim reports in different

formats that are available to agencies to run on demand and download. The AuthentiCare®

reports can be used by providers to integrate verified visit data into their in-house systems.

Do I need special equipment or software to access and use

AuthentiCare® Nevada?

A computer with Internet access is required – a high-speed (broadband) connection will

provide best performance. No special software is required.

What is the cost to providers?

There is no cost to providers for using the AuthentiCare® system that includes electronic

billing, Interactive Voice Response (IVR), and Web access to the system and report

generation.

However, it is the responsibility of the provider’s PCAs to provide their own mobile devices

(i.e., Android phones, Apple iPhone or Android tablet).

Has a system like this been used before?

Yes. The AuthentiCare® system is being used in other markets. Many system features and

enhancements are based on feedback from providers in those states.





Page 4 of 4

Will there be a help desk available after the implementation date?

Yes, First Data will host an AuthentiCare® Help Desk to assist you with technical support

and answers to questions. Support will be available 24 hours a day, seven days a week.

If you have questions regarding AuthentiCare® or Nevada policy or procedure questions,

please email [email protected].

mailto:[email protected]

MCAC MEETING MINUTESdhcfp.nv.gov/uploadedFiles/dhcfpnvgov/content... · Helping People -- It's Who...

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