Medicaid and Children’s Health Insurance Program Dental Services Follow Solicitation

The principal objectives of Medicaid and Children’s Health Insurance Program (CHIP) managed care children’s dental services are to provide quality, comprehensive dental services in a manner that improves the oral health of the Members through Preventive care, health education, early intervention, and to promote improved access to quality care, thereby significantly improving health outcomes for the target populations.

Members’ primary and Preventive Medicaid and CHIP dental services are provided statewide through Dental Contractors. Each Dental Contractor is responsible for contracting with general dentists, pediatric dentists, and dental specialists to create a robust delivery Network.

In this RFP, there is a single, statewide, Service Area (SA). Each Dental Contractor must serve both Medicaid and CHIP Members in all areas of Texas under this statewide service delivery model. [...]

For the purposes of this RFP, the eligible population are the individuals identified below, who are qualified to participate in the Dental Program:

1. Children, birth through age 20, who are eligible for Medicaid Texas Health Steps services, including Supplemental Security Income recipients; and
2. All children under the age of 19 who are enrolled in CHIP.
3. Medicaid recipients other than:

• Recipients age 21 and over;
• All recipients, regardless of age, residing in Medicaid-paid facilities such as nursing homes, state supported living centers, or Intermediate Care Facilities for Individuals with Intellectual Disabilities; and
• STAR Health program recipients

The Dental Contractor must create and maintain a robust Network accessible to all Members for prompt delivery of all Medically Necessary Covered Dental Services. [...] The Dental Contractor must ensure all Members receive quality services in the most efficient and effective manner possible. [...] The Dental Contractor must comply with HHSC’s claims adjudication requirements in a timely manner, as set forth in Chapter 2 of Exhibit B, Texas Medicaid and CHIP - Uniform Managed Care Manual (UMCM). [...] The Dental Contractor must deliver all Covered Dental Services without discrimination. [...]

HHSC or its designee will make eligibility determinations for each potential enrollee for the Dental Program. [...] The Dental Contractor must successfully complete each of the Transition Phase tasks per the approved Transition Plan. [...] No later than 30 Days after the Effective Date the Dental Contractor must submit an initial Transition Plan, and thereafter throughout the Transition Phase, the Dental Contractor must update the Transition Plan and submit these updated plans to HHSC on a monthly basis for review.

Respondent's Solicitation Response will remain a firm and binding offer for 240 days from the date the Solicitation Response is due.

The Transition Phase includes Readiness Reviews, which must be completed to HHSC’s satisfaction no later than 90 Days prior to the Operational Start Date, unless otherwise indicated throughout this Section 2.5 or agreed upon by HHSC.

Refer to *Exhibit A, Dental Contract Terms and Conditions*, and *Exhibit C, Deliverables-Liquidated Damages Matrix*, for liquidated damage values.