Section 482-5-002 - DENTAL BENEFITS PLAN Medicaid managed care delivers the dental benefits package to eligible Medicaid members through a Prepaid Ambulatory Health Plan. The following provisions describe the Dental Benefits Manager's responsibilities in Managed Care.
002.01GENERAL REQUIREMENTS. The Dental Benefits Manager is responsible for establishing a statewide system of dental services. The Dental Benefits Manager is required to comply with, but is not limited to, the following general requirements: (A) Credential only providers enrolled in Nebraska Medicaid;(B) Provide a full array of services along a continuum of care in accordance with 471 NAC 6;(C) Provide access to dental services and necessary referrals twenty-four (24) hours per day, seven (7) days per week;(D) Provide a client handbook, a comprehensive list of providers, and other informational materials about the dental benefits package to its members. The Dental Benefits Manager must not perform any direct solicitation to individual Medicaid members. The Department must approve any general marketing to Medicaid members prior to use and must comply with applicable marketing guidelines7;(E) Comply with Medicaid's continuous Quality Assessment and Performance Improvement, provide dental services meeting Medicaid's quality standards, and comply with all requests for reports and data to ensure that the Quality Assessment and Performance Improvement requirements are met (See 482 NAC 6);(F) Coordinate activities with Medicaid, other managed care contractors, and other providers for services, as appropriate, to meet the needs of the member, and ensure systems are in place to promote well-managed patient care;(G) Maintain, at all times, an appropriate certificate of authority to operate issued by the Nebraska Department of Insurance;(H) Prohibit hiring, employing, contracting with or otherwise conducting business with individuals or entities barred from participation in Medicaid or Medicare;(I) Allow members with chronic, severe conditions, or experience-sensitive conditions to go directly to a qualified provider within the Dental Benefits Manager's network;(J) Report all fraud and abuse information to Medicaid in a timely manner; and(K) Make available twenty-four (24) hour, seven (7) days per week access by telephone to a live voice (an employee of the plan or an answering service) so that referrals can be made for non-emergency services or so information can be given about accessing services or how to handle medical problems during non-office hours.482 Neb. Admin. Code, ch. 5, § 002
Amended effective 7/29/2020Amended effective 9/27/2021