HHSC determines Medicaid eligibility for individuals residing in Nursing Facilities (“NFs”). HHSC is responsible for making determinations regarding allowable Incurred Medical Expenses (“IME”) for dental services for NF residents. HHSC processes between 300-350 dental requests each quarter or about 1200 annually. Collectively, requests may be referred to in this Contract as “cases.” Each case may contain a request for more than one dental service. The purpose of this OE is to provide one or more Texas licensed dentist(s) (the “dentist”) to assist HHSC to make determinations regarding allowable IME for dental services for NF residents.
September 15, 2023 — 05:00 pm CDT