Eye Care and Dental Care for Medicaid Residents

Dental and eye health are essentials for a good life. Fortunately, Medicaid residents have this care paid for by their MCO or TNCARE provider. The “how-to’s” can be a little complicated, so hopefully this information pamphlet can help family members and CCRC staff make sure our residents receive this care.

First, what is an “Item D”? This is important because when you take your family member/resident to the dentist, optometrist or ophthalmologist, etc., you are usually expected to pay for this service the day(s) service is provided, unless of course you have an established account with a specific doctor. So how does Medicaid pay you back?  You will take a copy of your receipt (keep a copy for your files) to our receptionist, Bobbie Benford, and she will file an “Item D” – an allowable medical deduction – with Medicaid. Then Medicaid will process this deduction, which decreases the resident’s patient liability (amount that is paid to the nursing home of the resident’s monthly income) for the necessary period of time to cover the allowable cost. This deduction allows the family to be reimbursed for your (the family’s) payment to the doctor. If family or resident has authorized CCRC in writing (Social Security & retirement checks come to facility) to be the responsible party by opening a resident trust fund account for the resident, CCRC will cash-flow/pay the cost to the physician, and we will file the Item D.

Transportation is also an issue. For eye care appointments, Medicaid (except Blue Care) will pay for the NET (Non-Emergency Transport), but not for an ambulance to take residents. We are in the process of completing a contract with Blue Care. However, dental care is another story. Medicaid has mandated that residents receive dental care, but has not approved payment for transports. This means the families/residents are responsible for transportation to and from the dentist or oral care specialist.

For transport information or to set up an appointment, call Tricia Bell at 615-898-7900 or (615) 893-2624.

For more information regarding eye care or dental care, please call Belinda Skidmore or Pam Jackson during office business hours at 615-893-2624.