10/29/2013

State implements rate cuts on Denti-Cal providers


The Department of Health Care Services (DHCS) is implementing cuts for Denti-Cal providers that were originally authorized through the state budget process in 2011. 

Initially, it was thought that the 10 percent rate cut applied to all services provided on and after Sept. 5, 2013. However, recent clarification by the state explained that it is implementing the cuts on all payment checks cut on Sept. 5 and ongoing, even if the services were provided in previous months.  DHCS’ Bulletin on this issue can be found here.

After the cuts were approved by the California Legislature and governor in 2011, the state had to seek permission from the federal Center for Medicare and Medicaid Services (CMS) to implement them. California received that approval for the cuts to Denti-Cal rates, but with the condition that the state actively monitor the impact on access to dental care.

CDA is working to ensure that the state’s monitoring plan and activities are robust and accurately reflect the impact these cuts will have on access to care. 

Shortly after the Legislature’s approval of the cuts, CDA and a coalition of health care organizations filed suit against the state challenging the rate cuts in federal court, and, as a result, the court had suspended these rate cuts for the last two years while considering the legal challenges. CDA and its coalition partners are continuing their lawsuit activity, recently petitioning the U.S. Supreme Court to hear the case. Despite that ongoing effort, the state has begun to implement the cuts. 

Furthermore, DHCS in the near future will begin working on the process for implementing the “clawback” of payments paid to providers dating back to June 2011.  The department’s announcement stated that recoupment of overpaid funds will not begin until after at least a 60-day advanced notice is provided. CDA is continuing its advocacy to ensure the repayments are spread out over many months or years to minimize the impact on dental offices. 

In addition, DHCS has exempted from the cuts certain nonprofit surgery centers.  CDA is actively advocating for the administration to determine if the exemption criteria could be appropriately applied to additional facilities and programs. 

If you are currently providing services through the Medi-Cal program and are no longer able to participate in the program, please notify the Denti-Cal program by submitting the Medi-Cal Supplemental Changes Form (form DHCS 6209) and deactivate your provider number. You can find that option under the “miscellaneous” section on page 5 of the form. You may also submit a letter in writing stating your request to deactivate/terminate your provider number. You must sign the letter and include a legible, valid copy of your driver's license or state-issued identification card number. The form or letter must be sent to DHCS at the address at the top of the form. You can find the form via this link to the DHCS website.  For more information, contact DHCS at 800.423.0507.

CDA would appreciate it if dentists notify the association if they are choosing to deactivate as a Denti-Cal provider. Capturing information on member actions related to this program will be helpful to CDA’s ongoing legal efforts and advocacy on this issue. It will be instrumental in CDA’s work to ensure the DHCS’ own monitoring efforts are accurately reflecting the impact on provider network capacity and access to care. Please send an email to Manager of Legislative Affairs Nicette Short at nicette.short@cda.org.