12/31/2012

Update on California's Healthy Families Program transition


California is continuing to move forward with the transition of 875,000 children currently enrolled in the Healthy Families Program (HFP) to the Medi-Cal program, which is expected to begin on Jan. 1.

For many months, advocates were pushing for the delay of the transition, but recently, many of those advocates have sensed the inevitability of the transition. The focus of many organizations has turned to ensuring the transition goes smoothly for families and on monitoring access to care as the transition occurs.

CDA Activities

CDA has been actively participating and representing our members and their patients in all of the administration implementation meetings and has held many meetings with the department, legislative leaders and staff and advocates over the last few months regarding the Healthy Families Program transition and the newly developed departmental policies.  CDA will continue to engage with the Governor’s administration and with the Legislature, including in the upcoming legislative special session that will be called by the governor to address health care issues.

In an effort to provide streamlined, simplified information to its members, CDA hosted a second, live, interactive webinar on December 12 to help dentists better understand the upcoming transition. Webinar attendees gained a more detailed understanding of the transition plan, continuity of care issues and DHCS’ new policies and outreach efforts to support dentists interested in being Denti-Cal providers.

New State Department Policies

The California Department of Health Care Services (DHCS) has developed a transition plan that it hopes will ensure continuity of care for all beneficiaries during this transition and allows the development of a sufficient network of dental providers within the current Medi-Cal structure to provide dental care to all 875,000 new enrollees.

To that end, DHCS has developed two new policies to aid in the continuity of care goal and the goal to have more dentists join the network.

To support a smooth transition of services, DHCS has published a new policy in its December Denti-Cal Bulletin Volume 28, Number 17.

The new policy outlines that Denti-Cal will honor approved prior authorizations issued by the HFP dental plans where the services provided and billed are covered by the Denti-Cal Program. The Bulletin provides a step-by-step process to support dentists using this new procedure, as well as a benefit crosswalk to help dentists identify what the comparable Denti-Cal procedure is for key HFP procedures.

In an effort to simplify the transition of HFP dentists into the Denti-Cal network, DHCS has developed a new Preferred Provisional Provider (PPP) Status. This new policy is specifically aimed at helping HFP dentists to become Denti-Cal dentists, but is open to all dentists who meet the specified requirements. The department is proposing that dentists can become “provisional” Denti-Cal providers while their official application is going through the standard review process. This would allow these new “Preferred Provisional Providers” to bill Denti-Cal for up to 18 months while they become enrolled Denti-Cal providers. To apply for this new process, a dentist must attest that they meet the following:

  • hold a current license as a dentist issued by the Dental Board of California, which has not been revoked, suspended, placed on probation, or subjected to other limitation. To meet this criterion, the applicant must include a copy of his/her dental license;
  • be currently enrolled as a dental provider by a health care service plan licensed under the Knox-Keene Health Care Service Plan Act of 1975. To meet this criterion, dentists can submit a wide variety of documentation, which can include a copy of the provider contract, a current list of assigned enrollees, or a copy of a first capitation check from a contracted dental plan.
  • have never had revoked and/or suspended privileges through the California Medicaid program Medi-Cal Dental; and
  • have no adverse entries in the Healthcare Integrity and Protection Data Bank/National Practitioner Data Bank.

The Department’s overarching goal is to ensure more children can achieve continuity of care and maintain a relationship with their dentist during and after this transition. The Department intends to provide more details on this policy in an upcoming Special Bulletin that can be found on its website.

CDA will keep members informed as this issue progresses. For more information, please contact Nicette Short at CDA at nicette.short@cda.org or 916-554-4970.





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