Dental providers who receive incentive payments through the Medi-Cal Dental Transformation Initiative can continue participation for one more year. The Centers for Medicare and Medicaid Services approved in late December the Department of Health Care Services’ request for a one-year extension of the Medi-Cal Section 1115 waiver, also known as Medi-Cal 2020, and to include the DTI incentive pilot programs. The five-year pilot program was set to expire at the end of 2020, but due to the COVID-19 pandemic the DHCS requested the extension from the federal government.
The goal of the DTI is to increase the use of preventive dental services for children, prevent and treat more early childhood caries and increase continuity of care for children. Three of the four pilot programs were extended (Domains 1, 2 and 3) through Dec. 31, 2021, but DHCS did not include the Local Dental Pilot Projects (Domain 4) in the extension request.
Domain 1 – Increase Preventive Services Utilization
The goal of Domain 1 is to increase the statewide proportion of children ages 1 through 20 enrolled in Medi-Cal who receive a preventive dental service by 10 percentage points over a five-year period. In the first few years of the pilot, the preventive dental services utilization rate for children ages 1 to 20 increased by 8.06 percentage points from calendar year 2014 to calendar year 2018. The number of dental providers treating children in the Medi-Cal program has also increased by at least 5 percentage points so far.
Domain 2 – Caries Risk Assessment and Disease Management Pilot
This pilot aims to formally assess and manage caries risk by diagnosing early childhood caries via utilization of the Caries Risk Assessment to treat it as a chronic disease. Domain 2 also aims to introduce a model that prevents and mitigates oral disease through the provision of preventive services for Medi-Cal-aged children ages 6 and under. Due to early successes in this pilot, the number of counties selected to participate in the study was expanded, and providers in 29 counties can now participate.
Providers in the 29 selected counties are eligible to receive incentives for performing predefined treatment plans for children based upon the beneficiaries' risk assessment. To participate in Domain 2, providers must complete the no-cost, DHCS approved CRA Training Treating Young Kids Everyday (TYKE). Providers must complete the TYKE training and Domain 2 Provider Opt-In Attestation prior to submitting claims for payment.
Domain 3 – Continuity of Care
The Domain 3 pilot aims to improve the continuity of dental care for children in Medi-Cal through incentive payments awarded to dental providers in select counties who have maintained continuity of care by providing examinations for their enrolled children ages 20 and under. Domain 3 expanded from 17 to 36 pilot counties on Jan. 1, 2019, and DHCS increased the three flat-rate annual incentive payment amounts by $60 per beneficiary with dates of service of Jan. 1, 2019, or later.
Information about each domain’s criteria, payments, methodology and opt-in forms can be found on the Department of Health Care Services’ DTI page. To learn about changes in the Medi-Cal Dental program, sign up to be added to the provider email distribution list.