CDA-secured rate cut reversal takes effect

In a significant victory for CDA advocacy, the California Department of Health Care Services has announced that the federal Centers for Medicare and Medicaid Services (CMS) has approved the 10 percent rate cut reversal for dental services that was included in the 2015-16 California budget. 

CDA strongly advocated for the rate cut reversal, which applies to Denti-Cal and not broadly to all Medi-Cal providers. The new change exempts dental services provided on or after July 1, 2015, from the Medi-Cal 10 percent provider payment reductions that were implemented in 2013. The state's reversal of the rate cuts is a positive first step in ensuring access to care for Denti-Cal patients.

The Denti-Cal program's deficiencies have been the subject of a number of legislative hearings and a highly critical state audit that exposed the program's flaws. The audit found that 56 percent of children enrolled in Denti-Cal were not able to access any dental care in 2013. The report cited Denti-Cal's low reimbursement rates as one of the primary reasons for the lack of providers participating in the program and noted that the state's reimbursement rates, which have not increased since 2000, are 35 percent of the national average for most services.

According to the Denti-Cal Bulletin,the increase in provider payments is expected to be reflected in checks issued on Nov. 19. The state plans to reassess all claims for services from July 1 to determine underpayments and issue reimbursements to affected providers. If providers have any questions about the rate cut reversal, contact the Provider Customer Service line at 800.423.0507 or CDA's Director of Public Policy Nicette Short at 916.554.4970.

CDA will continue to keep members informed about the state's ongoing budget process and the reversal of Denti-Cal rate cuts through the Update, e-newsletter and cda.org.

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California and the federal government have reached a significant agreement that will ensure an additional $750 million investment in California’s Denti-Cal program over a five-year time frame.  The majority of the funding focuses on the medical portion of the state’s Medicaid program, including investments in the state’s public hospital system and a county-based pilot project to provide more integrated care for high-risk, vulnerable populations. The goal is to reform the delivery system and develop outcome improvements with the long-term goal of reducing costs to the state and federal government.

CDA participated in a special hearing recently to review the deficiencies of the state’s Denti-Cal program. An independent oversight committee held a meeting at the state Capitol to delve into the problems highlighted in a report that found that California’s 2014 reimbursement rates for the 25 most common Medicaid dental services were well below those in the comparable states of New York, Texas and Florida.