09/17/2015

Denti-Cal general anesthesia changes coming


The California Department of Health Care Services (DHCS) recently released a Denti-Cal Provider Bulletin outlining the modified policy for the administration of general anesthesia (D9220/D9221) and intravenous sedation (D9241/D9242). The September 2015 Bulletin stated that effective Nov. 1, Denti-Cal providers will be required to submit a Treatment Authorization Request (TAR) for the provision of intravenous sedation and general anesthesia services.

The Bulletin outlines the Intravenous Sedation and General Anesthesia Guidelines, Criteria Indications and Reimbursement Scenarios based on treatment location and anesthesiology provider. Additionally, the Bulletin provides guidance regarding the administration of nonintravenous conscious sedation (D9248).

CDA advocated extensively with the Department of Health Care Services, in partnership with the California Society of Pediatric Dentists, the Oral and Facial Surgeons of California and other stakeholders, over the course of the last year on this critical issue. CDA's focus on the development of this policy was to ensure that Denti-Cal beneficiaries receive access to much-needed dental care using the appropriate sedation modality based on the clinical judgment of the treating dentist(s).

CDA and other stakeholders were successful in convincing the department to change the policy implementation date from "immediately" to Nov. 1, ensuring patients could receive necessary dental treatment in a timely manner. The department initially released the policy in late August and stated that it was in effect "immediately." This was problematic for several reasons, the first being that it would delay previously scheduled dental care for beneficiaries since obtaining a TAR can take anywhere from two to six weeks depending on whether authorization is needed from the patients' medical plan and/or dental plan (or both). Implementation of the policy without prior notification would further contribute to the logjam of Denti-Cal patients needing dental treatment under general anesthesia or intravenous sedation.

CDA and its advocacy partners were also successful in ensuring the department included language in the guidelines that allowed dentists to continue to rely on their best clinical judgment when making treatment care plans and referrals for this type of care. 

There are still several issues related to the new policy that CDA will continue to address on behalf of its members and the Denti-Cal patients they serve to ensure timely access to dental treatment. CDA will focus on expanding the list of providers able to submit the treatment request and ensuring medical plans do not create new administrative barriers to care. 

For more information regarding the policy, members can contact CDA's senior policy analyst, Ann Milar, at ann.milar@cda.org, visit the Denti-Cal website at denti-cal.ca.gov or call the Denti-Cal provider service line at 800.423.0507.



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