10/18/2018

Higher reimbursement rates in effect for Medi-Cal dental program


New state revenue from the taxation of tobacco products, along with support from legislators and Gov. Jerry Brown, is putting over half a billion dollars toward increased Medi-Cal dental provider reimbursements for 2018-19. The higher reimbursement follows years of activity to improve the Medi-Cal dental program and increase access to oral health care for California’s 13.5 million Medi-Cal members.

More than 50 percent of children in California today are eligible for dental benefits through the state’s Medi-Cal program. Similarly, 7.1 million adults can receive dental services through the program due to the newly restored full benefit package in 2018. Low reimbursement rates have been one of the troubling aspects of the program for many years, but these new investments represent a significant effort to reverse that problem, bringing reimbursement on some of the most common services up to 70-90 percent of commercial rates. Shown below is a theoretical reimbursement for a simple adult annual visit.

 

The state last year allocated $140 million of the Proposition 56 tobacco tax funds for Medi-Cal dental provider payments, which were disbursed as a 40 percent reimbursement supplement on hundreds of CDT codes, including restorative, endodontic, prosthodontic, surgical and adjunctive services. Those supplemental payments will continue in 2018-19. Preventive and periodontal services were not included in last year’s increases but both of these treatment categories will receive increases in 2018-19. Following federal approval, which is anticipated later this fall, participating Medi-Cal dental providers will receive retroactive payment back to July 1, 2018, for the following:

  • Additional incentives for the top 26 most utilized CDT codes, including adult dental preventive services and some diagnostic services.
  • Forty percent rate supplement for periodontal services.
  • Increased reimbursement to support the additional time needed to treat individuals with special health care needs.
  • Increasing reimbursement for general anesthesia and IV sedation to create parity with medical providers.

The supplemental payments will be applied to both Medi-Cal dental fee-for-service (Denti-Cal) and dental managed care delivery systems. DHCS will post detailed methodologies for these proposals on its website before Sept. 30. Providers do not need to take any action; they can simply continue normal billing and the supplemental payments will be added automatically to payment checks.

Beyond rate advocacy, CDA has worked closely with DHCS to roll out the following promising program changes that make it easier than ever for dentists who wish to become a Medi-Cal dental provider:

  • New provider application reduces time and paperwork. The average time from application to approval is now 14 days. Additionally, dentists may receive one-on-one assistance from an enrollment specialist at an in-person workshop or by calling the Denti-Cal Customer Service line at 800.423.0507.
  • New webinars and in-person trainings. Continuing education credit can be earned as part of an extensive training program for new and experienced dentists and their staff. Individual and on-site training assistance is also available.
  • The Dental Transformation Initiative is currently providing additional incentives for treating children under age 6.
  • New online provider portal lets providers log in and check treatment authorization request status and history, claim status or payment history.

To automatically receive the monthly Denti-Cal Bulletin and related communications, sign up for the DHCS email listserv.

Find more information about the Medi-Cal dental program online or contact Denti-Cal at 800.423.0507 or CDA Public Affairs at 916.554.4984.



Related Items

The 2018-19 state budget signed by Gov. Jerry Brown dedicates $210 million from the Proposition 56 Tobacco Tax revenue to Denti-Cal providers, a $70 million increase from last year’s amount. And a new aspect in this year’s budget is an additional one-time allocation of $30 million toward a program that would repay student loans for dentists who commit to serving Denti-Cal beneficiaries and locate their practice in a county or region that lacks adequate providers.

California's Little Hoover Commission, an independent state oversight agency, held a special hearing March 22 to assess progress within the Denti-Cal program since the commission released the April 2016 report titled Fixing Denti-Cal. The commission heard from several panels, including Denti-Cal providers who serve the population in a variety of settings. CDA member dentist Nagaraj Murthy, DDS, spoke about his experiences as a long-term Denti-Cal program provider.

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