New resources for dentists treating young children

First-time resources available to participating Denti-Cal providers resulted in increased access to care for the nearly 6 million California children enrolled in the Medicaid dental program in the first half of 2016.

In 2016, the Department of Health Care Services rolled out the 1115 waiver, known as Medi-Cal 2020, which allocated $740 million to the Dental Transformation Initiative. This first-time investment in oral health for Denti-Cal-enrolled children has three goals: to increase access and utilization of preventive services, improve continuity of care and identify and manage dental disease. Dentist participation in the DTI provides the opportunity to help improve the oral health of children in California, while at the same time bringing new patients in their practice and receiving increased incentive payments.

The DTI is divided into four separate studies, or Domains. Now fully underway, Domain 1 seeks to improve oral health by increasing the number of children who receive preventive dental services each year. Enrolled providers who increase the number of Denti-Cal children in their practice are eligible for incentive payments of 75 percent above the Schedule of Maximum Allowances for specified preventive services. Currently, of the four DTI domains, only Domain 1 incentives are available to participating dentists statewide.

DHCS issues nearly $21 million in first round of incentive payments

On Jan. 31, the Department of Healthcare Services mailed the first round of Domain 1 incentive payments to Denti-Cal providers meeting either the 1 percent or 2 percent increase in preventive services to children in the first half of 2016 over their 2014 baseline figure. More than $20.5 million was disbursed to 2,534 dental service-office locations based upon their performance in increasing utilization identified through approved dental treatment. Fee-for-service dental office locations received $8,400 each, on average. The second incentive payments for Domain 1, based upon program year 2016 performance, is anticipated in July 2017.

All dentists currently enrolled as Denti-Cal providers are eligible to participate in Domain 1 without the need to opt in; they simply need increase the number of approved, preventive services to Denti-Cal eligible children (under 21 years of age) by either 1 percent or 2 percent over benchmark-year figures.

Streamlined provider application makes it easier to become a Denti-Cal provider

In addition to the DTI incentives, recent changes to the Denti-Cal provider application are making it easier than ever for dentists to newly enroll as a Denti-Cal provider. On Jan. 31, the DHCS began accepting the new, abbreviated application, which is specific to dental practices. The new application eliminates redundancies of the information requested and significantly reduces the number of pages a provider must complete. Additionally, dentists may receive one-on-one assistance navigating the enrollment application package with an enrollment specialist at an in-person workshop or by calling the Denti-Cal Customer Service line at 800.423-0507.  The December 2016 Denti-Cal Bulletin provides more information.

Disease management pilot training is now available online

Nearly one-quarter of all children under age 6 have dental caries in primary teeth. Increasing early preventive care can have profound effects on the life of a child, as well as save the state millions of dollars each year in more costly restorative care due to untreated caries. The second domain of the DTI, the Caries Risk and Disease Management Pilot, is an innovative pilot study aiming to address early childhood caries. The Domain 2 goals include the following: diagnosing early childhood caries by utilizing Caries Risk Assessments; introducing a treatment model that proactively prevents and mitigates oral disease through the delivery of preventive services in lieu of more invasive and costly procedures (restorative services); and finally, identifies the effectiveness of CRA and treatment plans for children ages 6 and under.

Since Domain 2 is a pilot study, only dentists in the 11 selected pilot counties are eligible to participate. The selected pilot counties are Glenn, Humboldt, Inyo, Kings, Lassen, Mendocino, Plumas, Sacramento, Sierra, Tulare and Yuba. Providers in these counties must opt in and complete the self-guided CRA training, developed through a collaboration of CDA and DHCS, called “Treating Young Kids Every day.” The course encourages dental teams to use CRA, disease prevention and early interventions to reduce tooth decay among children ages birth to 6 years (cda.org/TYKE).

Participating dentists will receive a bundled incentive payment for using the standardized CRA, development of a treatment plan, nutritional counseling, motivational interviewing, prophylaxis, application of topical fluoride varnish and oral evaluation. The program provides an opportunity for dentists to determine increased frequencies of prophylaxis, fluoride varnish and exams for children evaluated and determined to be at higher risk level for caries.

For more specifics regarding the Dental Transformation Initiative, visit the DHCS website.

Related Items

Now in its 76th year, National Children’s Dental Health Month is observed annually in February with an ADA campaign that brings together dentists and other dental professionals, health care providers and educators to “promote the benefits of good oral health to children, their caregivers, teachers and many others.”

The 2017-18 state budget proposed by Gov. Jerry Brown calls for using tobacco tax-generated funds from Proposition 56 to offset the state’s current obligations to Medi-Cal rather than provide additional funding for provider reimbursement rates. This proposal disregards the will of the voters and the ballot measure’s provisions.

Dentists in California now have an opportunity to participate in the Dental Transformation Initiative to help improve dental health for low-income children enrolled in the Denti-Cal program, while receiving enhanced reimbursement by meeting specific incentive metrics. As part of California's 1115 waiver, known as Medi-Cal 2020, the DTI focuses on high-value care, improved access and utilization of performance measures to drive delivery system reform.