08/14/2017

Rate increases and benefit restoration for Denti-Cal program


The Department of Health Care Services on June 30 announced hundreds of procedure codes will receive a 40 percent supplemental rate increase as the result of Proposition 56, the tobacco tax measure sponsored and supported by CDA and approved by voters last November. Over $1 billion of the tobacco tax revenue is allocated to improved payments to physicians and dentists who treat Medi-Cal patients, with an unprecedented $140 million dollars allotted for dentists. If approved by the federal Centers for Medicare and Medicaid Services, anticipated federal matching dollars will bring up to $350 million in supplemental payments to dentists who treat Medi-Cal beneficiaries.

DHCS has proposed supplemental payments of 40 percent above the Schedule of Maximum Allowances on hundreds of CDT codes across several categories including restorative, endodontic, prosthodontics, surgical and adjunctive services.

An example of a few procedure codes and the supplemental rate increase are shown here.

Dental Managed Care providers will be eligible to receive the fee increase, which will be paid through the DMC plans after the Department develops methodology and receives approval from CMS. The approval process could take 90 days; however, upon implementation the supplemental payments will be retroactive to July 1. The August 2017 Denti-Cal Provider Bulletin has the complete list of all the procedure codes that will receive this supplemental payment.

Full restoration of adult dental
In addition to the allocation of Proposition 56 funds to improve reimbursement for Medi-Cal providers, the state budget for 2017-18 included the full restoration of adult dental benefits for Medi-Cal beneficiaries. Previously eliminated in 2009 due to the state budget crisis, some adult dental benefits were restored in May 2014. In addition to the restored benefits of May 2014, effective Jan. 1, 2018, the adult benefit package will include the following procedures:

  • root canals
  • laboratory processed crowns
  • periodontics (scaling and root planing)
  • implants
  • partial dentures

The restoration of the full adult dental benefit package presents an opportunity to further improve the oral health of the 7 million Denti-Cal enrolled adults throughout the state. The 40 percent rate supplements from Proposition 56 revenue will also apply to some of the newly restored adult benefits, such as endodontics, prosthodontics and oral surgery.

Easier to become a Denti-Cal provider with streamlined provider application

Recent changes to the Denti-Cal provider application are making it easier for dentists to enroll as a program 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 issue of the Denti-Cal Provider Bulletin provides more information.

For more information regarding the Denti-Cal program, please visit cda.org or contact CDA Public Affairs at 916.554.4984. To automatically receive the monthly Denti-Cal Bulletin and related communications, sign up for the DHCS email list.



Related Items

The August Journal of the California Dental Association outlines efforts to set the foundation for two major initiatives supported by CDA — the Dental Transformative Initiative and the Department of Public Health’s State Oral Health Program. Articles discuss the concepts and frameworks of creating a state oral health plan for California; approaches that three local health departments used to address oral health problems in their communities; and more.

As California’s new fiscal year starts, dentists can expect significant reimbursement increases for hundreds of procedures covered by Denti-Cal because of the passage of CDA-sponsored and supported Proposition 56, the tobacco tax measure. With anticipated federal participation, it is expected that an estimated $300 million in additional funding will be committed to increasing coverage for dental care in the program.

The House of Representatives’ vote May 4 to approve the American Health Care Act is the first step down a long, winding road of a possible repeal or replacement of the Affordable Care Act. CDA and other health care organizations have expressed their concerns to policymakers that the AHCA would harm Californians due to the erosion of pre-existing condition protections, decrease patient access to physicians and dentists and cause over 3 million Californians to lose health care coverage.

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