10/12/2016

State launches children's disease management pilot


Beginning in January 2017, dentists in select California counties will have an opportunity to participate in an innovative pilot that seeks to assess and manage caries risk and emphasize the provision of preventive services to Denti-Cal-enrolled children ages 6 and under.

Domain 2, referred to as the Caries Risk and Disease Management Pilot, is one of four Dental Transformation Initiative domains that seek to increase access to care, identify and treat dental disease and incentivize continuity of care for the approximately 5 million California children enrolled in the Denti-Cal program. The DTI is one element of California's Medi-Cal 1115 waiver.

Dentists enrolled in the Denti-Cal Fee-for-Service, Dental Managed Care and Safety Net Clinics in the following 11 counties are eligible to participate in Domain 2: Glenn, Humboldt, Inyo, Kings, Lassen, Mendocino, Plumas, Sacramento, Sierra, Tulare, and Yuba. The Department of Health Care Services selected these counties due to the higher incidence of restorative services versus the utilization of preventive services, specifically for children under 6 years old.

To participate in the Domain 2 pilot, dentists in these counties must complete DHCS-approved training and submit a certification of completion of the training prior to participating in the pilot. Once enrolled in the pilot, dentists participating in Domain 2 will utilize the DHCS-approved Caries Risk Assessment (CRA) evaluation form to ensure uniform application of the assessment tool and to standardize the risk determination process.

CDA is working with DHCS on developing a course to inspire and increase the confidence of dentists to see babies and young children. Known as TYKE, Treating Young Kids Every day, the course includes information on using a chronic disease management approach to preventing and managing dental caries, knee-to-knee examination, motivational interviewing, and preventive and minimally invasive techniques.

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 will compensate for increased frequencies of prophylaxis, fluoride varnish and exams for children evaluated and determined to be at a particular caries risk level over a 12-month period, as follows:

  • "High risk" children will be authorized to visit the dentist every three months;
  • "Moderate risk" children will be authorized to visit the dentist every four months; and
  • "Low risk" children will be authorized to visit the dentist every six months.

DHCS will track and report on the ratio of restorative procedures to preventive procedures to determine if the Domain has been effective in lowering caries risk and reducing the number of restorations provided. Since preventive services do not yield immediate results, the department will be required to collect data on these measures annually for a number of years. Additionally, the department will track and report on provider participation in the Domain.

CDA continues to engage with the department and monitor the rollout of the Dental Transformation Initiative on behalf of its members. Any dental practice in one of the identified counties that would like more information on how to participate, contact Gayle Mathe.

For more specifics regarding Domain 2 and the other domains of the Dental Transformation Initiative, visit the DTI page on the Department of Health Care Services' website.



Related Items

Hospital systems have been critical supporters of CDA Cares since 2013. Every year, due to the lack of effective and adequately funded government safety net programs, thousands of individuals seek treatment for dental pain and infection in hospital emergency rooms, compounding an already strained system.

Covered California, California's health insurance marketplace for the federal Affordable Care Act, has released some of the participating dental plans for the 2017 benefit year. Covered California's open enrollment period for 2017 coverage begins on Nov. 1 and ends Jan. 31, 2017.

The 2016-17 budget, totaling $167 billion, was recently signed by Gov. Brown and includes $3.2 million for the restoration of the California Children’s Dental Disease Prevention Program, a school-based prevention program managed at the local level by local health departments, county superintendents and other contracted entities.

Topics
Top