State program expands provider incentives to new counties

February 14, 2019
Quick Summary:
As part of California's 1115 waiver, known as Medi-Cal 2020, the DTI focuses on high-value care, improved access to dental care, and the use of performance measures to improve the program through four “domains,” or pilot programs.

Dentists in 26 counties have a new opportunity to participate in the Dental Transformation Initiative to help improve dental health for low-income children enrolled in the Medi-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 to dental care, and the use of performance measures to improve the program through four “domains,” or pilot programs. Effective Jan 1, 2019, the Department of Health Care Services announced it would expand to additional counties two pilot programs testing new delivery models for treating young children.

Bundled payments and incentives for treating young children

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 goals of Domain 2 include diagnosing early childhood caries by utilizing caries risk assessments (CRA); introducing a treatment model that prevents and mitigates oral disease by increasing delivery of preventive services in lieu of more invasive and costly procedures (restorative services); and, finally, identifying the effectiveness of CRA and treatment plans for children ages 6 and under.

Domain 2 is a pilot study and was launched in 2017 in 11 selected pilot counties. The recent expansion allows dentists in a combined 29 counties to be eligible to participate. Providers in these counties must complete the self-guided CRA training, “Treating Young Kids Every day,” developed through a collaboration between CDA and DHCS.

The course encourages dental teams to use CRA, disease prevention and early interventions to reduce tooth decay among children ages birth to 6 years (TYKE). This interactive educational experience is available to CDA members and nonmembers at no charge. Upon successful completion, participants are eligible for two continuing education credits.

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. Through the program, dentists will have the opportunity to provide prophylaxis, fluoride varnish and exams at increased frequencies for children evaluated and determined to be at higher risk for caries.

Providers must opt in to the pilot in order to bill for and receive incentive payments in this domain. (See the Domain 2 webpage for program criteria.)

Domain 2 pilot counties

The original 11 pilot counties are: Glenn, Humboldt, Inyo, Kings, Lassen, Mendocino, Plumas, Sacramento, Sierra, Tulare and Yuba.

The 18 expansion counties are: Merced, Monterey, Kern, Contra Costa, Santa Clara, Los Angeles, Stanislaus, Sonoma, Imperial, Madera, San Joaquin, Fresno, Orange, San Bernardino, Riverside, Ventura, Santa Barbara and San Diego.

Incentives for increasing recall visits for children

The Continuity of Care Pilot (Domain 3) aims to improve the continuity of dental care for children in Medi-Cal. Domain 3 was launched in 17 pilot counties, but the new expansion will allow incentive payments to be awarded to providers in a combined 36 select counties who have maintained consecutive years of care for children under the age of 20. The goal is to increase continuity of care for children for two, three, four, five and six continuous years.

Domain 3 pilot counties
The original 17 pilot counties are: Alameda, Del Norte, El Dorado, Fresno, Kern, Madera, Marin, Modoc, Nevada, Placer, Riverside, San Luis Obispo, Santa Cruz, Shasta, Sonoma, Stanislaus and Yolo.


The 19 expansion counties are: Butte, Contra Costa, Imperial, Merced, Monterey, Napa, Orange, San Bernardino, San Diego, San Francisco, San Joaquin, San Mateo, Santa Barbara, Santa Clara, Solano, Sutter, Tehama, Tulare and Ventura.

Additionally, DHCS will increase the Domain 3 flat-rate annual incentive payment amounts by $60 per beneficiary with dates of service of Jan. 1, 2019, or later.

Providers do not need to opt in to this pilot. (See the Domain 3 webpage for incentive criteria.)

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 into their practice and receiving increased incentive payments. Launched in 2016, the DTI allocated $740 million in incentive opportunities to participating Medi-Cal Dental Program providers over five years. This investment in oral health for Medi-Cal-enrolled children has three goals: to increase access and utilization of preventive services, improve continuity of care and identify and manage dental disease.

Find more details about the Dental Transformation Initiative on the DHCS website.


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