To ensure that child beneficiaries throughout California can reasonably access dental services under Medi-Cal and to increase child beneficiary utilization and provider participation, Health Care Services should take the following steps for the fee-for-service delivery system by May 2015: establish criteria for assessing beneficiary utilization of dental services.
DHCS consulted with the stakeholder community throughout the month of April 2015 to establish criteria for assessing provider participation and beneficiary utilization. Through this collaborative effort, DHCS developed dental measures that will increase the Medi-Cal Dental Program's monitoring capabilities and assist DHCS to establish mitigation strategies that improve access and utilization of dental care for Medi-Cal beneficiaries. Beneficiary utilization measures established shall inform outreach efforts in Delta Dental's annual beneficiary outreach and education plan, including activities triggered by the benchmark of 41.17% for underserved areas pursuant to the current Delta Dental contract. DHCS will begin reporting on final measures in the fall of 2015.
Health Care Services provided a document labeled "Policies and Procedures Guide for Beneficiary Utilization Measurements" (guide). This guide identifies the utilization criteria (41.17 percent), five utilization measures (e.g., annual dental visit, use of preventive services, and use of sealants), a quarterly reporting schedule (January, April, July, and October), monitoring parameters (e.g., counties that fall below the 41.17 percent benchmark and counties in which utilization has declined for two successive quarters), and how results will be used (e.g., the fiscal intermediary's outreach unit will use the results to "inform" current and future outreach activities described in the Beneficiary Outreach and Education Program Plan).
DHCS is in the process of gathering and assessing existing beneficiary data and assessing health care industry methodologies to establish measures that best represent the plight of the beneficiary experience and utilization in the Medi-Cal Dental Program. Once the DHCS establishes a standardized measure by which it will assess beneficiary utilization, the DHCS will develop annual benchmarks for beneficiary utilization. Once benchmarks are established, the DHCS will identify beneficiary populations that have not performed to the standard and employ appropriate mitigation strategies. The DHCS will consult and engage with stakeholders during the development of the measure for beneficiary utilization and benchmarks. The DHCS will publicly report this measurement in accordance with DHCS reporting policies. The DHCS expects to meet the established implementation date of May 1, 2015
Agency responses received are posted verbatim.