To ensure that the influx of beneficiaries resulting from recent changes to federal and state law is able to access Medi-Cal's dental services, Health Care Services should immediately take action to resolve any declining trends identified during its monitoring efforts.
This recommendation has been implemented and DHCS continues to monitor dental utilization of all Medi-Cal beneficiaries and explore innovative approaches to increase access and utilization, as mentioned via outreach plans and monitoring and assessment of DTI. Additionally, in 2017, DHCS increased outreach efforts including multiple visits to county and community agencies, school districts, and participation in county health events. Additional details for conducted outreach are also provided in A4. Further, as part of monitoring and child-beneficiary specific outreach, DHCS has implemented outreach campaigns to increase utilization using Mailers/Robo Calls to households with children ages 0-3 with no utilization of services within the previous 12 months, and mailers to all new enrollees each quarter through the end of 2017. Teledentistry live transmission services also offers another modality for a beneficiary to receive services. DHCS is implementing initiatives to influence provider participation through supplemental payments to providers on specific procedures utilizing funding from Proposition 56 in accordance with AB 120. These funds are in addition to the current Dental Schedule of Maximum Allowances (SMA) and will be at a payment rate equal to 40 percent of the SMA for the specified codes for dates of service during July 1, 2017 through June 30, 2018. Upon federal approval, effective January 1, 2018, DHCS will restore adult dental benefits previously eliminated from the 2009 SPA, resulting in full-scope adult dental benefits.
We cannot confirm that DHCS fully implemented this recommendation. Although DHCS provided documents supporting its implementation of measures related to monitoring dental access (e.g., number of dental providers, beneficiary utilization by region and total, and a comparison of Medi-Cal dental reimbursement rates to other states' rates), these documents noted that DHCS will perform its first analysis on data for FYs 2015-16 and 2016-17. DHCS did not provide documents related to the results of its data analysis for these two fiscal years nor any actions it took in response to declining trends it identified therefrom.
DHCS has designed and implemented components of the beneficiary utilization and provider participation outreach plans. The results of these outreach plans support DHCS in identifying county-specific access to care issues and serve as a useful resource for the DTI and other utilization monitoring efforts. DHCS has also completed the implementation of the exemption of dental services and applicable ancillary services from the Assembly Bill 97 ten percent provider payment reductions for dates of service on or after July 1, 2015, and retroactively reimbursed the affected providers as of April 2016. Lastly, DHCS reports that appropriate actions and measures are effectively underway as part of the successful commencement of the dental provider incentive proposals through the Medi-Cal Waiver 2020. Additionally, in conjunction with Denti-Cal stakeholders, DHCS implemented administrative simplifications added clarifying language and materials to assist in the prior authorization requirement for general anesthesia/intravenous sedation. Teledentistry is now offered as an alternative modality for dental services and the live transmission option is currently pending CMS approval which is anticipated for December 2016. In addition, with the DTI, DHCS is consolidating the proposed set of Current Dental Terminology code additions and anticipates the regulatory package will be submitted formally for a public comment period and review with the Office of Administrative Law anticipated in the second quarter of 2017.
As the nature of this recommendation is ongoing, there is no definitive implementation date. Once the reporting of the beneficiary utilization and provider participation measures is complete, the results of these measures will help identify any declining trends in county-specific access to care issues and will be used as the standard benchmark criteria in the annual outreach plans. In addition, in October 2015, the Centers for Medicare and Medicaid Services (CMS) approved the exemption of dental services and applicable ancillary services from the Assembly Bill 97 ten percent provider payment reductions for dates of service on or after July 1, 2015. DHCS has implemented this exemption on a prospective basis since November 19, 2015 and expects providers to begin receiving retroactive payments for claims that were submitted before the date of implementation beginning December 2015. In addition, DHCS' dental provider incentive proposals through the Medi-Cal Waiver 2020 efforts propose $740 million to fund the incentive programs over a five-year period. Through this proposal, DHCS has the opportunity to earn an additional $10 million in funding by meeting additional performance metric criteria. The projected effective date for the Medi-Cal Waiver 2020 dental incentive programs is January 2016.
DHCS has established criteria for assessing provider participation and beneficiary utilization and has developed procedures for periodically identifying counties where beneficiary utilization and provider participation fail to meet applicable criteria. In accordance with the processes outlined in these procedures and the efforts previously described, DHCS will actively assess access to care and will take necessary steps to resolve declining trends that are within its purview to implement during monitoring efforts. Some mitigation strategies in order to implement may require additional resources or funding, which would be subject to approval through the annual budget process. As the nature of this recommendation is ongoing, there is no definitive implementation date.
Once DHCS has established beneficiary utilization and provider participation measures and have institutionalized mechanisms to capture the number of beneficiaries having difficulty accessing appointments, it will take necessary steps to resolve declining trends that are within its purview to implement. The DHCS recognizes that some solutions may require additional resources and funding and will take the necessary steps to seek approval within the Administration in order to implement identified mitigation strategies to resolve declining trends identified during its monitoring efforts. As the nature of this recommendation is ongoing, there is no definitive implementation date
†Response Type refers to the interval in which the auditee is providing the State Auditor with their status in implementing recommendations made in an audit report. Auditees must submit a response regarding their progress in implementing recommendations from our reports at three intervals from the release of the report: 60 days, six months, and one year or subsequent to one year.
*Agency responses received after June 2013 are posted verbatim.