Cal. WIC § 14184.90 — California Code / Code wic / Division 9 / Part 3 / Chapter 7 / Article 5.5 / Section 14184.90
Section 14184.90
Status: in_force

(a) Subject to appropriation by the Legislature, beginning no sooner than July 1, 2019, and consistent with Section 14184.20, the department may authorize a dental integration pilot program in San Mateo County as a component of the Medi-Cal 2020 demonstration project established by this article, or any extension or amendment to the Medi-Cal 2020 demonstration project pursuant to subdivision (j) of Section 14184.20. The pilot program shall be designed to test the impact to oral care access, quality, and utilization, as well as medical cost impacts by the delivery of covered dental care services as a managed care benefit under the operation of the Health Plan of San Mateo.

(b) Before the start date of the approved pilot program, the department shall do all of the following:

(1) Seek input from affected stakeholders including, but not limited to, the Health Plan of San Mateo, currently enrolled Medi-Cal dental providers, other dental providers, and consumer advocates.

(2) Establish objectives for improving dental utilization through the pilot program.

(3) Establish objectives for improving access to oral health care through the pilot program.

(4) Determine that the Health Plan of San Mateo meets the department’s readiness requirements, including, but not limited to, the demonstration of an adequate network of dental care providers.

(c) Under the approved pilot program, covered Medi-Cal dental care services currently provided under the Medi-Cal fee-for-service system to enrollees of the Health Plan of San Mateo shall be made the responsibility of the Health Plan of San Mateo, including covered dental care services provided through safety net clinics, such as federally qualified health centers. For the duration of the approved pilot program, enrollees of the Health Plan of San Mateo will no longer receive covered Medi-Cal dental care services through the Medi-Cal fee-for-service system.

(d) To minimize interruptions in ongoing dental care, enrollees impacted by the approved pilot program who have been in treatment with a specific Medi-Cal dental provider for more than 12 months shall be permitted to continue to receive covered dental services from that provider, if all of the following are met:

(1) The provider is willing to continue to treat the enrollee at existing Medi-Cal fee-for-service rates, or at another rate or rate methodology as agreed upon by the plan and provider.

(2) The provider remains an eligible provider of dental services in Medi-Cal.

(3) The Health Plan of San Mateo has not identified a significant quality issue with the provider.

(e) The pilot program described in this section shall be authorized for no more than a period of six years.

(f) Pursuant to subdivision (e) of Section 14184.20, and to the extent the department obtains federal approval for the pilot program described in this section, the department shall contract with an external entity to conduct an evaluation of the pilot program to be completed and published no later than December 31 of the sixth state fiscal year the pilot program is in operation. The evaluation shall include all of the following:

(1) Assessment of the pilot program’s ability to meet the utilization objectives established in this section.

(2) Assessment of the pilot program’s ability to meet the improved access objectives established in this section.

(3) Assessment of overall dental utilization and changes in utilization compared to utilization in the fee-for-service system that occurred prior to the pilot program.

(4) Assessment of the medical cost impacts of the pilot program, if any, such as reductions in emergency room visits.

(5) Assessment of the impacts to the available provider network for dental services in the pilot program compared to the provider network available in the fee-for-service system before the pilot program.

(g) The funding for the evaluation described in subdivision (f) shall be provided by the Health Plan of San Mateo to the department. The department shall seek federal matching funds if available.

(h) The department shall consult with the Health Plan of San Mateo no later than six months before the start date of the approved pilot program regarding any necessary adjustments to its capitation rates developed pursuant to Section 14301.1 and methods required to integrate dental care services for plan enrollees.

(i) (1) This section shall not be implemented until all necessary federal approvals have been obtained.

(2) This section shall be implemented only to the extent the department determines federal financial participation is available and is not otherwise jeopardized.