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1. What are Medi-Cal dental managed care plans?
Answer:
The Medi-Cal dental managed care plans are like HFP dental plans.  They help manage your child’s dental care, and provide a 24-hour member service phone line.  Medi-Cal provides dental managed care services in Los Angeles and Sacramento counties.  Children, who live in all other counties in California, will receive dental services through Denti-Cal.

2. What is Denti-Cal?
Answer:
The Medi-Cal FFS dental program is known as Denti-Cal.  In Denti-Cal, your child can go to any dentist who accepts Denti-Cal.  You can find out more information about Denti-Cal online at: http://www.denti-cal.ca.gov/WSI/Default.jsp?fname=Default

3. When will my child’s dental coverage transition?
Answer:
Your child’s dental coverage will transition at the same time as his/her medical coverage.  (Please see “Health Plans” section Question 3 for further information on when your child’s medical coverage will transition.)

4. Will my child be in the same dental plan?
Answer:
Your child will have dental coverage, but may not be in the same dental plan.  If you live in a county other than Los Angeles or Sacramento Counties, your child will enroll into Denti-Cal.

  • If your child lives in Los Angeles County, your child will enroll into the same dental plan, if your child’s plan is also a Medi-Cal dental managed care plan or, if not, he/she will enroll into Denti-Cal.  Either way you can choose to change your child’s dental plan or enroll your child in Denti-Cal.  (Please see “Dental Services” section Question 16 for further information.)
  • If you live in Sacramento County, your child will enroll into the same dental plan, if your child’s plan is also a Medi-Cal dental managed care plan or, if not, they will enroll into another Medi-Cal dental managed care plan. Either way you can choose to change your child’s dental plan.  (Please see Dental Services Question 16 for further information.)

 

You will receive more information about dental coverage closer to the date your child moves to Medi-Cal.

5. How will DHCS ensure access to care and providers for my child, who is moving from HFP to Denti-Cal or Medi-Cal dental managed care?
Answer:
DHCS, along with the Department of Managed Health Care (DMHC), will assess Medi-Cal dental managed care plan readiness jointly.  The assessment includes the dental plans submitting their provider network and answering specific questions on how the plan is preparing for the move of children from HFP to Medi-Cal in accordance with statutory and regulatory requirements.

The Denti-Cal provider network will be assessed in two ways:

  • Denti-Cal Provider Network Adequacy – adequacy will be assessed by analyzing the number of Denti-Cal and HFP children currently enrolled with Denti-Cal providers.  This will determine areas where the beneficiary to provider ratio is high and what counties are in need of concentrated provider outreach.
  • Denti-Cal to HFP Network Adequacy – adequacy will be assessed by comparing the current Denti-Cal network and HFP network.  Data will be used to determine level of disruption, looking at number of providers by county by program, utilization by provider by program, and number of members assigned by provider.

 

6. How can my child continue to receive treatment from a HFP dental provider after he/she moves to Medi-Cal?
Answer:
Depending on your county of residence, the dental provider may need to sign up with Denti-Cal or a Medi-Cal dental managed care plan.  Please see the November 2012, provider bulletin (Volume 28, No. 16) at: http://www.denti-cal.ca.gov/provsrvcs/bulletins/Volume_28_Number_16.pdf.

7. When my child moves from HFP to Medi-Cal, how will I know if he/she is going to receive Denti-Cal or Medi-Cal dental managed care services?
Answer:
Your child’s dental benefits will move in the same phase as his/her medical benefits.  If you live in Los Angeles County, your child will have a choice between Denti-Cal or Medi-Cal dental managed care.  If you live in Sacramento County, your child will be enrolled in Medi-Cal dental managed care.  If you live in any other county in California, your child will be enrolled in Denti-Cal.

8. Will my child lose dental benefits moving from HFP to Medi-Cal?
Answer:
No.  Denti-Cal and Medi-Cal dental managed care offer the same dental benefits as HFP.

9. Will my child be able to continue treatment when moved to Denti-Cal or Dental Managed Care?
Answer:
Denti-Cal and Dental Managed Care will honor prior authorizations for treatments and services, if the service is a Denti-Cal or Dental Managed Care benefit and performed by a Denti-Cal or Dental Managed Care provider respectively within the authorization time period.  If you have questions on whether the service is a Denti-Cal benefit call the Beneficiary Telephone Service Center at 1-800-322-6384.  If you have questions on whether the service is a Dental Managed Care benefit call the Beneficiary Dental Exception (BDE) Line at 1-855-347-3310.

10. If my child is receiving orthodontia services, will my child be able to continue treatment with the same orthodontist?
Answer:
Yes.  HFP members receive orthodontic services through California Children’s Services (CCS).  CCS dentists, including orthodontists, are already enrolled with Denti-Cal to provide services to CCS members so your child can continue seeing the same orthodontist.

11. Do I have to fill out an application for my child to enroll into Denti-Cal or Medi-Cal dental managed care?
Answer:
No. Your child will be automatically enrolled into Denti-Cal or Medi-Cal dental managed care depending on your county of residence.  Prior to your child moving from HFP to Medi-Cal, DHCS will send you information on how dental services will be provided.  If you live in Los Angeles County, your child will have a choice between Denti-Cal and Medi-Cal dental managed care.  If you live in Sacramento County, your child will have choices between Medi-Cal dental managed care plans.  You can learn more about these choices by calling HCO toll free at 1-800-430-4263 or by filling out a dental Choice Packet, which you will receive shortly after your child moves to Medi-Cal or by going to:
http://www.denti-cal.ca.gov/WSI/Default.jsp?fname=Default.

12. Once my child moves to Medi-Cal, can he/she still see the same dentist?
Answer:
This depends.  If your child’s dentist under HFP is also a dentist under Denti-Cal, he/she can see the same dentist.  You can contact the Denti-Cal Beneficiary Toll Free line at 1-800-322-6384 to find out if your child’s dentist is part of Denti-Cal or go to: http://www.denti-cal.ca.gov/WSI/Bene.jsp?fname=ProvReferral

If your child receives services under Medi-Cal dental managed care, you can call the Medi-Cal dental plan your child is moving into to see if your child’s current dentist is part of the plan’s provider network or go to: http://www.denti-cal.ca.gov/WSI/ManagedCare.jsp?fname=ManagedCareMain

13. How can I find a dental provider for my child?
Answer:
For Denti-Cal, you can locate Denti-Cal providers in your area by calling the Beneficiary Toll Free line at 1-800-322-6384.  A customer service representative will assist you with provider options or go to: http://www.denti-cal.ca.gov/WSI/Bene.jsp?fname=ProvReferral

For Medi-Cal dental managed care, you can contact the Medi-Cal dental managed care plan that your child will be enrolled in or go to:
http://www.denti-cal.ca.gov/WSI/ManagedCare.jsp?fname=ManagedCareMain

14. Can I change my child’s plan or provider(s)?
Answer:
If you live in a county other than Los Angeles or Sacramento, your child will be enrolled in Denti-Cal.  Medi-Cal Dental managed care plans are only available in Los Angeles and Sacramento.  If you would like to change your child’s Denti-Cal provider call the Denti-Cal Beneficiary Telephone Service Center at 1-800-322-6384.

If your child is enrolled in Medi-Cal dental managed care plan in Los Angeles County, you may change his/her plan at any time or elect to enroll your child into Denti-Cal by calling HCO at 1-800-430-4263.  If you would like to change your child’s Denti-Cal provider, please contact your child’s dental plan's Member Services phone number.

If your child is enrolled in Medi-Cal dental managed care in Sacramento County, you may change his/her plan at any time by calling HCO at 1-800-430-4263.  If you would like to change your child’s provider, please contact your child’s dental plan's Member Services phone number.

15. How does a provider enroll in Denti-Cal or a Medi-Cal dental managed care?
Answer:
To enroll in Denti-Cal, a provider must complete an application.  Denti-Cal can mail the provider an application or a dentist can get one online at http://www.denti-cal.ca.gov/WSI/Prov.jsp?fname=enrollment_tool_kit.  Providers can call the Provider Customer Service line at (800) 423-0507.  To enroll in a Medi-Cal dental managed care plan, a provider must complete and submit an application to the dental plan(s).  Providers who are interested in enrolling with a Medi-Cal dental managed care plan should contact the plan directly.  Please see the Plan Directory at www.denti-cal.ca.gov > Dental Managed Care > Managed Care Dental Plan Directory.

16. Will the Medi-Cal dental rates be increased to encourage/increase provider participation to ensure access to care?
Answer:
The Schedule of Maximum Allowances for benefits will not be increased.  DHCS is looking into other avenues to simplify program requirements and policies that would encourage provider participation.

17. Will DHCS perform provider outreach?
Answer:
Medi-Cal dental managed care plans will be required to perform outreach to their enrolled providers to ensure continuity of care.  DHCS will perform provider outreach to encourage current providers to accept new children enrolled in Medi-Cal and to encourage HFP dental providers to enroll in Medi-Cal dental managed care plans.  Provider outreach will include:

  • Provider Survey – a survey was sent to providers to determine provider capacity, ability to accept new patients, and identify barriers to enrollment.  Survey results will assess which providers are willing to enroll in Medi-Cal and/or continue providing services to their HFP enrollees.  A survey was sent to three provider groups: Denti-Cal only billing providers, HFP only providers, and Healthy Families/Denti-Cal rendering providers.  A link to the survey is also available on the Denti-Cal website (www.denti-cal.ca.gov) for providers to complete the survey.
  • Call Campaign – Denti-Cal will place calls to follow up with providers, who have not responded to surveys or have stated that they will not enroll in Medi-Cal.  This will be another attempt to encourage the providers to enroll to ensure network adequacy and access to care.
  • Provider Mailing – a letter was mailed to all HFP service office locations to inform HFP providers about the transition, how HFP members will transition in each county, and how to continue treating their HFP members.  The mailing included information on how the providers can enroll into Denti-Cal or a Medi-Cal dental managed care plan, if not already enrolled.
  • Streamlined Enrollment – HFP provider applications to enroll in Denti-Cal will have high priority for processing.  If additional information is needed to process the applications, Denti-Cal staff will contact the provider by phone to collect information and expedite the processing of the application.
  • Workshops/Seminars/Online Tutorials – Denti-Cal will hold a series of workshops, seminars, and online tutorials to educate providers on how to enroll in Denti-Cal, how to bill for services, and other frequently asked questions.
  • Enrollment Phone Bank – Denti-Cal will hold a series of phone sessions, where providers can call in to speak directly with provider enrollment staff to get assistance with enrollment.
  • Provider Bulletins – bulletins will be published monthly to educate providers on program changes and/or reminders on events (i.e. trainings).
  • Reporting – Medi-Cal dental managed care plans will be required to report on performance measures including, but not limited to, utilization, enrollment/disenrollment of providers, network adequacy, and continuity of care.
  • Beneficiary Surveys – a survey will be sent to beneficiaries after they transition to Denti-Cal or Medi-Cal dental managed care plans.  The survey results will be used to identify common barriers beneficiaries may have in accessing services.  DHCS will also use the results to identify how to provide education to beneficiaries on accessing services.

 

18. How will DHCS monitor performance of Denti- Cal or Medi-Cal Dental managed care plans?
Answer:
Both Denti-Cal and Medi-Cal dental managed care plans will be required to report on several identified performance measures during and after the move of children from HFP to Medi-Cal.  This information will be made available to the public.  These performance measures include:

  • Annual Dental Visits – the percentage of beneficiaries, who had at least one dental visit during the measurement year;
  • Continuity of Care – the percentage of beneficiaries continuously enrolled for two years with no gap in coverage, who received a comprehensive oral evaluation or a prophylaxis in both the year prior to the measurement year and in the measurement year;
  • Use of Preventive Services – the percentage of beneficiaries, who received any preventative dental service during the past year;
  • Use of Sealants – the percentage of beneficiaries ages 6-9 and 10-14, who received a dental sealant on at least one permanent molar tooth during the past year;
  • Sealant to Restoration Ratio (Surfaces) – the ratio of occlusal surfaces of permanent first and second molars receiving dental sealant to those receiving restoration among beneficiaries ages 6-9 and 10-14 during the past year;
  • Treatment/Prevention of Caries – the percentage of beneficiaries, who received either treatment for caries or a caries-preventive procedure during the past year;
  • Exams/Oral Health Evaluations – the percentage of beneficiaries, who received a comprehensive or periodic oral health evaluation or, for beneficiaries under 3 years of age, who received an oral evaluation and counseling with the primary care giver, during the past year;
  • Overall Utilization of Dental Services – the percentage of beneficiaries continuously enrolled for 1, 2, and 3 years, who received any dental service during those periods;
  • Usual Source of Care – the percentage of beneficiaries, who received any dental service each year for two consecutive years;
  • Use of Dental Treatment Services – the percentage of Members who received any dental treatment service during the past year; and,
  • Preventive Services to Filling – the percentage of members who received one or more fillings in the measurement year who also received preventive services (topical fluoride application, sealant, preventive resin restoration, education) in the measurement year.

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