California Advancing and Innovating Medi-Cal Dental Directed Payment
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CalAIM Txoj Kev Kho Hniav DP tau taw qhia Medi-Cal Dental Managed Care Plans (DMCPs) kom them nyiaj ib yam nkaus thiab ruaj khov nyiaj ntxiv rau cov chaw muab kev pabcuam tsim nyog raws li kev siv thiab xa cov kev pabcuam kho hniav tsim nyog, uas suav nrog kev kho mob tshwj xeeb, endodontic, prosthodontic, periodontal, qhov ncauj thiab maxillofacial, orthodontics, adjunctive, thiab mus ntsib rau kev kuaj mob thiab kev tiv thaiv kev pab cuam txheeb xyuas los ntawm Current Dental Terminology (CDT) codes.
Pib txij Lub Ib Hlis Ntuj 1, 2022, DHCS tau ua raws li Lub Xeev tau hais kom them nyiaj raws li 42 CFR 438.6(c) ua tus nqi qis kawg nkaus rau cov chaw muab kev pabcuam network uas muab qee yam kev pabcuam kho hniav raws li daim ntawv cog lus siv lub Xeev txoj kev pom zoo tus nqi. Tus nqi qis kawg nkaus rau cov txheej txheem kho hniav no siv rau txhua tus neeg muab kev pabcuam tsim nyog uas ua cov kev pabcuam no rau DMC rau npe. Tsis tas yuav sau ntawv ua ntej thiab yuav tsis xa mus rau CMS rau qhov kev pib them nyiaj no raws li 42 CFR 438.6(c)(2)(ii).
Muaj kev hloov kho rau cov kev pabcuam tiv thaiv uas siv tau los ua kom tus nqi ntawm ib chav tsev nce ntxiv los ntawm qib kev saib xyuas kev noj qab haus huv uas xav tau mus txog 75% siab dua li Daim Ntawv Teev Npe Siab Tshaj Plaws ntawm Lub Xeev (SMA), uas sib xws nrog kev them nyiaj uas Lub Xeev qhia.
Yog tias koj muaj lus nug txog kev tswj hwm kev kho mob txog qhov kev pab cuam no, thov hu rau pab pawg neeg Health Plan Directed Payment ntawm PlanDP@dhcs.ca.gov.