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).
An adjustment was applied to applicable preventative services to increase the unit cost from base expected managed care levels to 75% above the State’s Schedule of Maximum Allowances (SMA), consistent with the State directed payment.
For any managed care questions regarding this program, please reach out to the Health Plan Directed Payment team at PlanDP@dhcs.ca.gov.