Proposition 56 Supplemental Dental Payments

Overview | Current Materials

On November 8, 2016, California voters approved the California Healthcare, Research and Prevention Tobacco Tax Act (commonly known as Prop. 56) to increase the excise tax rate on cigarettes and tobacco products. Under Prop. 56, a specified portion of the tobacco tax revenue is allocated to DHCS for use as the nonfederal share of health care expenditures in accordance with the annual state budget process. In accordance with Assembly Bill 120 (Ch. 22, §3, Item 4260-101-3305, Statutes of 2017), Senate Bill 856 (Ch. 30, §3, Item 4260-101-3305, Statutes of 2018), and approved State Plan Amendments (SPA) 17-031 and SPA 18-0024, DHCS provided supplemental payments during Fiscal Year (FY) 2017-18, and FY 2018-19, as an increase to the current dental Schedule of Maximum Allowances (SMA) for specific dental procedures. The supplemental payment, effective July 1, 2017, through June 30, 2018, was at a rate equal to 40 percent of the SMA for specific restorative, endodontic, prosthodontic, oral and maxillofacial, adjunctive, and visits and diagnostic services. For FY 2018-19, the existing codes and supplemental payments were continued with the exception of 8 codes that were increased and 23 new codes were added (including general anesthesia, periodontal, and orthodontia) to receive supplemental payments which vary between 20-60 percent of the SMA, or a specific dollar increase effective July 1, 2018 through June 30, 2019.

 

Pursuant to Assembly Bill 74 (Chapter 23, §3, Item 4260-101-3305, Statutes of 2019), and approved SPA 19-0038, DHCS was authorized to continue the supplemental payments for the specified codes identified for FY 2018-19, for an additional 29 months effective July 1, 2019 through December 31, 2021.

SPA 20-0015 specifies the removal and addition of Current Dental Terminology (CDT) codes eligible for supplemental payments using Prop 56 funds. New procedure codes approved in SPA 20-0015 are effective March 14, 2020 through December 31, 2021.