California Advancing and Innovating Medi-Cal Dental Directed Payment
Back to: CalAIM Dental | CalAIM Dental Preventative Services | Directed Payments
CalAIM’s Dental DP Program directs Medi-Cal
Dental Managed Care Plans (DMCPs) to make uniform and fixed dollar amount
add-on payments to eligible network providers based on the utilization and
delivery of qualifying dental services, which includes specific restorative,
endodontic, prosthodontic, periodontal, oral and maxillofacial, orthodontics,
adjunctive, and visits for diagnostic and preventative services identified by
the Current Dental Terminology (CDT) codes.
Effective January 1, 2022, DHCS implemented a State directed payment under 42 CFR 438.6(c) imposing a minimum fee schedule for network providers that provide certain dental services under the contract using State plan approved rates. The minimum fee schedule for these dental procedure codes applies to all eligible providers who perform these services for DMC enrollees. A preprint is not required and will not be submitted to CMS for this payment initiative in accordance with 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.
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