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Proposition 56 Supplemental Dental Payments
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), and approved State Plan Amendment (SPA) 17-031, DHCS provided supplemental payments during Fiscal Year (FY) 2017-18, in addition to the current dental Schedule of Maximum Allowances (SMA) for specific procedures in an effort to increase provider participation.
Pursuant to Senate Bill 856 (Chapter 30, §3, Item 4260-101-3305, Statutes of 2018), and approved SPA 18-0024, DHCS received additional funds to extend supplemental payments for FY 2018-19 and issue additional supplemental payments for the specified codes, linked below, for dates of service during the period of July 1, 2018 through June 30, 2019.
The FY 2017-18 supplemental payment categories for dental services included restorative, endodontic, prosthodontic, oral and maxillofacial, adjunctive, and visits and diagnostic services. As detailed in SPA 18-0024, linked below, for FY 2018-19, the supplemental payment rates for the FY 2017-18 categories stated above will remain at a rate equal to 40 percent of the Medi-Cal SMA, unless noted as a change for FY 2018-19. The top 26 utilized dental services, along with general anesthesia, periodontal and orthodontia, will receive a supplemental payment at either a specific dollar increase or a percentage increase above the existing Medi-Cal SMA.