龋齿风险评估
CalAIM 的这项举措将龋齿风险评估 (CRA) 套餐作为一项新的牙科福利，符合国家牙科保健标准。 这项新福利的总体目标是评估和管理龋齿风险，并强调为 0-6 岁儿童提供预防服务，以代替更具侵入性和更昂贵的程序。 这项福利在全州范围内适用，允许服务提供商（包括相关牙科专业人员）按 CRA 捆绑费率收费，其中包括针对中度和高度龋齿风险人群的某些预防服务的允许增加频率。
The CRA bundle consists of either D0601, D0602, or D0603 (CRA exams at low, moderate, and high risk) and D1310 (nutritional counseling). The bundle’s rate of payment, also known as the Schedule of Maximum Allowances (SMA) fee, is $61, with $15 being assigned to codes D0601-D0603 and $46 being assigned to D1310. The risk level associated with a specific patient determines billing limitations for that bundle. Based on the risk level associated with each Medi-Cal member (ages 0-6), the following frequency of services applies:
- 低风险 – 提供商每年可对 CRA 套餐（CDT 代码 D0601 和 D1310）以及其他预防性服务（如清洁或氟化物治疗）（D0120、D1120、D1206、D1208）进行两次计费
- 中等风险 – 提供商可能会每年三次收取 CRA 套餐（D0602 和 D1310）以及清洁或氟化物治疗等其他预防性服务（D0120、D1120、D1206、D1208）的费用
- 高风险——提供商每年可能会收取四次 CRA 捆绑服务（D0603 和 D1310）以及清洁或氟化物治疗等其他预防性服务（D0120、D1120、D1206、D1208）的费用
To receive payment for the CRA bundle benefit, dental providers must take the Treating Young Kids Everyday (TYKE) training hosted by the California Dental Association or Strengthening Many Young Lives Everyday (SMYLE) training available on Medi-Cal Dental’s Learning Management System (LMS). Fee-For-Service (FFS) providers must provide an attestation form and proof of course completion to the Dental Administrative Services Organization (ASO) before payment will be rendered for CRA services. DMC and SNC providers must keep an attestation form and proof of course completion on file for auditing purposes. Rendering providers who have already taken the TYKE training under Domain 2 of Dental Transformation Initiative are not required to re-take the TYKE training under CalAIM.