牙齒風險評估
這項 CalAIM 計劃添加了牙齒風險評估（CRA）包，作為符合國家牙科護理標準的新牙科福利。 這項新福利的整體目標是評估和管理毛病的風險，並強調提供預防服務，以取代為 0-6 歲兒童進行更具侵入性和昂貴的程序。 此福利在全州範圍內提供，並允許包括聯盟牙科專業人員在內的提供商計費 CRA 包費率，包括針對中度和高毛病風險患者對某些預防服務的允許增加頻率。
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:
- 低風險 — 提供者可每年向 CRA 服務包（CDT 代碼 D0601 和 D1310）以及其他預防服務，例如清潔或氟化物處理（D0120，D1120，D1206，D1208）計費兩次
- 中等風險 — 供應商每年可向 CRA 套餐（D0602 和 D1310）以及其他預防服務，例如清潔或氟化物治療（D0120，D1120，D1206，D1208）計費三次
- 高風險 — 提供者每年可向 CRA 套餐（D0603 和 D1310）以及其他預防服務，例如清潔或氟化物處理（D0120，D1120，D1206，D1208）計費四次
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.