SB 1464: Medi-Cal: benefits: enrollees with special dental care needs.

Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law provides for a schedule of benefits under the Medi-Cal program, including certain dental services that are referred to as Denti-Cal. Denti-Cal, and dental managed care plans.

This bill would require the department, for Denti-Cal and dental managed care plan beneficiaries with special dental care needs, to provide coverage for behavior management and dental case management necessary to provide dental services as a covered benefit a payment adjustment to providers in the Denti-Cal program, program and for dental managed care plans, as specified. The bill would require the department to establish reimbursement rates for those services when billed in addition to the provision of other dental services for a Denti-Cal beneficiary. The bill would not limit the provision or scope of Denti-Cal services covered under existing law. The bill would require the department to seek any necessary approvals from the federal Centers for Medicare and Medicaid Services to implement the bill. The bill would require the department to implement its provisions only in a manner that is consistent with federal Medicaid law and regulations, and only to the extent that the necessary approvals are obtained and federal financial participation is not jeopardized. The bill would authorize the department to implement, interpret, or make specific its provisions, and any applicable federal waivers and state plan amendments, by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions, without taking regulatory action, and would require the department to subsequently adopt regulations, as specified, by July 1, 2022. The bill would require the department, commencing January 1, 2020, to provide the Legislature with semiannual status reports to the Legislature until regulations have been adopted.