Dental Plan Reform

The Biden administration this week expanded coverage for medically necessary dental procedures in Medicare. Coverage of some services — specifically, elimination of infection preceding an organ transplant and certain cardiac procedures — will begin in 2023, while coverage of dental services linked to head and neck cancers will start in 2024.  

Update 11/9/22: The CDA-endorsed ballot measure in Massachusetts – Question 2 – passed in Tuesday's election and will require dental insurance companies to spend at least 83% of premium dollars collected on dental services as opposed to using the money for administrative costs and executive compensation.

A proposed rule from the Center for Medicare & Medicaid Services would cover medically necessary dental services as part of the existing medical services benefit in Medicare. CDA last week submitted specific recommendations on coverage of services.
 

A new California law will help inform patients who use telehealth about their health plan coverage limitations and options so they can make informed choices about the care they receive. It takes effect in January 2023.
 

CalAIM is a multiyear initiative by the Department of Health Care Services that aims to improve the quality of life and health outcomes of the Medi-Cal population by implementing broad delivery system, program and payment reform across Medi-Cal.

California Insurance Commissioner Ricardo Lara last Wednesday issued a notice to California health insurance and specialized health insurance companies, including 55 dental benefits companies, requesting that they “provide their policyholders with a partial premium refund no later than December 31, 2020.

The state Legislature and Gov. Gavin Newsom reached an agreement yesterday on a balanced state budget for 2020-21 fiscal year that preserves critical safety net health care funding in the Medi-Cal dental (Denti-Cal) program.

CDA-sponsored legislation that further increases dental plan transparency became law on Jan. 1. AB 954 requires dental plans to be more transparent about the leasing of dental networks. The new law will reduce patient and dentist confusion caused by the increasing number of plans leasing their networks to other payers, many times unbeknownst to the enrollee or contracted dentist(s). The law took effect for contracts entered into on or after Jan. 1, 2020.

Health care providers can expect to see major revisions to the Medi-Cal program over the next couple of years as a result of a new initiative by the Department of Health Care Services. Released in late October, the California Advancing and Innovating Medi-Cal (CalAIM) proposal will implement “broader delivery system, program and payment reform across the Medi-Cal Program,” according to the proposal summary.

Improvements to the Medi-Cal Dental program continue with new options for dentists who treat Medi-Cal members, including the ability to provide fluoride treatment and fluoride varnish as a benefit once every four months for patients under age 6. The increase in the benefit periodicity underscores the state’s commitment to regular preventive oral health visits for young children in California.

As part of the finalized 2019-20 California state budget, the Legislature and Gov. Gavin Newsom approved a continuation of supplemental Medi-Cal provider rates, including significant dollars for dentists serving Medi-Cal patients. An additional $20 million was dedicated to dentists through a recently launched student loan repayment program.

A San Francisco Superior Court judge has granted final approval of the $65 million amended settlement agreement between Delta Dental…