Amended in Senate June 9, 2016

Amended in Assembly April 26, 2016

California Legislature—2015–16 Regular Session

Assembly BillNo. 2207


Introduced by Assembly Member Wood

February 18, 2016


An act to amend Sections 14132.915 and 14459.6 of,begin insert to add Sections 14184.72, 14184.73, 14184.74, and 14184.75 to,end insert and to add Article 4.10 (commencing with Section 14149.8) to Chapter 7 of Part 3 of Division 9 of, the Welfare and Institutions Code, relating to Medi-Cal.

LEGISLATIVE COUNSEL’S DIGEST

AB 2207, as amended, Wood. Medi-Cal: dental program.

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income persons receive health care benefits. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law provides that certain optional benefits, including, among others, certain adult dental services, are excluded from coverage under the Medi-Cal program. Existing law, beginning May 1, 2014, or the effective date of any necessary federal approvals, whichever is later, provides that only specified adult dental services are a covered Medi-Cal benefit for persons 21 years of age or older.

This bill would require the department to undertake specified activities for the purpose of improving the Medi-Cal Dental Program, such as expediting provider enrollment and monitoring dental service access and utilization. The bill would require a Medi-Cal managed care health plan to provide dental health screenings for eligible beneficiaries and refer them to appropriate Medi-Cal dental providers. This bill would provide that those provisions shall only be implemented to the extent that the department obtainsbegin insert anyend insert necessary federalbegin delete approvals,end deletebegin insert approvals andend insert federal matchingbegin delete funds, and an appropriation in the annual Budget Act for the specific purpose of implementing those provisions.end deletebegin insert funds.end insert

Existing law requires the department to establish a list of performance measures to ensure the dental fee-for-service program meets quality and access criteria required by the department. Existing law requires the department to annually post on October 1 the list of performance measures and data of the dental fee-for-service program for the previous calendar year on its Internet Web site. Existing law also requires the department to establish a list of performance measures to ensure dental health plans meet quality criteria required by the department. Existing law requires the department to post, on a quarterly basis, the list of performance measures and each plan’s performance on the department’s Internet Web site.

This bill would add to the performance measures for both the dental fee-for-service program and dental plans described above the total number of patients seen on a per-provider basis and the total number of dental services rendered by each provider during each calendar year. The bill would, as of October 31, 2016, eliminate the requirement that the department annually post the performance measures and program data relating to the dental fee-for-service program for the previous calendar year on October 1 and instead would require the department, commencing January 31, 2017, to post that information for the previous fiscal year on its Internet Web site on or before January 31 of each year. The bill, commencing April 30, 2017, and on specified dates thereafter, would require the department to post dental fee-for-service program performance data, the dental health plan performance measures, and each dental health plan’s performance on a quarterly basis for the preceding fiscal quarter on its Internet Web site. The bill would require the department to ensure, to the greatest degree possible, that the categories of data and performance measures selected for the dental fee-for-service program and for dental health plans are consistent with one another.

begin insert

SB 815 of the 2015-16 Regular Session, if enacted, would establish the Medi-Cal 2020 Demonstration Project Act, under which the department is required to implement specified components of a Medicaid 1115(a) demonstration project, referred to as California’s Medi-Cal 2020 demonstration project, consistent with the Special Terms and Conditions approved by the federal Centers for Medicare and Medicaid Services. AB 1568 of the 2015-16 Regular Session, if enacted, would require the department to implement the Dental Transformation Initiative (DTI), a component of the Medi-Cal 2020 demonstration project, under which DTI incentive payments, as defined, within specified domain categories would be made available to qualified providers who meet achievements within one or more of the project domains, and would require the department to evaluate the DTI as required under the Special Terms and Conditions.

end insert
begin insert

This bill would require, consistent with the Special Terms and Conditions and the evaluation requirement described above, the department’s reports of data and quality measures submitted to CMS and made publicly available for each of the domain areas under the DTI to include specified information.

end insert

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

P3    1

SECTION 1.  

Section 14132.915 of the Welfare and Institutions
2Code
is amended to read:

3

14132.915.  

(a) (1) The department shall establish a list of
4performance measures to ensure the dental fee-for-service program
5meets quality and access criteria required by the department. The
6performance measures shall be designed to evaluate utilization,
7access, availability, and effectiveness of preventive care and
8treatment.

9(2) Prior to establishing the quality and access criteria described
10in paragraph (1), the department shall consult with stakeholders,
11including representatives from counties, local dental societies,
12nonprofit entities, legal aid entities, and other interested parties.

13(3) The performance measures established by the department
14to monitor the dental fee-for-service program for children shall
15include, but not be limited to, all of the following:

16(A) Overall utilization of dental services.

17(B) Number of annual dental visits, the total number of patients
18seen, on a per-provider basis, and the total number of preventive
19dental services, dental treatment services, and examinations and
20oral health evaluations rendered by each provider during each
21calendar year.

P4    1(C) Number of applications of dental sealants.

2(D) Continuity of care and overall utilization over an extended
3period of time.

4(E) All of the following ratios:

5(i) Sealant to restoration.

6(ii) Filling to preventive services.

7(iii) Treatment to caries prevention.

8(4) The performance measures established by the department
9to monitor the dental fee-for-service program for adults shall
10include, but not be limited to, all of the following:

11(A) Number of annual dental visits and preventive dental
12services, the total number of patients seen on a per-provider basis,
13and the total number of dental services rendered by each provider
14during each calendar year.

15(B) Treatment to caries prevention ratio.

16(5) The performance measures shall be reported as aggregate
17numbers and as percentages, if appropriate, using standards that
18are as equivalent to those used by managed care entities as feasible.
19Performance measures for the dental fee-for-service program for
20children shall be reported by age groupings if appropriate.

21(b) The department shall include the initial list of performance
22 measures in any dental contract entered into between the
23department and a fee-for-service contractor on or after enactment
24of this section.

25(c) To ensure that the dental health needs of Medi-Cal
26beneficiaries are met, the department shall, when evaluating
27performance measures for retention on, addition to, or deletion
28from, the list of performance measures, consider all of the
29following criteria:

30(1) Annual and multiyear Medi-Cal dental fee-for-service
31trended data.

32(2) Other state and national dental program performance and
33quality measures.

34(3) Other state and national performance ratings.

35(d) On October 1, 2014, for the 2013 calendar year, and on or
36before October 1, 2016, for the 2015 calendar year, the list of
37performance measures established by the department along with
38the data of the dental fee-for-service program performance shall
39be posted on the department’s Internet Web site.

P5    1(e) Commencing January 31, 2017, for the 2015-16 fiscal year,
2and annually on or before January 31 for each preceding fiscal
3year thereafter, the list of performance measures established by
4the department along with the data of the dental fee-for-service
5program shall be posted on the department’s Internet Web site.

6(f) Commencing April 30, 2017, for the July 2016 to September
72016, inclusive, fiscal quarter, and quarterly thereafter on or before
8April 30, July 31, October 31, and January 31 for the fiscal quarter
9ending seven months prior, the data of the dental fee-for-service
10program performance shall be posted on the department’s Internet
11Web site.

12(g) The department may amend or remove performance
13measures and establish additional performance measures in
14accordance with all of the following:

15(1) The department shall consider performance measures
16established by other states, the federal government, and national
17organizations developing dental program performance and quality
18measures.

19(2) The department shall notify a fee-for-service contractor, at
20least 30 days prior to the implementation date, of any updates or
21changes to performance measures. The department shall also post
22these updates or changes on its Internet Web site at least 30 days
23prior to implementation in order to maintain transparency to the
24public.

25(3) In establishing the performance measures, the department
26shall consult with stakeholders, including representatives from
27counties, local dental societies, nonprofit entities, legal aid entities,
28and other interested parties.

29(h) The department shall annually prepare a summary report of
30the nature and types of complaints and grievances regarding access
31to, and quality of, dental services, including the outcome.
32Commencing January 31, 2017, for the prior fiscal year, and
33annually thereafter, for each preceding fiscal year, this report shall
34be posted on the department’s Internet Web site.

35(i) The department shall ensure, to the greatest degree possible,
36that the categories of data and performance measures selected
37under this section are consistent with the categories of data and
38performance measures selected under Section 14459.6.

P6    1

SEC. 2.  

Article 4.10 (commencing with Section 14149.8) is
2added to Chapter 7 of Part 3 of Division 9 of the Welfare and
3Institutions Code
, to read:

4 

5Article 4.10.  Medi-Cal Dental Program
6

 

7

14149.8.  

(a) The department shall expedite the enrollment of
8Medi-Cal dental providers by streamlining the Medi-Cal provider
9enrollment process. The department shall pursuebegin insert and implementend insert
10 all of the following activities, to the extent permitted by federal
11law:

12(1) Create a dental-specific enrollment form.

13(2) Pursue an alternative automatic enrollment process for a
14provider already commercially credentialed by either a dental
15fee-for-service contractor or an administrative services contractor
16for the purpose of providing services as a commercial provider.

17(3) Discontinue requiring providers to resubmit an enrollment
18application that has been deemed incomplete if the missing
19information is available elsewhere within the application packet.

20(4) To the extent that the department expedites the enrollment
21of Medi-Cal dental providers by streamlining the Medi-Cal
22provider enrollment process, the department shall publish the
23criteria for those processes in applicable provider bulletins and
24manuals.

25(b) (1) The department shall maintain the provider network by
26disenrolling a billing and rendering provider who has not, over a
27continuous 12-month period, submitted a claim for reimbursement
28for services rendered.

29(2) Prior to disenrolling a provider described in paragraph (1),
30the department shall send a notice to the provider that the provider
31shall be disenrolled from the dental program six months after the
32date of the notice. The department shall not disenroll a provider
33pursuant to paragraph (1) until six months after the date of that
34notice.

35 (3) In order to improve the quality of the dental provider
36network, the department also shall exercise additional measures
37as appropriate and permitted by law, including, but not limited to,
38temporary suspensions.begin insert The parameters and criteria developed by
39 the department for additional measures for disenrollments shall
40be published in applicable provider bulletins and manuals.end insert

P7    1(c) (1) The department shall monitor access and utilization of
2Medi-Cal dental services in the fee-for-service and managed care
3delivery systems to assess opportunities to improve access and
4utilization.

5(2) The department shall assess opportunities to develop and
6implement innovative payment reform proposals within the
7Medi-Cal dental programs.

8(d) The department shall explore additional opportunities to
9improve the Medi-Cal Dental Program, in consultation with
10stakeholders and as deemed appropriate by the department and to
11the extent permitted by federal law, including, but not limited to,
12the following:

13(1) Aligning the provision of dental anesthesia services with
14that of medical anesthesia services, including the ability to bill for
15applicable facility fees and ancillary services.

16(2) Adjusting other utilization controls for specialty services,
17as appropriate, to promote access to care while still protecting
18program integrity.

19(3)  Expanding the scope of beneficiary outreach activities
20required by an entity that is contracted with the department to more
21broadly address underutilization throughout the state.

22(e) Prior to implementing an action pursuant to subdivisionbegin delete (g),end delete
23begin insert (d),end insert the department shall post the proposed action on its Internet
24Web site at least 30 days before implementation.

25(f) The department shall work with dental managed care plans
26that contract with the department for the purposes of implementing
27the Medi-Cal Dental Program, which includes, but is not limited
28to, contracts authorized pursuant to Sections 14087.46, 14089, and
2914104.3, to provide beneficiaries with access tobegin insert dentalend insert plan liaisons
30to assist in the coordination of care for enrolled members.

31(g) A Medi-Cal managed care health plan shall do all of the
32following:

33(1) Provide dental screenings for every eligible beneficiary as
34a part of the beneficiary’s initial health assessment.

35(2) Ensure that an eligible beneficiary is referred to an
36appropriate Medi-Cal dental provider.

37(3) Identify plan liaisons available to dental managed care
38contractors and dental fee-for-service contractors to assistbegin delete in
39coordination of care.end delete
begin insert with referrals to health plan covered services
P8    1that may be needed by the beneficiary to aid in the treatment of
2an identified oral health care condition.end insert

3(h) (1) To increase the efficiency and timeliness of changes,
4any contract amendment, modification, or change order to any
5contract entered into by the department for the purposes of
6implementing the state Medi-Cal Dental Program shall be exempt,
7except as provided in paragraph (2), from Part 2 (commencing
8with Section 10100) of Division 2 of the Public Contract Code, as
9well as Sections 11545 and 11546 of the Government Code, in
10addition to any policies, procedures, or regulations authorized by
11those provisions.

12(2) Paragraph (1) shall not exempt the department from
13establishing a competitive bid process for awarding new contracts
14pursuant to Section 14104.3, as well as for awarding new dental
15contracts pursuant to Sections 14087.46 and 14089.

16(i) Prior to implementing any change pursuant to this section,
17the department shall consult with, and provide notification to,
18stakeholders, including representatives from counties, local dental
19societies, nonprofit entities, legal aid entities, and other interested
20parties.

21(j) begin insert(1)end insertbegin insertend insert Notwithstanding Chapter 3.5 (commencing with Section
2211340) of Part 1 of Division 3 of Title 2 of the Government Code,
23the department, without taking any further regulatory action, shall
24implement, interpret, or make specific policies and procedures
25pertaining to the dental fee-for-service program and dental managed
26care plans, as well as applicable federal waivers and state plan
27amendments, including the provisions set forth in this section, by
28means of all-county letters, plan letters, plan or provider bulletins,
29or similar instructions until regulations are adopted.begin delete Thereafter,end delete

30begin insert(2)end insertbegin insertend insertbegin insertNo later than December 31, 2018, end insertthe department shall adopt
31regulations in accordance with the requirements of Chapter 3.5
32(commencing with Section 11340) of Part 1 of Division 3 of Title
332 of the Government Code. Beginning six months after the effective
34date of this section, and notwithstanding Section 10231.5 of the
35Government Code, the department shall provide a status report to
36the Legislature on a semiannual basis until regulations have been
37adopted.

38(k) This section shall be implemented only to the extent that all
39of the following occur:

P9    1(1) The department obtains any federal approvals necessary to
2implement this section.

3(2) The department obtains federal matching funds to the extent
4permitted by federal law.

begin delete

5(3) The department receives an appropriation in the annual
6Budget Act each fiscal year for the specific purpose of
7implementing this section.

end delete
8

SEC. 3.  

Section 14459.6 of the Welfare and Institutions Code
9 is amended to read:

10

14459.6.  

(a) The department shall establish a list of
11performance measures to ensure dental health plans meet quality
12criteria required by the department. The list shall specify the
13benchmarks used by the department to determine whether and the
14extent to which a dental health plan meets each performance
15measure. Commencing January 1, 2013, and quarterly thereafter,
16the list of performance measures established by the department
17along with each plan’s performance shall be posted on the
18department’s Internet Web site. The Department of Managed
19Health Care and the advisory committee established pursuant to
20Section 14089.08 shall have access to all performance measures
21and benchmarks used by the department as described in this
22section.

23(1) Commencing April 30, 2017, the quarterly reporting required
24by this subdivision shall be posted in the following manner:

25(A) On or before April 30, 2017, the reporting shall be posted
26for the July 2016 to September 2016, inclusive, fiscal quarter.

27(B) After April 30, 2017, the reporting shall be posted on a
28quarterly basis on or before April 30, July 31, October 31, and
29January 31 for the fiscal quarter ending seven months prior.

30(2) The performance measures established by the department
31shall include, but not be limited to, all of the following: provider
32network adequacy, overall utilization of dental services, annual
33dental visits, the total number of patients seen on a per-provider
34basis and the total number of dental services rendered by each
35provider during each calendar year, use of preventive dental
36services, use of dental treatment services, use of examinations and
37oral health evaluations, sealant to restoration ratio, filling to
38preventive services ratio, treatment to caries prevention ratio, use
39of dental sealants, use of diagnostic services, and survey of member
40satisfaction with plans and providers.

P10   1(3) The survey of member satisfaction with plans and providers
2shall be the same dental version of the Consumer Assessment of
3Healthcare Providers and Systems (CAHPS) survey as used by
4the Healthy Families Program.

5(4) The department shall notify dental health plans at least 30
6days prior to the implementation date of these performance
7measures.

8(5) The department shall include the initial list of performance
9measures and benchmarks in any dental health contracts entered
10into between the department and a dental health plan pursuant to
11Section 14204.

12(6) The department shall update performance measures and
13benchmarks and establish additional performance measures and
14benchmarks in accordance with all of the following:

15(A) The department shall consider performance measures and
16benchmarks established by other states, the federal government,
17and national organizations developing dental program performance
18and quality measures.

19(B) The department shall notify dental health plans at least 30
20days prior to the implementation date of updates or changes to
21performance measures and benchmarks. The department shall also
22post these updates or changes on its Internet Web site at least 30
23days prior to implementation in order to provide transparency to
24the public.

25(C) To ensure that the dental health needs of Medi-Cal
26beneficiaries are met, the department shall, when evaluating
27performance measures and benchmarks for retention on, addition
28to, or deletion from the list, consider all of the following criteria:

29(i) Monthly, quarterly, annual, and multiyear Medi-Cal dental
30managed care trended data.

31(ii) County and statewide Medi-Cal dental fee-for-service
32performance and quality ratings.

33(iii) Other state and national dental program performance and
34quality measures.

35(iv) Other state and national performance ratings.

36(b) In establishing and updating the performance measures and
37benchmarks, the department shall consult the advisory committee
38established pursuant to Section 14089.08, as well as dental health
39plan representatives and other stakeholders, including
P11   1representatives from counties, local dental societies, nonprofit
2entities, legal aid entities, and other interested parties.

3(c) In evaluating a dental health plan’s ability to meet the criteria
4established through the performance measures and benchmarks,
5the department shall select specific performance measures from
6those established by the department in subdivision (a) as the basis
7for establishing financial or other incentives or disincentives,
8including, but not limited to, bonuses, payment withholds, and
9adjustments to beneficiary assignment to plan algorithms. These
10incentives and disincentives shall be included in the dental health
11plan contracts.

12(d) (1) The department shall designate an external quality
13review organization (EQRO) that shall conduct external quality
14reviews for any dental health plan contracting with the department
15pursuant to Section 14204.

16(2) As determined by the department, but at least annually,
17dental health plans shall arrange for an external quality of care
18review with the EQRO designated by the department that evaluates
19the dental health plan’s performance in meeting the performance
20measures established in this section. Dental health plans shall
21cooperate with and assist the EQRO in this review. The Department
22of Managed Health Care shall have direct access to all external
23quality of care review information upon request to the department.

24(3) An external quality of care review shall include, but not be
25limited to, all of the following: performance on the selected
26performance measures and benchmarks established and updated
27by the department, the CAHPS member or consumer satisfaction
28survey referenced in paragraph (2) of subdivision (a), reporting
29systems, and methodologies for calculating performance measures.
30An external quality of care review that includes all of the above
31components shall be paid for by the dental health plan and posted
32online annually, or at any other frequency specified by the
33department, on the department’s Internet Web site.

34(e) All marketing methods and activities to be used by dental
35plans shall comply with subdivision (b) of Section 10850, Sections
3614407.1, 14408, 14409, 14410, and 14411, and Title 22 of the
37California Code of Regulations, including Sections 53880 and
3853881. Each dental plan shall submit its marketing plan to the
39department for review and approval.

P12   1(f) Each dental plan shall submit its member services procedures,
2beneficiary informational materials, and any updates to those
3procedures or materials to the department for review and approval.
4The department shall ensure that member services procedures and
5beneficiary informational materials are clear and provide timely
6and fair processes for accepting and acting upon complaints,
7grievances, and disenrollment requests, including procedures for
8appealing decisions regarding coverage or benefits.

9(g) Each dental plan shall submit its provider compensation
10agreements to the department for review and approval.

11(h) The department shall post to its Internet Web site a copy of
12all final reports completed by the Department of Managed Health
13Care regarding dental managed care plans.

14(i) The department shall ensure, to the greatest degree possible,
15that the categories of data and performance measures selected
16under this section are consistent with the categories of data and
17performance measures selected under Section 14132.915.

18begin insert

begin insertSEC. 4.end insert  

end insert

begin insertSection 14184.72 is added to the end insertbegin insertWelfare and
19Institutions Code
end insert
begin insert, end insertimmediately following Section 14184.71begin insert, to
20read:end insert

begin insert
21

begin insert14184.72.end insert  

In connection with the evaluation of the DTI required
22by Section 14184.71, the department’s report of data and quality
23measures submitted to the federal Centers for Medicare and
24Medicaid Services (CMS) and made publicly available pursuant
25to the Special Terms and Conditions for the Increase Preventive
26Services Utilization for Children domain shall include, but not be
27limited to, all of the following:

28
(a) A detailed description of how the department has
29operationalized the domain, including information identifying
30which entities have responsibility for the components of the domain.

31
(b) The number of individual incentives paid and the total
32amount expended under the domain for the current program year.

33
(c) An awareness plan that describes all of the following:

34
(1) How the department has generated awareness of the
35availability of incentives for providing preventive dental services
36to children, including steps taken to increase awareness of the DTI
37among dental and primary care providers.

38
(2) How the department has generated awareness among
39beneficiaries of the availability of, the importance of, and how to
40access preventive dental services for children.

P13   1
(3) The different approaches to raising awareness undertaken
2among specific groups, including age groups, rural and urban
3residents, and primary language groups.

4
(d) An analysis of whether the awareness plan described in
5subdivision (c) has succeeded in generating the utilization
6necessary, by subgrouping, to meet the goals of the domain, and
7a description of changes to the awareness plan needed to address
8any identified deficiencies.

9
(e) Data describing both of the following:

10
(1) The use of, and expenditures on, preventive dental services.

11
(2) The use of, and expenditures on, other nonpreventive dental
12services.

13
(f) A discussion of the extent to which the metrics described for
14the domain are proving to be useful in understanding the
15effectiveness of the activities undertaken in the domain.

16
(g) An analysis of changes in cost per capita.

17
(h) A descriptive analysis of program integrity challenges
18 generated by the domain and how those challenges have been, or
19will be, addressed.

20
(i) A descriptive analysis of the overall effectiveness of the
21activities in the domain in meeting the intended goals of the
22domain, any lessons learned, and any recommended adjustments.

end insert
23begin insert

begin insertSEC. 5.end insert  

end insert

begin insertSection 14184.73 is added to the end insertbegin insertWelfare and
24Institutions Code
end insert
begin insert, to read:end insert

begin insert
25

begin insert14184.73.end insert  

In connection with the evaluation of the DTI required
26by Section 14184.71, the department’s report of data and quality
27measures submitted to the federal Centers for Medicare and
28Medicaid Services (CMS) and made publicly available pursuant
29to the Special Terms and Conditions for the Caries Risk Assessment
30(CRA) and Disease Management Pilot domain shall include, but
31not be limited to, all of the following:

32
(a) A detailed description of how the department has
33operationalized the domain, including information identifying
34which entities have responsibility for the components of the domain.

35
(b) The number of individual incentives paid and the total
36amount expended, by county, under the domain in the current
37demonstration year.

38
(c) A descriptive assessment of the impact of the domain on
39targeted children in the age ranges of under one year of age, one
P14   1through two years of age, three through four years of age, and five
2through six years of age, for all of the following:

3
(1) Provision of CRAs.

4
(2) Provision of dental exams.

5
(3) Use of, and expenditures on, preventive dental services.

6
(4) Use of, and expenditures on, dental treatment services.

7
(5) Use of, and expenditures on, dental-related general
8anesthesia.

end insert
9begin insert

begin insertSEC. 6.end insert  

end insert

begin insertSection 14184.74 is added to the end insertbegin insertWelfare and
10Institutions Code
end insert
begin insert, to read:end insert

begin insert
11

begin insert14184.74.end insert  

In connection with the evaluation of the DTI required
12by Section 14184.71, the department’s report of data and quality
13measures submitted to the federal Centers for Medicare and
14Medicaid Services (CMS) and made publicly available pursuant
15to the Special Terms and Conditions for the Increase Continuity
16of Care domain shall include, but not be limited to, all of the
17following:

18
(a) A detailed description of how the department has
19operationalized the domain, including information identifying
20which entities have responsibility for the components of the domain.

21
(b) The number of individual incentives paid and the total
22amount expended, by county, under the domain in the current
23demonstration year.

24
(c) A descriptive assessment of the impact of the domain, with
25respect to targeted children, of all of the following:

26
(1) Provision of dental exams.

27
(2) Use of, and expenditures on, preventive dental services.

28
(3) Use of, and expenditures on, other nonpreventive dental
29services.

30
(d) A discussion of the extent to which the metrics prescribed
31for the domain are proving to be useful in understanding the
32effectiveness of the activities undertaken in the domain.

33
(e) An analysis of change in cost per capita.

34
(f) A descriptive analysis of program integrity challenges
35 generated by the domain and how those challenges have been, or
36will be, addressed.

37
(g) A descriptive analysis of the overall effectiveness of the
38activities in the domain in meeting the intended goals of the
39domain, any lessons learned, and any recommended adjustments.

end insert
P15   1begin insert

begin insertSEC. 7.end insert  

end insert

begin insertSection 14184.75 is added to the end insertbegin insertWelfare and
2Institutions Code
end insert
begin insert, to read:end insert

begin insert
3

begin insert14184.75.end insert  

In connection with the evaluation of the DTI required
4by Section 14184.71, the department’s report of data and quality
5measures submitted to the federal Centers for Medicare and
6Medicaid Services (CMS) and made publicly available pursuant
7to the Special Terms and Conditions for the Local Dental Pilot
8Program domain shall include, but not be limited to, all of the
9following:

10
(a) A detailed description of how the department has
11operationalized the domain, including information identifying
12which entities have responsibility for the components of the domain.

13
(b) The number of individual incentives paid and the total
14amount expended, by county, under the domain in the current
15demonstration year.

16
(c) A description of the pilot projects selected for award that
17for each project shall include, but not be limited to, all of the
18following:

19
(1) Specific strategies for the project.

20
(2) Target populations.

21
(3) Payment methodologies.

22
(4) Annual budget for the project.

23
(5) Expected duration of the project.

24
(6) Performance metrics by which the project shall be measured.

25
(7) The intended goal of the project.

26
(d) An assessment of the pilot projects selected for award that
27includes for each project all of the following:

28
(1) Project performance and outcomes.

29
(2) Project replicability.

30
(3) Challenges encountered and actions undertaken to address
31those challenges.

32
(4) Information on payments made by the department to the
33project.

34
(e) A descriptive assessment of the impact of the Local Dental
35Pilot Program domain on achieving the goals of the Increase
36Preventive Services Utilization for Children, Caries Risk
37Assessment (CRA) and Disease Management Pilot, and Increase
38Continuity of Care domains.

P16   1
(f) A descriptive analysis of program integrity challenges
2generated by the domain and how those challenges have been, or
3will be, addressed.

end insert


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