Amended in Senate June 28, 2016

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, to add Sections 14184.72, 14184.73, 14184.74, and 14184.75 to, 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 obtains any necessary federal approvals and federal matching funds.

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 addbegin insert performance measuresend insert to thebegin delete performance measuresend deletebegin insert listsend insert for both the dental fee-for-service program and dental plans describedbegin delete 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.end deletebegin insert above, as specified.end insert 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.

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 Medicaidbegin delete Services.end deletebegin insert Services (CMS).end insert 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.

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.

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.

begin delete

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
P4    1oral health evaluations rendered by each provider during each
2calendar year.

end delete
begin insert

3
(B) For each provider, all of the following:

end insert
begin insert

4
(i) Number of annual dental visits.

end insert
begin insert

5
(ii) Number of patients seen during the calendar year.

end insert
begin insert

6
(iii) Number of annual preventive dental services.

end insert
begin insert

7
(iv) Number of annual dental treatment services.

end insert
begin insert

8
(v) Number of annual examinations and oral health evaluations.

end insert

9(C) Number of applications of dentalbegin delete sealants.end deletebegin insert sealants and
10fluoride varnishes.end insert

11(D) Continuity of care and overall utilization over an extended
12period of time.

13(E) All of the following ratios:

14(i) Sealant to restoration.

15(ii) Filling to preventive services.

16(iii) Treatment to caries prevention.

begin insert

17
(F) Number of beneficiaries requiring general anesthesia to
18perform procedures.

end insert

19(4) The performance measures established by the department
20to monitor the dental fee-for-service program for adults shall
21include, but not be limited to, all of the following:

begin delete

22(A) Number of annual dental visits and preventive dental
23services, the total number of patients seen on a per-provider basis,
24and the total number of dental services rendered by each provider
25during each calendar year.

end delete
begin insert

26
(A) Overall utilization of dental services.

end insert
begin insert

27
(B) For each provider, all of the following:

end insert
begin insert

28
(i) Number of annual dental visits.

end insert
begin insert

29
(ii) Number of patients seen during the calendar year.

end insert
begin insert

30
(iii) Number of annual preventive dental services.

end insert
begin insert

31
(iv) Number of annual dental treatment services.

end insert
begin insert

32
(v) Number of annual examinations and oral health evaluations.

end insert
begin delete

15 33(B)

end delete

34begin insert(C)end insert Treatment to caries prevention ratio.

35(5) The performance measures shall be reported as aggregate
36numbers and as percentages, if appropriate, using standards that
37are as equivalent to those used by managed care entities as feasible.
38Performance measures for the dental fee-for-service program for
39children shall be reported by age groupings if appropriate.

P5    1(b) The department shall include the initial list of performance
2 measures in any dental contract entered into between the
3department and a fee-for-service contractor on or after enactment
4of this section.

5(c) To ensure that the dental health needs of Medi-Cal
6beneficiaries are met, the department shall, when evaluating
7performance measures for retention on, addition to, or deletion
8from, the list of performance measures, consider all of the
9following criteria:

10(1) Annual and multiyear Medi-Cal dental fee-for-service
11trended data.

12(2) Other state and national dental program performance and
13quality measures.

14(3) Other state and national performance ratings.

15(d) On October 1, 2014, for the 2013 calendar year, and on or
16before October 1, 2016, for the 2015 calendar year, the list of
17performance measures established by the department along with
18the data of the dental fee-for-service program performance shall
19be posted on the department’s Internet Web site.

20(e) Commencing January 31, 2017, for the 2015-16 fiscal year,
21and annually on or before January 31 for each preceding fiscal
22year thereafter, the list of performance measures established by
23the department along with the data of the dental fee-for-service
24program shall be posted on the department’s Internet Web site.

25(f) Commencing April 30, 2017, for the July 2016 to September
262016, inclusive, fiscal quarter, and quarterly thereafter on or before
27April 30, July 31, October 31, and January 31 for the fiscal quarter
28ending seven months prior, the data of the dental fee-for-service
29program performance shall be posted on the department’s Internet
30Web site.

31(g) The department may amend or remove performance
32measures and establish additional performance measures in
33accordance with all of the following:

34(1) The department shall consider performance measures
35established by other states, the federal government, and national
36organizations developing dental program performance and quality
37measures.

38(2) The department shall notify a fee-for-service contractor, at
39least 30 days prior to the implementation date, of any updates or
40changes to performance measures. The department shall also post
P6    1these updates or changes on its Internet Web site at least 30 days
2prior to implementation in order to maintain transparency to the
3public.

4(3) In establishing the performance measures, the department
5shall consult with stakeholders, including representatives from
6counties, local dental societies, nonprofit entities, legal aid entities,
7and other interested parties.

8(h) The department shall annually prepare a summary report of
9the nature and types of complaints and grievances regarding access
10to, and quality of, dental services, including the outcome.
11Commencing January 31, 2017, for the prior fiscal year, and
12annually thereafter, for each preceding fiscal year, this report shall
13be posted on the department’s Internet Web site.

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 14459.6.

18

SEC. 2.  

Article 4.10 (commencing with Section 14149.8) is
19added to Chapter 7 of Part 3 of Division 9 of the Welfare and
20Institutions Code
, to read:

21 

22Article 4.10.  Medi-Cal Dental Program
23

 

24

14149.8.  

(a) The department shall expedite the enrollment of
25Medi-Cal dental providers by streamlining the Medi-Cal provider
26enrollment process. The department shall pursue and implement
27all of the following activities, to the extent permitted by federal
28law:

29(1) Create a dental-specific enrollment form.

30(2) Pursue an alternative automatic enrollment process for a
31provider already commercially credentialed by either a dental
32fee-for-service contractor or an administrative services contractor
33for the purpose of providing services as a commercial provider.

34(3) Discontinue requiring providers to resubmit an enrollment
35application that has been deemed incomplete if the missing
36information is available elsewhere within the application packet.

37(4) To the extent that the department expedites the enrollment
38of Medi-Cal dental providers by streamlining the Medi-Cal
39provider enrollment process, the department shall publish the
P7    1criteria for those processes in applicable provider bulletins and
2manuals.

3(b) (1) The department shallbegin insert continuouslyend insert maintain the provider
4network by disenrolling a billing and rendering provider who has
5not, over a continuous 12-month period, submitted a claim for
6reimbursement for services rendered.

7(2) Prior to disenrolling a provider described in paragraph (1),
8the department shall send a notice to the provider that the provider
9shall be disenrolled from the dental program six months after the
10date of the notice. The department shall not disenroll a provider
11pursuant to paragraph (1) until six months after the date of that
12notice.

13 (3) In order to improve the quality of the dental provider
14network, the department also shall exercise additional measures
15as appropriate and permitted by law, including, but not limited to,
16temporary suspensions. The parameters and criteria developed by
17 the department for additional measures for disenrollments shall
18be published in applicable provider bulletins and manuals.

19(c) (1) The department shall monitor access and utilization of
20Medi-Cal dental services in the fee-for-service and managed care
21delivery systems to assess opportunities to improve access and
22
begin delete utilization.end deletebegin insert utilization, including an annual review of the treatment
23authorization review process.end insert

24(2) The department shall assess opportunities to develop and
25implement innovative payment reform proposals within the
26Medi-Cal dental programs.

27(d) The department shall explore additional opportunities to
28improve the Medi-Cal Dental Program, in consultation with
29stakeholders and as deemed appropriate by the department and to
30the extent permitted by federal law, including, but not limited to,
31the following:

32(1) Aligning the provision of dental anesthesia services with
33that of medical anesthesia services, including the ability to bill for
34applicable facility fees and ancillary services.

35(2) Adjusting other utilization controls for specialty services,
36as appropriate, to promote access to care while still protecting
37program integrity.

38(3) Expanding the scope of beneficiary outreach activities
39required by an entity that is contracted with the department to more
40broadly address underutilization throughout the state.

P8    1(e) Prior to implementing an action pursuant to subdivision (d),
2the department shall post the proposed action on its Internet Web
3site at least 30 days before implementation.

4(f) The department shall work with dental managed care plans
5that contract with the department for the purposes of implementing
6the Medi-Cal Dental Program, which includes, but is not limited
7to, contracts authorized pursuant to Sections 14087.46, 14089, and
814104.3, to provide beneficiaries with access to dental plan liaisons
9to assist in the coordination of care for enrolled members.

10(g) A Medi-Cal managed care health plan shall do all of the
11following:

12(1) Provide dental screenings for every eligible beneficiary as
13a part of the beneficiary’s initial health assessment.

14(2) Ensure that an eligible beneficiary is referred to an
15appropriate Medi-Cal dental provider.

16(3) Identify plan liaisons available to dental managed care
17contractors and dental fee-for-service contractors to assist with
18referrals to health plan coveredbegin delete services that may be needed by
19the beneficiary to aid in the treatment of an identified oral health
20care condition.end delete
begin insert services.end insert

21(h) (1) To increase the efficiency and timeliness of changes,
22any contract amendment, modification, or change order to any
23contract entered into by the department for the purposes of
24implementing the state Medi-Cal Dental Program shall be exempt,
25except as provided in paragraph (2), from Part 2 (commencing
26with Section 10100) of Division 2 of the Public Contract Code, as
27well as Sections 11545 and 11546 of the Government Code, in
28addition to any policies, procedures, or regulations authorized by
29those provisions.

30(2) Paragraph (1) shall not exempt the department from
31establishing a competitive bid process for awarding new contracts
32pursuant to Section 14104.3, as well as for awarding new dental
33contracts pursuant to Sections 14087.46 and 14089.

34(i) Prior to implementing any change pursuant to this section,
35the department shall consult with, and provide notification to,
36stakeholders, including representatives from counties, local dental
37societies, nonprofit entities, legal aid entities, and other interested
38parties.

39(j) (1) Notwithstanding Chapter 3.5 (commencing with Section
4011340) of Part 1 of Division 3 of Title 2 of the Government Code,
P9    1the department, without taking any further regulatory action, shall
2implement, interpret, or make specific policies and procedures
3pertaining to the dental fee-for-service program and dental managed
4care plans, as well as applicable federal waivers and state plan
5amendments, including the provisions set forth in this section, by
6means of all-county letters, plan letters, plan or provider bulletins,
7or similar instructions until regulations are adopted.

8(2) No later than December 31, 2018, the department shall adopt
9regulations in accordance with the requirements of Chapter 3.5
10(commencing with Section 11340) of Part 1 of Division 3 of Title
112 of the Government Code. Beginning six months after the effective
12date of this section, and notwithstanding Section 10231.5 of the
13Government Code, the department shall provide a status report to
14the Legislature on a semiannual basis until regulations have been
15adopted.

16(k) This section shall be implemented only to the extent that all
17of the following occur:

18(1) The department obtains any federal approvals necessary to
19implement this section.

20(2) The department obtains federal matching funds to the extent
21permitted by federal law.

22

SEC. 3.  

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

24

14459.6.  

(a) The department shall establish a list of
25performance measures to ensure dental health plans meet quality
26criteria required by the department. The list shall specify the
27benchmarks used by the department to determine whether and the
28extent to which a dental health plan meets each performance
29measure. Commencing January 1, 2013, and quarterly thereafter,
30the list of performance measures established by the department
31along with each plan’s performance shall be posted on the
32department’s Internet Web site. The Department of Managed
33Health Care and the advisory committee established pursuant to
34Section 14089.08 shall have access to all performance measures
35and benchmarks used by the department as described in this
36section.

37(1) Commencing April 30, 2017, the quarterly reporting required
38by this subdivision shall be posted in the following manner:

39(A) On or before April 30, 2017, the reporting shall be posted
40for the July 2016 to September 2016, inclusive, fiscal quarter.

P10   1(B) After April 30, 2017, the reporting shall be posted on a
2quarterly basis on or before April 30, July 31, October 31, and
3January 31 for the fiscal quarter ending seven months prior.

4(2) The performance measures established by the department
5shall include, but not be limited to, all of the following: provider
6network adequacy, overall utilization of dental services, annual
7dental visits, the total number of patients seen on a per-provider
8basis and the total number of dental services rendered by each
9provider during each calendar year, use of preventive dental
10services, use of dental treatment services, use of examinations and
11oral health evaluations, sealant to restoration ratio, filling to
12preventive services ratio, treatment to caries prevention ratio, use
13of dental sealants, use of diagnostic services,begin insert use of general
14anesthesia for dental services,end insert
and survey of member satisfaction
15with plans and providers.

16(3) The survey of member satisfaction with plans and providers
17shall be the same dental version of the Consumer Assessment of
18Healthcare Providers and Systems (CAHPS) survey as used by
19the Healthy Families Program.

20(4) The department shall notify dental health plans at least 30
21days prior to the implementation date of these performance
22measures.

23(5) The department shall include the initial list of performance
24measures and benchmarks in any dental health contracts entered
25into between the department and a dental health plan pursuant to
26Section 14204.

27(6) The department shall update performance measures and
28benchmarks and establish additional performance measures and
29benchmarks in accordance with all of the following:

30(A) The department shall consider performance measures and
31benchmarks established by other states, the federal government,
32and national organizations developing dental program performance
33and quality measures.

34(B) The department shall notify dental health plans at least 30
35days prior to the implementation date of updates or changes to
36performance measures and benchmarks. The department shall also
37post these updates or changes on its Internet Web site at least 30
38days prior to implementation in order to provide transparency to
39the public.

P11   1(C) To ensure that the dental health needs of Medi-Cal
2beneficiaries are met, the department shall, when evaluating
3performance measures and benchmarks for retention on, addition
4to, or deletion from the list, consider all of the following criteria:

5(i) Monthly, quarterly, annual, and multiyear Medi-Cal dental
6managed care trended data.

7(ii) County and statewide Medi-Cal dental fee-for-service
8performance and quality ratings.

9(iii) Other state and national dental program performance and
10quality measures.

11(iv) Other state and national performance ratings.

12(b) In establishing and updating the performance measures and
13benchmarks, the department shall consult the advisory committee
14established pursuant to Section 14089.08, as well as dental health
15plan representatives and other stakeholders, including
16representatives from counties, local dental societies, nonprofit
17entities, legal aid entities, and other interested parties.

18(c) In evaluating a dental health plan’s ability to meet the criteria
19established through the performance measures and benchmarks,
20the department shall select specific performance measures from
21those established by the department in subdivision (a) as the basis
22for establishing financial or other incentives or disincentives,
23including, but not limited to, bonuses, payment withholds, and
24adjustments to beneficiary assignment to plan algorithms. These
25incentives and disincentives shall be included in the dental health
26plan contracts.

27(d) (1) The department shall designate an external quality
28review organization (EQRO) that shall conduct external quality
29reviews for any dental health plan contracting with the department
30pursuant to Section 14204.

31(2) As determined by the department, but at least annually,
32dental health plans shall arrange for an external quality of care
33review with the EQRO designated by the department that evaluates
34the dental health plan’s performance in meeting the performance
35measures established in this section. Dental health plans shall
36cooperate with and assist the EQRO in this review. The Department
37of Managed Health Care shall have direct access to all external
38quality of care review information upon request to the department.

39(3) An external quality of care review shall include, but not be
40limited to, all of the following: performance on the selected
P12   1performance measures and benchmarks established and updated
2by the department, the CAHPS member or consumer satisfaction
3survey referenced in paragraph (2) of subdivision (a), reporting
4systems, and methodologies for calculating performance measures.
5An external quality of care review that includes all of the above
6components shall be paid for by the dental health plan and posted
7online annually, or at any other frequency specified by the
8department, on the department’s Internet Web site.

9(e) All marketing methods and activities to be used by dental
10plans shall comply with subdivision (b) of Section 10850, Sections
1114407.1, 14408, 14409, 14410, and 14411, and Title 22 of the
12California Code of Regulations, including Sections 53880 and
13begin delete 53881.end deletebegin insert 53881 of Title 22 of the California Code of Regulations.end insert
14 Each dental plan shall submit its marketing plan to the department
15for review and approval.

16(f) Each dental plan shall submit its member services procedures,
17beneficiary informational materials, and any updates to those
18procedures or materials to the department for review and approval.
19The department shall ensure that member services procedures and
20beneficiary informational materials are clear and provide timely
21and fair processes for accepting and acting upon complaints,
22grievances, and disenrollment requests, including procedures for
23appealing decisions regarding coverage or benefits.

24(g) Each dental plan shall submit its provider compensation
25agreements to the department for review and approval.

26(h) The department shall post to its Internet Web site a copy of
27all final reports completed by the Department of Managed Health
28Care regarding dental managed care plans.

29(i) The department shall ensure, to the greatest degree possible,
30that the categories of data and performance measures selected
31under this section are consistent with the categories of data and
32performance measures selected under Section 14132.915.

33

SEC. 4.  

Section 14184.72 is added to the Welfare and
34Institutions Code
, immediately following Section 14184.71, to
35read:

36

14184.72.  

In connection with the evaluation of the DTI required
37by Section 14184.71, the department’s report of data and quality
38measures submitted to the federal Centers for Medicare and
39Medicaid Services (CMS) and made publicly available pursuant
40to the Special Terms and Conditions for the Increase Preventive
P13   1Services Utilization for Children domain shall include, but not be
2limited to, all of the following:

3(a) A detailed description of how the department has
4operationalized the domain, including information identifying
5which entities have responsibility for the components of the
6domain.

7(b) The number of individual incentives paid and the total
8amount expended under the domain for the current program year.

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

10(1) How the department has generated awareness of the
11availability of incentives for providing preventive dental services
12to children, including steps taken to increase awareness of the DTI
13among dental and primary care providers.

14(2) How the department has generated awareness among
15beneficiaries of the availability of, the importance of, and how to
16access preventive dental services for children.

17(3) The different approaches to raising awareness undertaken
18among specific groups, including age groups, rural and urban
19residents, and primary language groups.

20(d) An analysis of whether the awareness plan described in
21subdivision (c) has succeeded in generating the utilization
22necessary, by subgrouping, to meet the goals of the domain, and
23a description of changes to the awareness plan needed to address
24any identified deficiencies.

25(e) Data describing both of the following:

26(1) The use of, and expenditures on, preventive dental services.

27(2) The use of, and expenditures on, other nonpreventive dental
28services.

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

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

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

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

39

SEC. 5.  

Section 14184.73 is added to the Welfare and
40Institutions Code
, to read:

P14   1

14184.73.  

In connection with the evaluation of the DTI required
2by Section 14184.71, the department’s report of data and quality
3measures submitted to the federal Centers for Medicare and
4Medicaid Servicesbegin delete (CMS)end delete and made publicly available pursuant
5to the Special Terms and Conditions for the Caries Risk
6Assessment (CRA) and Disease Management Pilot domain shall
7include, but not be limited to, all of the following:

8(a) A detailed description of how the department has
9operationalized the domain, including information identifying
10which entities have responsibility for the components of the
11domain.

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

15(c) A descriptive assessment of the impact of the domain on
16targeted children in the age ranges of under one year of age, one
17through two years of age, three through four years of age, and five
18through six years of age, for all of the following:

19(1) Provision of CRAs.

20(2) Provision of dental exams.

21(3) Use of, and expenditures on, preventive dental services.

22(4) Use of, and expenditures on, dental treatment services.

23(5) Use of, and expenditures on, dental-related general
24anesthesia.

25

SEC. 6.  

Section 14184.74 is added to the Welfare and
26Institutions Code
, to read:

27

14184.74.  

In connection with the evaluation of the DTI required
28by Section 14184.71, the department’s report of data and quality
29measures submitted to the federal Centers for Medicare and
30Medicaid Servicesbegin delete (CMS)end delete and made publicly available pursuant
31to the Special Terms and Conditions for the Increase Continuity
32of Care domain shall include, but not be limited to, all of the
33following:

34(a) A detailed description of how the department has
35operationalized the domain, including information identifying
36which entities have responsibility for the components of the
37domain.

38(b) The number of individual incentives paid and the total
39amount expended, by county, under the domain in the current
40demonstration year.

P15   1(c) A descriptive assessment of the impact of the domain, with
2respect to targeted children, of all of the following:

3(1) Provision of dental exams.

4(2) Use of, and expenditures on, preventive dental services.

5(3) Use of, and expenditures on, other nonpreventive dental
6services.

7(d) A discussion of the extent to which the metrics prescribed
8for the domain are proving to be useful in understanding the
9effectiveness of the activities undertaken in the domain.

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

11(f) A descriptive analysis of program integrity challenges
12 generated by the domain and how those challenges have been, or
13will be, addressed.

14(g) A descriptive analysis of the overall effectiveness of the
15activities in the domain in meeting the intended goals of the
16domain, any lessons learned, and any recommended adjustments.

17

SEC. 7.  

Section 14184.75 is added to the Welfare and
18Institutions Code
, to read:

19

14184.75.  

In connection with the evaluation of the DTI required
20by Section 14184.71, the department’s report of data and quality
21measures submitted to the federal Centers for Medicare and
22Medicaid Servicesbegin delete (CMS)end delete and made publicly available pursuant
23to the Special Terms and Conditions for the Local Dental Pilot
24Program domain shall include, but not be limited to, all of the
25following:

26(a) A detailed description of how the department has
27operationalized the domain, including information identifying
28which entities have responsibility for the components of the
29domain.

30(b) The number of individual incentives paid and the total
31amount expended, by county, under the domain in the current
32demonstration year.

33(c) A description of the pilot projects selected for award that
34for each project shall include, but not be limited to, all of the
35following:

36(1) Specific strategies for the project.

37(2) Target populations.

38(3) Payment methodologies.

39(4) Annual budget for the project.

40(5) Expected duration of the project.

P16   1(6) Performance metrics by which the project shall be measured.

2(7) The intended goal of the project.

3(d) An assessment of the pilot projects selected for award that
4includes for each project all of the following:

5(1) Project performance and outcomes.

6(2) Project replicability.

7(3) Challenges encountered and actions undertaken to address
8those challenges.

9(4) Information on payments made by the department to the
10project.

11(e) A descriptive assessment of the impact of the Local Dental
12Pilot Program domain on achieving the goals of the Increase
13Preventive Services Utilization for Children, Caries Risk
14Assessmentbegin delete (CRA)end delete and Disease Management Pilot, and Increase
15Continuity of Care domains.

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



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