Medi-Cal: dental care.

Plain English Breakdown

The bill summary and digest do not specify exact amounts or details about extra payments.

Medi-Cal Dental Care Improvements

This law requires Medi-Cal to pay extra money for dental care that needs more time and attention due to special conditions, limits these payments to three times a year, and adds new services like behavior management and desensitization if needed.

What This Bill Does

• Requires Medi-Cal providers to get extra payment when they need to spend more time or use more staff to safely treat patients with physical, behavioral, developmental, or emotional conditions.
• Limits the number of times extra payments can be given in one year to three times.
• Adds behavior management and desensitization services as covered benefits under Medi-Cal if these are needed before a dental visit or during treatment due to special patient conditions.
• Conditions implementation on federal financial participation and necessary approvals.

Who It Names or Affects

• Medi-Cal providers who give dental care
• Patients with physical, behavioral, developmental, or emotional conditions requiring extra attention during dental visits

Terms To Know

Utilization controls

Rules that limit how often certain services can be used to make sure they are needed and not overused.

Behavior management

Helping patients learn to behave in ways that allow them to get dental care safely.

Limits and Unknowns

• The bill only applies if federal funding is available.
• It does not specify how much extra money providers will receive for additional services.
• Implementation details are left up to the State Department of Health Care Services through instructions like all-county letters and plan bulletins.

Official Summary Text

AB 1670, as amended, Arambula.
Medi-Cal:
additional compensation.
dental care.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services, including dental care, as specified. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.
Existing law establishes reimbursement rates for services provided by Medi-Cal providers to beneficiaries.
This bill would require that a provider be paid additional compensation when a patient’s physical, behavioral, developmental, or emotional condition requires significant extra time, attention, or personnel to safely deliver dental care. The bill would limit this additional payment to 3 times in a 12-month period.
This bill would make behavior management and desensitization services without an accompanying dental procedure covered benefits under the Medi-Cal program, subject to utilization controls, when a patient’s physical, behavioral, developmental, or emotional condition requires significant extra time, attention, or personnel, or requires such services preceding a dental visit, respectively, in order to safely deliver dental care. The bill would condition implementation of these provisions on the availability of federal financial participation and any necessary federal approvals having been obtained. The bill would, notwithstanding any other law, authorize the department to implement, interpret, or make specific these provisions by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions without taking any further regulatory action.

Current Bill Text

Download Bill PDF