(a)
(1)The department shall establish a list of performance measures to ensure the dental fee-for-service program meets quality and access criteria required by the department. The performance measures shall be designed to evaluate utilization, access, availability, and effectiveness of preventive care and treatment.(2)
Prior to establishing the quality and access criteria described in paragraph (1), the department shall consult with stakeholders, including representatives from counties, local dental societies, nonprofit entities, legal aid entities, and other interested parties.(3)
The performance measures established by the department to monitor the dental fee-for-service program for children shall include, but not be limited to, all of the following:(A)
Overall utilization of dental services.(B)
Number of annual dental visits, preventive dental services, dental treatment services, and examinations and oral health evaluations.(C)
Number of applications of dental sealants.(D)
Continuity of care and overall utilization over an extended period of time.(E)
All of the following ratios:(i)
Sealant to restoration.(ii)
Filling to preventive services. (iii)Treatment to caries prevention.(4)
The performance measures established by the department to monitor the dental fee-for-service program for adults shall include, but not be limited to, all of the following:(A)
Number of annual dental visits and preventive dental services.(B)
Treatment to caries prevention ratio.(5)
The performance measures shall be reported as aggregate numbers and as percentages, if appropriate, using standards that are as equivalent to those used by managed care entities as feasible. Performance measures for the dental fee-for-service program for children shall be reported by age groupings if appropriate.(b)
The department shall include the initial list of performance measures in any dental contract entered into between the department and a fee-for-service contractor on or after enactment of this section.(c)
To ensure that the dental health needs of Medi-Cal beneficiaries are met, the department shall, when evaluating performance measures for retention on, addition to, or deletion from, the list of performance measures, consider all of the following criteria:(1)
Annual and multiyear Medi-Cal dental fee-for-service trended data.(2)
Other state and national dental program performance and quality measures.(3)
Other state and national performance ratings.(d)
Commencing October 1, 2014, for the 2013 calendar year, and annually on or before October 1 for each preceding calendar year thereafter, the list of performance measures established by the department along with the data of the dental fee-for-service program performance shall be posted on the department’s Internet Web site.(e)
The department may amend or remove performance measures and establish additional performance measures in accordance with all of the following:(1)
The department shall consider performance measures established by other states, the federal government, and national organizations developing dental program performance and quality measures.(2)
The department shall notify a fee-for-service contractor, at least 30 days prior to the implementation date, of any updates or changes to performance measures. The department shall also post these updates or changes on its Internet Web site at least 30 days prior to implementation in order to maintain transparency to the public.(3)
In establishing the performance measures, the department shall consult with stakeholders, including representatives from counties, local dental societies, nonprofit entities, legal aid entities, and other interested parties.(f)
The department shall annually prepare a summary report of the nature and types of complaints and grievances regarding access to, and quality of, dental services, including the outcome. Commencing no sooner than October 1, 2015, for the prior calendar year, and annually thereafter, for each preceding calendar year, this report shall be posted on the department’s Internet Web site.
Source:
Section 14132.915, https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=WIC§ionNum=14132.915..