Sacramento County Medi-Cal Dental Advisory Committee (MCDAC)

Transcription

1 Sacramento County Medi-Cal Dental Advisory Committee (MCDAC) MEETING AGENDA First 5 Sacramento Commission 2:00 pm 4:00 pm 2750 Gateway Oaks Drive, Ste. 330 Sacramento, CA Purpose: The purpose of the advisory committee is to provide oversight and guidance to improve Denti-Cal utilization rates, the delivery of oral health and dental care services, including prevention and education services, dental managed care and fee-for-service Denti-Cal. Authority: AB 1467 (Budget Committee), Effective July 1, 2012; Sacramento County BOS, Dec 11, 2012, Resolution No establishing a Sacramento County Medi-Cal Dental Advisory Committee & Resolution No appointing the initial membership to the Advisory Committee. Public comment may be given on any of the agenda items and before a vote. Chair: Terrence Jones, DDS Vice-Chair: Debra Payne, MSW Agenda Item Time Speaker 1. Welcome and Introductions 2:00-2:05 Dr. Jones 2. Approve April 6, 2017 Minutes Action Item 2:05-2:10 Dr. Jones 3. Approve New Member Action Item: Approve Jan 2:10-2:15 Dr. Jones Resler, DHHS seat 4. DHCS Update 2:15-2:45 DHCS Staff Staffing Update Dental Transformation Initiative What s The Status Dental Data Information Streamlined Provider Application February BDE Report May Revise and Tobacco Tax Prop. 56 General Anesthesia Update Managed Care Final Rule Report to the Legislature for CDA Update 2:45-2:55 Dharia McGrew 6. Dental Plan Updates Access Dental; Health Net Dental; LIBERTY Dental 2:55-3:10 Dental Plans 7. MCDAC Annual Update to the Board of Supervisors 3:10-3:20 Dr. Jones 8. Kindergarten Oral Health Assessment SB379 3:20-3:30 Katie Andrew 9. GA Ad Hoc Subcommittee Update 3:30-3:35 Cathy Levering 10. Every Smile Counts! Sacramento County s DTI-LDPP 3:35-3:45 Debra Payne Project 11. Member Updates 3:45-3:50 Julie Beyers 12. Agenda Items for Thursday, August 3, 2017 or future meetings 13 Other Items and Announcements Open for announcements Meeting Convener: First 5 Sacramento Staff: Julie Beyers, (916) , beyersju@saccounty.net Next Meeting: First Thursday Bi Monthly August 3, 2017, 2 pm to 4 pm 3:50-3:55 All 3:55-4:00 All First 5 Sacramento Page 1 of 18 MCDAC Meeting

2 DRAFT MEETING MINUTES April :00 pm 4:00 pm Location: First 5 Sacramento Commission 2750 Gateway Oaks Drive, Ste. 330 Sacramento, CA Sacramento County Medi-Cal Dental Advisory Committee (MCDAC) Purpose: The purpose of the advisory committee is to provide oversight and guidance to improve Denti-Cal utilization rates, the delivery of oral health and dental care services, including prevention and education services, dental managed care and fee-for-service Denti-Cal. Authority: AB 1467 (Budget Committee), Effective July 1, 2012; Sacramento County BOS, Dec 11, 2012, Resolution No establishing a Sacramento County Medi-Cal Dental Advisory Committee & Resolution No appointing the initial membership to the Advisory Committee. Public comment may be given on any of the agenda items and before a vote. Chair: Terrence Jones, DDS Vice-Chair: Debra Payne Agenda Item Time Speaker 1. Welcome and Introductions Members Present: Melinda Anderson; Robin Blanks; Julie Gallelo; Terrence Jones; Jim Musser; Sean O Brien; Debra Payne; Cynthia Vanzant; Mary Jess Wilson. Members Calling In: Olivia Kasirye Members Excused: Alisha Hightower; Cathy Levering; Jonathan Porteus; Members Unexcused: None Public: Katie Andrew; Julie Beyers; Edward Bynum; Joseph Canas; Danielle Cannarozzi; Rachel Cavalli; Martha Cisneros; Geneva Luedtke; Dharia McGrew; Denise Silva; J. Miguel Suarez; Griselda Zamora. Public Calling In None 2:00-2:05 Dr. Jones Packet items phone attendees can request items via . The meeting agenda order was changed during the meeting to allow Item 7 to be addressed earlier in the meeting. That item was heard after Item Approve February 23, 2017 Minutes Action Item December minutes approved as written. (Julie G/Robin) 3. Approve New Members Action Item: A motion was approved to accept new members Dharia McGrew, and Griselda Zamora. (Dr. Jones/Dr. Wilson) 2:05-2:10 Dr. Jones 2:10-2:15 Dr. Jones Page 1 of 4 First 5 Sacramento Page 2 of 18 MCDAC Meeting

3 4. CDA Update The Proposition 56 funding disbursement proposed by the Governor does not match what voters approved. CDA and other advocates are trying to address this disparity. SB 379 (Atkins) is supported by CDA, Children Now, The Childrens Partnership and others. This bill improves data reporting from the Kindergarten Oral Health form. AB 1277 (Daly) concerns water lines in dental offices in response to the infections that occurred in southern California. There was substantial discussion on this item. AB 224 (Thurmond) codifies the CA Dental Board s recommendations regarding staffing when dealing with pediatric patients undergoing general anesthesia in a dental office. SB 501 and SB 392 were also discussed. 5. Dental Plan Updates Access Dental; Health Net Dental; LIBERTY Dental Access Dental: They are working on expanding the provider network. Health Net Dental: They are working on the Early Smiles Sacramento program. Also involved with Every Smile Counts. LIBERTY Dental: Utilization has increased 100% in the last 5 years. Noticed that there has been a plateau for nearly a year. Q: How to get past the plateau? A: Working with Center for Oral Health on Early Smiles Sacramento and doing a training program for PCP s and their staff. They looking at ways to reach beneficiaries; 90% of beneficiaries have cell phones and many use social media. 98% of GA cares are being approved by Liberty but then denied by the Health Plans. Suggested to compare FFS reimbursement rates connected with GA to the GMC rates. -General Discussion: Danielle shared about outreach efforts including events where Rachel was able to do screenings. Examples of presentations/events include: a talk and screenings at International Rescue; several presentations at the FRC New Employee training; presenting at a Making Parenting a Pleasure class; booth at the Arden-Arcade Resource Fair; at Ralph Richardson school. -Rachel shared statistics on Early Smile: 46 schools; 10 Community events; 5176 screenings; MOU s in place with 6 schools/districts. They are laying the ground work for the upcoming school year. Attended an event at Fairy Tale Town. 2:15-2:35 Dharia McGrew 2:35-2:50 Dental Plans Page 2 of 4 First 5 Sacramento Page 3 of 18 MCDAC Meeting

4 5a Preliminary GMC Performance Measures Data and 2016 Preliminary GMC Performance Measures Data Extensive discussion on the 2015 numbers. The GMC 2015 benchmarks are based on 2013 data points. The 2016 numbers are presented in a 90-day utilization format rather than the 11 of 12 months enrollment that has been used previously. This is the CMS416 federal reporting style/format (HEDIS-like) for tracking. There are no benchmarks yet for Statewide FFS utilization rates are down. Dr. Jones is interested in learning more about the FFS rates/history. Data is difficult to read. Suggestions for improvement: Add Overall 0-20; format with larger font; Do a 21+; Do a 65+; also have 2016 data done in 11 or 12 months to be able to compare to prior years; Explain what services members are getting that are measured. Noted that some 65+ has Medicare Advantage plans that have dental coverage. Nationally 30 to 35% choose Advantage plans. The measurements are a mix of CMS416 measures (all states report on CMS416 numbers) and the prior Healthy Families measurements. Liberty has requested DHCS share how the benchmarks are calculated benchmarks are not yet established. Continuity of care was discussed. Q: How often to beneficiaries plan hop? A: Not much. A challenge is loss of continuity. January usually shows a large drop when redetermination occurs. Churning was also discussed the number of adds and terminations in a specific month. 6. GA Ad Hoc Subcommittee Update Caleb s Las is proposing a 2 nd provider be present due in office GA procedures with certain pediatric patients based on age. Dr. Musser shared about a child who dies in Washington from an in office procedure. He has testified regarding Caleb s Law. The number of providers doing hospital GA continues to decline. Denials by Medical Plans continue to occur. Reasons cited include requiring prior attempts at treatment. The Greater Sacramento Surgery Center has been purchased by River City Medical Group and they are encouraging dental cases consider their facility. They do need to recruit and retain more anesthesiologists. Q: Is there GA information in the Report Back from this committee? A: Yes, information is in the Report Back document approved by this committee. The GA Ad-Hoc workgroup was created to try to make progress on this issue. The problem with denials from Anthem Blue Cross continues to be frustrating as these clients need services, not delays. Noted that there have been staffing changes at Dignity hospital and it is unknown how these changes might impact access for GA. 2:50-3:10 Dr. Jones 3:10-3:15 Cathy Levering Page 3 of 4 First 5 Sacramento Page 4 of 18 MCDAC Meeting

5 7. Every Smile Counts! Sacramento County s DTI-LDPP Project Still in active negotiation with DHCS. The new budgets are due to DHCS on 4/7/17. A start date of 7/1/17 has been confirmed. Partner agencies have contract templates to review. Budget reduced to $10.1M with savings from the planned Health Information Data Base which won t occur in the manner envisioned. It is appreciated that so many of the partners are attending the planning meetings. 8. Member Update New member request to the Board on4/25/17 It was noted that this date is subject to change. Form 700 were due April 3 rd All forms were submitted timely Ethics Training remember to submit certificated Members reminded to submit their verification form. 9. Agenda Items for Thursday, or future meetings Send agenda items to Julie Beyers. 10. Other Items and Announcements open for announcements Information about Electronic Health Records for individual offices was shared. Support is available. Overall, CA is considered to be behind in implementation of EHRs. Reminded all that registration is required to participate in the DTI Domain 2 project on Caries Risk Assessment. Joseph shared that Access is working to communicate this to providers. There are multiple new regulations (Mega Regs) coming down from the Federal government. Information has been supplied to the Plans. Mega Regs include additional reporting requirements for the States. Healthy Kids Day is 5/6/2017. All are invited to attend. 3:15-3:40 Debra Payne 3:40-3:45 Julie Beyers 3:45-3:50 All 3:50-4:00 All Meeting Convener: First 5 Sacramento Staff: Julie Beyers, (916) , beyersju@saccounty.net Next Meeting:, 2 pm to 4 pm First Thursday (Bi- Monthly) Remaining Dates in 2017 First Thursday, Every Other Month 6/1/17; 8/3/17; 10/5/17; 12/7/17. Page 4 of 4 First 5 Sacramento Page 5 of 18 MCDAC Meeting

6 MEETING MINUTES Approved 04/06/2017 February 23, :00 pm 4:00 pm Location: First 5 Sacramento Commission 2750 Gateway Oaks Drive, Ste. 330 Sacramento, CA Sacramento County Medi-Cal Dental Advisory Committee (MCDAC) Purpose: The purpose of the advisory committee is to provide oversight and guidance to improve Denti-Cal utilization rates, the delivery of oral health and dental care services, including prevention and education services, dental managed care and fee-for-service Denti-Cal. Authority: AB 1467 (Budget Committee), Effective July 1, 2012; Sacramento County BOS, Dec 11, 2012, Resolution No establishing a Sacramento County Medi-Cal Dental Advisory Committee & Resolution No appointing the initial membership to the Advisory Committee. Public comment may be given on any of the agenda items and before a vote. Chair: Terrence Jones, DDS Vice-Chair: Debra Payne Agenda Item Time Speaker 1. Welcome and Introductions Members Present: Melinda Anderson; Robin Blanks; Julie Gallelo; Alisha Hightower; Terrence Jones; Olivia Kasirye; Cathy Levering; Ann Milar; Jim Musser; Sean O Brien; Debra Payne; Jonathan Porteus; Cynthia Vanzant; Kate Varanelli. Members Calling In: None Members Excused: Mary Jess Wilson. Members Unexcused: None Public: Katie Andrew; Barbara Aved; Julie Beyers; Edward Bynum; Joseph Canas; Danielle Cannarozzi; Rachel Cavalli; Anastasia Dodson; Kristine Gual; René Mollow; Miguel Mariona; Dharia McGrew; Paula Perez; Denise Silva; Griselda Zamora. Public Calling In: Sonya Bingaman; Alani Jackson. 2:00-2:05 Dr. Jones Packet items phone attendees can request items via . The meeting agenda order was modified by the Chair. Item 10 discussion and votes on Elections and Align Meetings will be moved to after Item Approve December 15, 2016 Minutes Action Item December minutes approved as written. (Cathy/Cynthia) 3. Approve Informational Report to the Legislature for 2016 Action Item A motion was made to approve the draft 2016 Report to the Legislature as written. (Julie/Cynthia) 2:05-2:10 Dr. Jones 2:10-2:25 Dr. Jones Page 1 of 6 First 5 Sacramento Page 6 of 18 MCDAC Meeting

7 4. DHCS Update Staffing Update Adrianna took a promotion to another department. Alani will be on maternity leave beginning March 1 st. Associate Director Anastasia Dodson will be filling in for Alani and will be main contact. Anastasia shared about her background with the State and DHCS. Either René or Deputy Director Laurie Weaver will attend MCDAC meetings; Anastasia will also attend. Dental Transformation Initiative What s the Status Domain 1 Over $20M in incentive payments have been made to providers. Safety net clinics still need to submit data to DHCS. Payments are sent directly to service provider office locations. Delta Dental sends the check. The next payment will be in July to FFS providers for care provided through June and to Safety Net Clinics for care through October They are working to align these dates. They are seeing increases in care, however the denominator has grown so more effort is required with a larger member denominator. They are working with CMS to reach the extra funding available for this Domain. Question: Some providers confused by the random check received. Is a letter going out to providers about the checks? Answer: Yes, the letter goes out separately from the checks. Comment: Some providers didn t get the initial letter or tossed it out because it wasn t clear. Reply: DHCS will look at what s been sent out so far. Domain 2 There are 11 counties in this Domain including Sacramento. Providers must opt in and do a required training. Only 7 providers have opted in; 6 have completed the training. No services completed yet due to the timing. Cathy requested a copy of the letter sent to members; SDDS did not know about the letter nor received a copy of it. SDDS is planning provider education to their members. They can promote the Domain with an article in their member publication. DHCS feels they ve done a lot of outreach and all information is available on the DTI website; they are also trying to engage all stakeholders to promote this effort. This Domain provides incentive payments of $126 up to 4 times per year for Caries Risk Assessment (CRA) and intervention based on client need. CRA is not currently a covered benefit. Reach out to Anastasia or René regarding this Domain. Domain 3 There are 17 counties participating in the Domain regarding Continuity of Care. Neither Sacramento nor LA are included. Letters went out to enrolled providers in the participating counties. Incentive payments for this Domain are based on paid claims data. Domain 4 DTI-LDPP grants Grant awards have been announced. Sacramento County was awarded a grant. There were 23 applications; 3 withdrew. Fifteen grants were selected for $150M in funding out of $185M available. Extra funds could be added to existing grants for expansion if goals are met. Funds can be rolled over from one grant year to another during the waiver period. Grants end 12/30/2020. Each grant will have a specific DHCS contact person assigned. Page 2 of 6 2:25-2:45 DHCS Staff First 5 Sacramento Page 7 of 18 MCDAC Meeting

8 Performance Measures The Plans have submitted their data; staff is reviewing. They are working to get data posted. Currently st and 2 nd Qtr data are posted. Working on the balance of 2015 data and the st and 2 nd Qtr data. Question: Has the issue with inconsistent numbers been resolved? Answer: They will post the corrected data from the Plans. Q: Are withholds being made from Plan payments for not reaching benchmarks? A: Not at this time. Q: Ann advised the legislation (1467) requires reporting of network adequacy. The Plans have been submitting information about their provider base. Has network adequacy been added to the Performance Measures? A: Will need to look into this. November BDE Both the November and December BDE reports are available online. Streamlined Provider Application The online Provider Application went live in January. This provides a shorter application for providers to complete (14 pages vs. 35 pages previously). There has been good feedback on this change. They are planning on providing an online verification of the status of enrollment applications, but it is not up yet and there is no timeline for this. They will work with the medical providers initially and then expand to dental providers. Medicaid and CHIP Managed Care Final Rule Comments Are Due 2/28/2017 Comments about the draft Final Rule are due 2/28/17. Network adequacy standards, care coordination, beneficiary rights and other issues are part of this document. General Discussion/Questions for DHCS: Q: Regarding senior access to care what is the plan for reporting demographic data by age stratification. A: Currently only 21+ to be reported. René said to think about what age grouping might be helpful and let them know. Dr. Jones said 65+ would be helpful. René advised they have an Open Data Portal and are working to get Dental information uploaded. There is good medical data there, but no dental data yet. René can share the link to the portal. 5. CDA Update CDA will be submitting comments on the Final Rule. Statewide they are trying to get more dentists to participate in Denti-Cal. The CDA website has a link to the Domain 2 training for use by dentists in the Domain 2 counties. Dr. Musser commented that the training takes about 1 hour. Cathy appreciates CDA s outreach on Domain 2 and encouraged the Plans to help get more providers participating in Domain 2. CDA congratulated Sacramento on their successful Domain 4 DTI-LDPP application. Prop 56 The LAO reports concern that the Governor s plans for the funding from Prop 56 might not fit with their understanding of how the funds were supposed to be spent. 2:45-2:55 Ann Milar; Dharia McGrew Page 3 of 6 First 5 Sacramento Page 8 of 18 MCDAC Meeting

9 Electronic Health Records CDA has assistance and funding available to help dentists convert to electronic health records under the Meaningful Use Program. Ann shared about the dentist office in Southern California with contaminated water lines and the impact on patients. There was an informational hearing in the Senate regarding the CA Dental Board recommendations regarding in-office anesthesia. If this moves forward, it would require a 2 nd person present during all in-office GA procedures. They are monitoring the ACA repeal and replace issue under discussion in Washington. Dharia will be replacing Ann as the representative from CDA. 6. Dental Plan Updates Access Dental; Health Net Dental; LIBERTY Dental Access Dental: They have done educational sessions at Sacramento Covered. They are also working on their next Community Training. Access Dental Centers will be hosting an Open House at each office with their dental van present at these events. Alisha will send out information about the events. Health Net Dental: They are participating in the Early Smiles program. A drop in membership across the board was noted in January. There is a possible increase in numbers in February. LIBERTY Dental: They have seen that their numbers plateaued about a year ago. They (and all the Plans) have stepped up contacting members instead of waiting for members to come to them. They are looking at ways to use technology to contact members as a significant number of members no longer have landlines. About 90% of members have cell phones. They are using Danielle as their on-the-ground person for events and activities. She is doing outreach tables at FRCs. Rachel has been attending and doing screenings at FRCs monthly. They are working with River Oak and MAN to do presentations/events at their locations. They have done screenings at 3 FRCs. Since September 2016, a total of 3,371 kids have been seen. As of 1/21/7, 1,600 GMC clients have used navigation services. An example of 25 Oral Health (OH) screenings in preschool classrooms was shared. Educational materials are provided to the kids with the hope that they will talk with their parents about OH. The How To Make A Dental Appointment flyer is included in the educational materials. Rachel has MOUs with 6 schools. Rachel did a meeting/training with 15 medical doctors on fluoride varnish. They intend to do Kindergarten Round Ups. Rachel shared that the Center for Oral Health has been able to do some assessments on older adults. Danielle thanked Cathy and SDDS for their coordination Page 4 of 6 2:55-3:05 Dental Plans First 5 Sacramento Page 9 of 18 MCDAC Meeting

10 efforts and the Smiles 4 Kids program which assisted young members. Cathy share about Smiles 4 Kids day, the 1 st Saturday in February each year. This year they partnered with Early Smiles and with school nurses who were able to connect children with dental homes. She is seeing improvement in kids dental care. Usually they refer 1,000 kids for Smiles 4 Kids Day; this year they had only 350 kids needing immediate care. The providers were able to do more extensive care on S4KD than in past years. They are also seeing that the working poor cannot afford dental co-payments. Cathy also shared about an 8-year old needing care and the effort involved in getting that child seen. She thanked Danielle and Rachel for their assistance with this child. Jonathan talked about the challenges of dealing with emergency cases. They are also dealing with lots of families with immigration issues. He asked the Plans Do they release information to ICE? Answer: They have a matrix of who can get information. ICE is not one of the agencies. 7. GA Ad Hoc Subcommittee Update Documents on specific cases were hand-carried to Alani on 10/24/16. There was no reply until last week when DHCS advised they were working on it. 8. Member Presentation An Overview of Foster Care Cynthia shared regarding children in Foster Care. Child Protective Services (CPS) has 3 main parts Front End (Emergency Response, Informal Supervision); Court Programs (Court Services, Permanency Services, Extended Foster Care, Guardianship, Adoption), and Other Support (Family Service Workers, Foster Home Licensing, Public Health Nurses, Centralized Placement & Support Unit, Kinship Care, Intestate Placement, Other Services). Highlights: The safety of the children is their priority. When children need care, they first look to the parents, then to relatives, then to placement in Foster Care. Of the 1,868 kids in care, 28% are in relative placement or with a close friend. They have 15 days to write up their report. The Court Services process was explained. The Court wants both medical and dental appointments within 30- days of placement. The Plans have been helpful in working to meet the need for these children. The concepts of Permanency were explained with examples family reunification is initial goal; alternate placement if reunification not feasible. Guardianships occur with relative or close friend placement. Guardianships suspend parental rights but do not terminate their rights. Adoption considered a last option; parental rights are terminated. Kids generally have multiple layers of trauma; working to use Trauma Informed Care practices. Extended Foster Care (AB12) allows youth to stay connected until age 21; the Independent Living Skills program supports these youth. Current Initiatives: Resource Family Approval (screening & training of relative caregivers & foster parents); Commercially Sexually Exploited Children (CSEC) Page 5 of 6 3:05-3:10 Cathy Levering 3:10-3:35 Cynthia Vanzant First 5 Sacramento Page 10 of 18 MCDAC Meeting

11 Protocol (child is a victim; different court process; team support of child); Expectant & Parenting Youth (EPY) Collaboration (currently serving 35 with resources & supplies); Crossover Youth Practice Model (currently serving 300 youth kids that committed crimes & are on Probation); Continuum of Care Reform (working to place youth/teens in care, not group homes, & additional training for foster parents of these youth). Questions: Q: How is the 30-day requirement for appointments met? A: A Public Health Nurse tracks the kids and works to have all the appointments done timely. 9. DTI-LDPP Sacramento County s Application Status Information about the DTI-LDPP project shared under item 4. No additional information was added. 10. Member Update Elections Chair and Vice Chair Action Item Elected Chair Dr. Jones (Cathy/Robin) Elected Vice Chair Debra Payne (Cathy/Robin) Form 700 electronic copy sent out Form 700 must be submitted electronically by April 3 rd to be in compliance with the requirements. Align meeting times Move meetings to 1 st Thursday, 2:00-4:00pm Bi-monthly Action Item Discussed proposed new meeting schedule to align date with Every Smile Counts! Meeting days as multiple members attend both meetings. New 2017 meeting schedule approved as written. (Ann/Robin) 11. Agenda Items for Thurs., April 6 th or 27th, 2017 or future meetings Send agenda items to Julie Beyers. 12. Other Items and Announcements open for announcements Kristine Gual, Chief Operating Officer, Sacramento Native American Health Center (SNAHC), share their excitement to be participating in Every Smile Counts!. She also shared that SNAHC has expanded their Dental Center and staffing, and currently has 14 chairs open and in use. SNAHC is also able to take emergency cases. Kate Varanelli is retiring in mid-march. Kate was the first Vice Chair of MCDAC. Dr. Jones and all thanked Kate for her commitment and dedication to improving the lives of children and families. Kate will be missed. Kate shared that she may become involved in community activities as part of her retirement after doing some traveling and family projects. 3:35-3:40 Debra Payne 3:40-3:50 Dr. Jones; Julie Beyers 3:50-3:55 All 3:55-4:00 All Meeting Convener: First 5 Sacramento Staff: Julie Beyers, (916) , beyersju@saccounty.net Next Meeting: April 6, 2017, 2 pm to 4 pm First Thursday (Bi- Monthly) Remaining Dates in 2017 First Thursday, Every Other Month 6/1/17; 8/3/17; 10/5/17; 12/7/17. Page 6 of 6 First 5 Sacramento Page 11 of 18 MCDAC Meeting

12 Beneficiary Dental Exception (BDE) February 2017 The BDE process is available to Medi-Cal Dental Managed Care (DMC) beneficiaries in Sacramento County to ensure timely access to services through their dental plan. Requests are made by mail, fax, , or utilization of the BDE phone line ( ). The Department staff work with the DMC plans on behalf of the beneficiary to schedule an appropriate appointment within specified time frames, based on the identified needs of the beneficiary. If no such appointment is secured, the beneficiary may request to opt-out of Medi-Cal DMC and move into Fee-For-Service (FFS) Denti-Cal where he or she may select his or her own dental provider on an ongoing basis. The following report includes the summary for February 2017, the 2016 annual summary, and the total summary for September 2012 through February 2017, since the inception of BDE. Summary of Total Requests in February 2017 A total of 445 requests were received during February; 69 (16%) were BDE requests, while 376 (84%) were non-bde requests (Table 1). Of these requests, 29 (7%) are in progress, and 416 (93%) were completed and closed to date. Table 1. February 2017 Incoming Totals Total Requests % BDE 69 16% Non-BDE % Inbound Phone Call Total % BDE 63 22% Non-BDE % Mail/Fax/ Total % BDE 6 4% Non-BDE % Table 2. February 2017 Non-BDE Totals Non-BDE Categories % BDE Info/No Need % Benefits 16 4% Eligibility 13 3% Plan/Provider Info 78 21% No Answer/Left Message 54 14% Other 66 18% Summary of BDE Cases Closed in February 2017 A total of 41 BDE requests were closed in February, including requests made during prior months that may have required several appointments. Of these scheduled appointments, 36 (88%) were for adult beneficiaries, while 5 (12%) were for children. In total, 25 (61%) scheduled appointments were successfully seen and treated by a dentist, while 16 (39%) were unsuccessful; patients were contacted to reschedule but did not answer or did not want to schedule another appointment. Of the successful appointments, 20 (70%) were adults, and 2 (30%) were children. Of the unsuccessful appointments, 16 (84%) were adults, and 3 (16%) were children. Emergency appointments were the most scheduled type of appointment with 20 (49%) total requests, followed by routine appointments with 16 (39%) total requests, urgent with 4 (10%) total requests, and 1 (2%) specialist appointment (Table 3). Page 1 of 6 First 5 Sacramento Page 12 of 18 MCDAC Meeting

13 Table 3. Summary of BDE Cases Closed in February 2017 Type of Visit Adult/ Child Service Provided Timely Access (Business Days) Dental Plan Department Perspective Emergency Adult Emergency Exam 1 Health Net Successful Emergency Adult No Show- Personal 1 Access Unsuccessful Emergency Adult ER Exam/Root Canal 1 LIBERTY Successful Emergency Adult No Show- Other 1 Access Unsuccessful Emergency Adult Exam/X-Ray 1 Access Successful Emergency Adult X-Ray/Medication Same Day LIBERTY Successful Emergency Adult No Show- Personal Same Day Health Net Unsuccessful Emergency Adult No Show- Other 2 LIBERTY Unsuccessful Emergency Adult X-Ray/Evaluation 1 Access Successful Emergency Adult Exam/X-Ray 1 LIBERTY Successful Emergency Adult No Show- Other Same Day Health Net Unsuccessful Emergency Adult No Show- Sick 2 LIBERTY Unsuccessful Emergency Adult Emergency Exam 2 Health Net Successful Emergency Adult No Show- No Response 1 Health Net Unsuccessful Emergency Adult X-Rays/Oral Evaluation 1 Access Successful Emergency Adult Emergency Exam Same Day Access Successful Emergency Adult Extraction Same Day Access Successful Emergency Adult ER Exam/Extraction 1 Access Successful Emergency Child No Show- Other 2 Access Unsuccessful Emergency Child X-Ray/Extraction 1 Access Successful Routine Adult X-Ray/Cleaning 4 Health Net Successful Routine Adult No Show- Other 6 Access Unsuccessful Routine Adult Exam/X-Ray/Extraction 13 LIBERTY Successful Routine Adult Exam\X-Ray 5 Health Net Successful Routine Adult No Show- Personal 5 Access Unsuccessful Routine Adult No Show- Other 6 Access Unsuccessful Routine Adult ER Exam/Extraction 8 LIBERTY Successful Routine Adult No Show- No Response 15 LIBERTY Unsuccessful Routine Adult ER Exam 7 LIBERTY Successful Routine Adult Exam/X-Ray/Cleaning 14 Health Net Successful Routine Adult ER Exam/Medication 9 LIBERTY Successful Routine Adult No Show- Personal 7 Health Net Unsuccessful Routine Adult X-Ray/Complete Exam 4 LIBERTY Successful Routine Adult Exam/Cleaning 17 Health Net Successful Routine Child No Show- Other 9 Access Unsuccessful Page 2 of 6 First 5 Sacramento Page 13 of 18 MCDAC Meeting

14 Type of Visit Adult/ Child Service Provided Timely Access (Business Days) Dental Plan Department Perspective Routine Child Exam/Cleaning 7 Health Net Successful Urgent Adult No Show- Other 6 Access Unsuccessful Urgent Adult Emergency Exam 9 Health Net Successful Urgent Adult Exam/X-Ray 7 Health Net Successful Urgent Child Emergency Exam 13 Access Successful Specialist Adult No Show- Forgot 4 Access Unsuccessful Note: Beneficiaries were asked to rate satisfaction on a scale of 1-5 (1= lowest satisfaction rate, and 5 = highest satisfaction rate); however, beneficiary satisfaction rates are not available due to no response or no show. Appointment Timeframes (as required by contract) Emergency 24 hours Urgent 72 hours (3 days) Routine 4 weeks Specialist 30 days from authorized request Total Summary for September 2012 through February 2017 Since September 2012, there have been 1,825 total BDE requests. 1,779 (97%) of the total BDE requests are completed and closed to date (Table 4). Of the completed requests, 1,359 (76%) beneficiaries were successfully seen and treated by a dentist, while 420 (24%) did not show for their appointments and were unsuccessful (Table 5). The total average number of incoming requests is 247 per month; the BDE monthly request average is 34 (13%), while the Non-BDE monthly request average is 222 (87%). No one has requested to transfer to FFS since the inception of BDE. Table 4. Summary of Total BDE Requests from September 2012 to February 2017 BDE Categories DMC Dental Plans Access Health Net LIBERTY **Western Adults Children Totals Emergency Urgent * * Routine * * 649 Specialist * * * * 89 In Progress * * * * 46 Closed* Total BDE *Values are not shown to protect the confidentiality of the individuals summarized in the data. **Western Dental is no longer a DMC plan as of Page 3 of 6 First 5 Sacramento Page 14 of 18 MCDAC Meeting

15 Table 5. Summary of Total Closed BDE Requests from September 2012 to February 2017 Closed BDE Categories DMC Dental Plans Access Health Net LIBERTY **Western Adults Children Totals Emergency Unsuccessful Urgent * * * * * * 87 (No-Show) Routine Specialist * * * * * * 14 Emergency Successful Urgent * * * * Routine Specialist * * * * Unsuccessful Total Successful Total Totals *Values are not shown to protect the confidentiality of the individuals summarized in the data. **Western Dental is no longer a DMC plan as of Annual Summary for 2017 Annual summary is unavailable pending future data. Figure Monthly BDE Requests by Type Number of BDE Requests Phone Calls Mail/Fax/ Page 4 of 6 First 5 Sacramento Page 15 of 18 MCDAC Meeting

16 Figure vs Monthly Incoming Requests Number of Total Incoming Requests Month Figure vs Monthly BDE Incoming Requests 80 Number of Total Incoming Requests Month Page 5 of 6 First 5 Sacramento Page 16 of 18 MCDAC Meeting

17 Figure vs Monthly Non-BDE Incoming Requests 400 Number of Total Incoming Requests Month Page 6 of 6 First 5 Sacramento Page 17 of 18 MCDAC Meeting

18 First 5 Sacramento Page 18 of 18 MCDAC Meeting