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 June 1, 2017 Minutes Action Item 2:05-2:10 Dr. Jones 3. DHCS Update 2:10-2:45 DHCS Staff Dental Transformation Initiative What s The Status Dental Data Information Streamlined Provider Application BDE Report Status Prop 56 impacts: Denti-Cal Provider Reimbursement rate increases Changes to coverage for adults General Anesthesia Update Report to the Legislature for 2016 Update Update on Timing of RFP Process for DMC Plans 4. CDA Update 2:45-2:55 Dharia McGrew 5. Dental Plan Updates Access Dental; Health Net Dental; LIBERTY Dental 2:55-3:10 Dental Plans 6. GA Ad Hoc Subcommittee Update 3:10-3:20 Cathy Levering 7. Children Now Update 3:20-3:30 Katie Andrew 8. Every Smile Counts! Sacramento County s DTI-LDPP 3:30-3:40 Debra Payne/ Project Robyn Alongi 9. Member Updates 3:40-3:45 Julie Beyers 10. Agenda Items for Thursday, October 5, 2017 or future meetings 11. Other Items and Announcements Open for announcements / Other items not on agenda Meeting Convener: First 5 Sacramento Staff: Julie Beyers, (916) , beyersju@saccounty.net Next Meeting: First Thursday Bi Monthly October 5, 2017, 2 pm to 4 pm 3:45-3:50 All 3:50-4:00 All First 5 Sacramento Page 1 of 11 MCDAC Meeting

2 DRAFT MEETING MINUTES June 1, :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; Cathy Levering; Dharia McGrew; Jim Musser; Debra Payne; Jonathan Porteus; Griselda Zamora. Members Calling In: Olivia Kasirye Members Excused: Alisha Hightower; Sean O Brien; Cynthia Vanzant; Mary Jess Wilson. Members Unexcused: None Public: Robyn Alongi; Katie Andrew; Barbara Aved; Julie Beyers; Edward Bynum; Joseph Canas; Danielle Cannarozzi; Rachel Cavalli; Martha Cisneros; Anastasia Dodson; John Duncan; Geneva Luedtke; Cynthia Morla; Jan Resler; Lorena Sanchez; Denise Silva. Public Calling In Angelica Jimenez-Bean; Brian Kennedy; Eileen McGee-Davidson; René Mollow; Ruben Romero; Venicia Wilson. 2:00-2:05 Dr. Jones Packet items phone attendees can request items via Approve April 6, 2017 Minutes Action Item April minutes approved with suggested changes. (Debra /Dr. Jones) 3. Approve New Member Action Item: A motion was approved to accept new member Jan Resler. (Debra/Dr. Porteus) 4. DHCS Update Staffing Update Updates on staffing changes were shared. Only a few positions remain unfilled. Anastasia remains the single point of contact until Alani returns in August. Page 1 of 6 2:05-2:10 Dr. Jones 2:10-2:15 Dr. Jones 2:15-2:45 DHCS Staff First 5 Sacramento Page 2 of 11 MCDAC Meeting

3 Dental Transformation Initiative What s The Status Remember to use the DTI Mailbox for specific DTI questions. Domain 1 Payments for the 1 st part of 2017 will be out in July and should be higher as baseline numbers are exceeded. Safety Net Clinic data is still challenging with GMC; FFS provider data is streamlined. Domain 2 Looking for additional providers to participate in the Caries Risk Assessment (CRA) project from the selected counties. May consider expanding the number of counties at the end of 2017; will consult with CMS on possible expansion. A question about recent Denti-Cal Bulletin re: DTI didn t clearly specify that DMC counties were included. DHCS will look into it. Also, providers wondering if there are additional instructions related to Domain 2; DHCS staff will look into it. Domain 3 Base year is 2015 for the pilot counties in this domain. Payments should be at end of June. Domain 4 Continuing with contracting with chosen projects. Re: evaluation - some data must go to CMS by the 1 st ; once approved, will be released. There have been multiple PRA requests including requests for ad hoc reports; these are time consuming. Standard data requirements done first, including AB2207 statutory requirements. Question: Is there a list of the required items? Answer: They are developing a list and will post it online. Dental Data Information Website redesign underway; FFS and DMC Performance Measures data moving. DHCS staff did a demo of the updated site; not all data has been moved yet. More changes and information in the future. Shared the historical data available online and info shared with Legislature. Open Data Portal in the future should aid in data inquiries. This presentation is not a deep dive into data but an overview. They are trying to have more data available for transparency. Staff could meet with a small group on data questions when more data available. Q: What month do they hope to be caught up with data online? A: Hopefully this calendar year. Q: Will AB2207 timeline be accelerated? DMC data was preliminary for 2015 and some data issues exist with 2016 data currently posted. A: Staff will check on the status. Comment: Requests for aggregate data not yet answered. Aggregate data is very useful. Comment: Data in one location is appreciated. Streamlined Provider Application Recently receiving about 40 per month. Processing is faster; some only needing 15 days to be processed. February BDE Report The February BDE Report was attached. Comment: More no shows were adults, not kids. May Revise and Tobacco Tax Prop. 56 The was $1/3 B for growth in the Medi-Cal budget but rejected by the Legislature. Will go to Conference Committee, then wait for Page 2 of 6 First 5 Sacramento Page 3 of 11 MCDAC Meeting

4 the Governor s final budget. General Anesthesia Update Deferred until Agenda Item 9. Managed Care Final Rule The comment period is part of the regular process for this document. The updates include changes to the appeals and grievance process must go to DMC Plan first, then to State hearing. There is still a complaint process which is different than an appeal process. A change at the Federal level regarding mailing information to beneficiaries will change CA s process. Also network adequacy assessment has to occur before certification to CMS is sent. Standard is still 1/2000, plus time and distance standards. Q: Are there standards for FFS? A: Yes, the analysis for it is different. Report to the Legislature for 2016 Still in draft status. Should be posted within the next month. Q: Is it a receive and file item? A:Yes and delivered to the chairmen of certain committees. General Discussion/Questions: Q: The current RFP/contracts has Plan accountability and withholds. Are withholds happening? A: No, not being withheld. There is an issue with the methodology not being actuarially sound. DHCS & Plans are conferring. The Plans are submitting data. Q: What is the timeline for the new RFP? The current contracts should be expiring. A: Current contract run through the end of There may be an opportunity to extend them. Re RFP timing information is not finalized. They will follow a public process when looking to release an RFP. When getting ready to release, the information will be available to all. The RFP timing has to be balanced with other workload. Comment: MCDAC would like to have input on the RFP documents. 5. CDA Update The Prop 56 funds in May Revise did not go to an increase in provider rates. Stakeholders still want to see a change/increase in rates. The Assembly and Senate have different proposals; will go to conference this week with more information by 6/15. The Assembly proposal has more total $ identified. The Senate has an increase in rates for certain top procedures and completely restores adult dental ($67M cost). Should have more information within a week. AB224 (Thurmond) passed the Assembly floor last night. This legislation would require a 2 nd provider in the room during in-office anesthesia. Has other requirements for providers. CDA opposes AB224 due to the technical nature of the requirements Proposed bills SB501 and SB392 have significant costs to dentist due to new licensing and permits. AB1277 regarding limiting contamination of dental office water lines appears to be moving forward. CDA is gathering provider feedback related to this. It was noted that this bill was in response to a number of patients harmed by bad water lines at a specific 2:45-2:55 Dharia McGrew Page 3 of 6 First 5 Sacramento Page 4 of 11 MCDAC Meeting

5 dental office in Southern CA. AB387 (Thurmond) relates to Allied Health Professional and intern hours, and the number of hours required for licensing. CDA is frustrated by lack of data. Comment: CDA opposes GMC and there is a fear that CDA is working against GMC. Dharia advised that CDA s position has not changed as it remains concerned about GMC; CDA has not done any active opposition, but has made previous statements regarding GMC requesting the termination of GMC. Cathy shared that SDDS finds GMC much better than it was years ago and GMC works because of all the Plans participate and are at the table. Comment: Dr. Musser thanked CDA for their assistance re: CalHIPSO and the implementation of electronic records. 6. Dental Plan Updates Access Dental; Health Net Dental; LIBERTY Dental Access Dental: They are actively recruiting new doctors; over 47 facilities now. There have been challenges with compliance with SB137 re: provider directory information, including performance benchmarks for each provider, prevention programs, and the 8/1 timing for system enhancement for online information for providers. Q: Are they monitoring providers for serving young beneficiaries? A: Yes the do a secret shopper program. Health Net Dental: No update. LIBERTY Dental: Several possible new initiatives but cannot discuss yet. A potential text messaging campaign has been approved by DHCS. The read rate is approx.. 90%. They re looking for new vendors to assist. Also looking at methods of online communications. Q: Can a patient opt out of messages? A: Yes FCC rules are being followed. A sample message was shared. Information on several outreach events was shared including participating in the National Kids Festival where services were provided in multiple languages and 83 screenings were done at the event. Danielle is working on getting a dental presentation connected with the Making Parenting a Pleasure classes at the FRC locations. Other ideas are encouraged and people are encouraged to come out to events or classes to observe, learn and comment. Rachel is working on setting up the school schedule for the upcoming school year. She will be going to a Sacramento City Unified School District event and attends an immunization clinic done by the San Juan Unified District. Over 7,300 have been served by Early Smiles Sacramento since September. 2:55-3:10 Dental Plans Page 4 of 6 First 5 Sacramento Page 5 of 11 MCDAC Meeting

6 7. MCDAC Annual Update to the Board of Supervisors The Update to the BOS was done on 5/23/17. The partnerships with the Plans, Early Smiles Sacramento, DTI (Every Smile Counts) were highlighted as were barriers to accessing care. Last year MCDAC set measurable goals from 2016 to 2019 of a 5% per year increase in utilization. The question of Is GMC effective is critical. The utilization rates are the measurement, but rates seem to have plateaued. The BOS will be expecting an update in 2018 related to measurable progress. Discussed the possibly upcoming RFP for the Plans and the opportunity for MCDAC to have input/impact on the future procurement process. If more information is available, this might be discussed at the August meeting or perhaps a special meeting (September?) may be called, depending on the timing. 8. Kindergarten Oral Health Assessment SB379 Information about SB379 (Atkins) Improving Kindergarten Oral Health Data Collection was shared. Looking for improvement in the number of schools that report data and the quality of the data submitted. Some schools have passive consent rather than active/forms that must be signed and returned by parents. There is some opposition to the bill. Bill has passed the Assembly; headed to Senate. 9. GA Ad Hoc Subcommittee Update Sacramento Surgery Center (SSC) has been doing GMC dental cases, but not for kids under 3. SSC has been bought by River City Medical Group and will continue to support dental surgeries at SSC. Have been in contact with DHCS on GA denials. Has a response last week, a conference call yesterday and will do a follow up call in a couple of weeks. Shared flowcharts Dental Treatment Plan and Treatment Authorization Request (TAR) Submitted for Intravenous Sedation or General Anesthesia that has also been shared with the Medical Plans. Sacramento County continues to have the most trouble with Anthem Blue Cross. ABC has seen the flowcharts. SDDS plans to do a template style document to assist dentists with the paperwork process 10. Every Smile Counts! Sacramento County s DTI-LDPP Project Will go to BOS on 7/11/17 for contracting authority. Currently completing the County s 71-J process that is done before contracting out services. Every Smile Counts! (ESC!) meets monthly. Robyn is fulltime staff for ESC! Putting into place an electronic process for resolving problems identified follow up should occur within 72-hours. Attending the CA Oral Health 2020 meeting. Page 5 of 6 3:10-3:20 Dr. Jones 3:20-3:30 Katie Andrew 3:30-3:35 Cathy Levering 3:35-3:45 Debra Payne First 5 Sacramento Page 6 of 11 MCDAC Meeting

7 11. Member Updates New members were welcomed. Will go to the BOS in July to formally approve Jan Resler. 12. Agenda Items for Thursday, or future meetings Send agenda items to Julie Beyers. Follow up on Dental Plan RFP process. 13. Other Items and Announcements open for announcements Open for announcements Katie extended an invitation to all to the Oral Health 2020 convening. Children Now is working on recommending a correction for a CPT Code issue. 3:45-3:50 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:, 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; and 12/7/17. Page 6 of 6 First 5 Sacramento Page 7 of 11 MCDAC Meeting

8 MEETING MINUTES Approved 06/01/2017 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 8 of 11 MCDAC Meeting

9 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 sponsored by CDA, and supported by Children Now, The Children s 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 cases 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 9 of 11 MCDAC Meeting

10 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 AB 224 (Thurmond) 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 died in Washington from an in office procedure. He has testified regarding pediatric anesthesia a the Senate Business and Professions Committee informational hearing. 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 Page 3 of 4 2:50-3:10 Dr. Jones 3:10-3:15 Cathy Levering First 5 Sacramento Page 10 of 11 MCDAC Meeting

11 and it is unknown how these changes might impact access for GA. 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, June 1, 2017 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: June 1, 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 4 of 4 First 5 Sacramento Page 11 of 11 MCDAC Meeting