Full Restoration of Adult Dental Benefits – Frequently asked questions (FAQ)

Description

Full Restoration of Adult Dental Benefits – Frequently asked questions (FAQ)  Effective January 1, 2018

This document is a compilation of Full Restoration of Adult Dental Benefits, FAQ and
responses regarding the restoration of dental services. DHCS will update this
document as necessary.

1. What is the Full Restoration of Adult Dental Benefits?
Answer: The new state budget includes a full restoration of adult dental benefits that
were eliminated in 2009 and some partially restored in 2014. Below are the
differences between the current benefits and the restored benefits effective January
1, 2018.

Current services:
• Exams and x-rays
• Cleanings (prophylaxis)
• Fluoride treatments
• Fillings
• Root canals in front teeth
• Prefabricated crowns
• Full dentures
• Other medically necessary dental services

Services to be added (some may require prior authorization/treatment plans):

• More types of exams
• Deep cleanings/periodontal (includes scaling and root planing)
• Laboratory crowns
• Partial dentures
• Root canals in back teeth

2. Can dental services go over the yearly-capped $1,800 limit?
Answer: If shown to be medically necessary, dental services can go over the yearly
$1800 limit.

3. When is the Full Restoration of Adult Dental Benefits effective?
Answer: January 1, 2018.

4. How long after January 1, 2018, will the services be covered?
Answer: These restored adult benefits will be available indefinitely. The Legislature
changed the law to restore the adult dental benefits, so it would require a legislative
action to make any changes to the current dental benefits. If there is a change made
to covered dental services, another Public Notice describing the changes will be
posted.

5. Are periodontal services covered under the Full Restoration of Adult Benefits?
Answer: Yes

6. What CDT codes are covered under Full Restoration of Adult Dental Benefits?
Where can I find the list?
Answer: For a complete list of included benefits, please see the Benefits Quick
Reference Guide and Provider Bulletin Volume 33 Number 14:
https://www.dentical.ca.gov/DC_documents/providers/provider_bulletins/Volume_33_Number_15.pdf

7. Was there a public notice posted announcing Full Restoration of Benefits? If so,
when?
Answer: Yes, the public notice was posted on Tuesday, October 10, 2017

8. Where can I find a copy of the public notice?
Answer: Full Restoration of Adult Dental Benefits public notice can be found here:
http://www.dhcs.ca.gov/formsandpubs/laws/Pages/Pro_SPA.aspx

9. Where can written comments be submitted?
Answer: Any written comments may be sent to: Department of Health Care
Services, Medi-Cal Dental Services Division, attention Alani Jackson, PO Box
997413, MS 4900, Sacramento, California 95899-7413, or may be emailed to
Publicinput@dhcs.ca.gov. Please indicate SPA 17-027 in the subject line of the
message.

10.Has CMS approved the Full Restoration of Adult Dental Benefits State Plan
Amendment (SPA-17-027)?
Answer: No; however, you can access a copy of proposed SPA 17-027 at:
http://www.dhcs.ca.gov/formsandpubs/laws/Pages/Pending_2017.aspx

11.For these adult dental services, are all these services being paid based on the
published fee scheduled rates only?
Answer: Yes

12. Where can providers call for questions about covered services?
Answer: If you are a dental provider enrolled in the dental fee-for-service system
(through Delta Dental), you can call the provider customer service line at 1-800-423-
0507. If you are a dental provider enrolled in a dental managed care network, you
can call your dental plan.

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