CDCAN REPORT #206-2011: New regional center dental program announced by DDS

NEW REGIONAL CENTER DENTAL PROGRAM FOR MEDI-CAL ELIGIBLE ADULTS WITH DEVELOPMENTAL DISABILITIES

New Program Will Access Existing Denti-Cal Program - Will Go Into Effect January 13, 2012 - Meant to Be Another Way for Regional Centers to Provide Dental Services for Adults With Developmental Disabilities Who Are Also Eligible for Medi-Cal

SACRAMENTO, CA (CDCAN) [Last updated 12/21/2011 10:00 AM] - The Department of Developmental Services announced officially late yesterday a new regional center funded dental program for adults with developmental disabilities who are also eligible for Medi-Cal, that will give regional centers a more structured way to provide dental services. The new program will go into effect on January 13, 2012, accessing the existing Medi-Cal dental program used by Medi-Cal eligible children and others.  The new program through the regional centers could impact thousands of adults with developmental disabilities across the State.

Currently the 21 non-profit regional centers - who are contracted with the Department of Developmental Services to coordinate funding for certain services and supports for over 240,000 eligible children and adults with developmental disabilities in California, are supposed to provide (to adults with developmental disabilities also eligible for Medi-Cal) adult dental services through dental providers vendored directly with a regional center.

The new regional center adult dental program using the existing Denti-Cal program - which is part of the Medi-Cal program, overseen by the Department of Health Care Services, will give regional centers an additional way to provide dental services.  That new option for regional centers will likely increase access to dental services and likely improve quality of care because the program already exists and is in place statewide under Medi-Cal for children and others still eligible for the dental benefit.

The Department of Developmental Services issued last week on December 16th, emergency regulations that makes neccessary changes to State regulations to allow regional centers to use dentists under the existing Denti-Cal program. Those changes are largely technical.  The Office of Administrative Law, the state agency that is responsible for reviewing and approving all state regulations, will likely give final approval to those emergency regulations within the next few days. The 27 page package containing the emergency regulations can be found at: http://www.oal.ca.gov/res/docs/pdf/emergency_postings/2011-1216-02E.pdf

Advocates Praise Department for New Program - But Worry About Impact of Existing and New Budget Cuts

• Advocates have praised the Department of Developmental Services - working with the Department of Health Care Services and regional centers - for implementing this new adult dental program that they say is critical for thousands of adults with developmental disabilities across the State.
• However advocates, regional centers and other organizations are worried and in some cases, in a near panic on the deepening impact of 2009, 2010, 2011 budget reductions - and the impact of new reductions in the coming State budget year that could have the affect of undermining the new Denti-Cal program.  California faces a projected budget shortfall of $13 billion by the end of the 2012-2013 State budget year that ends June 30, 2013 unless the Governor and Legislature takes action before that time.
• On December 13th Governor Brown announced that the State budget ":trigger cuts" would be pulled, enacting nearly $1 billion in automatic spending reductions beginning January 1, 2012 - including $100 million in new reductions to developmental services in the current budget year that ends June 30, 2012 and for the next budget year that follows.
• The $100 million cut to developmental services in the current year will - barring a surprise - come largely from existing or projected savings within that budget due to lower than expected spending or  higher than expected savings resulting from previous reductions.  The Department of Developmental Services will be releasing a list that identifies how the $100 million in reductions will be achieved during the current budget year.
• However the $100 million cut for the 2012-2012 State Budget year will likely mean some level of actual new spending cuts to programs and services - including possibly extending the existing 4.25% payment reduction to most regional center providers - a reduction that currently is set to expire June 30, 2012.  The Department of Developmental Services will convene sometime early next year a stakeholder group to discuss and consider optionson how to achieve the $100 million reduction in the 2012-2013 State Budget year that begins July 1, 2012.  No date for that meeting - or the makeup of the stakeholder group - has been announced, though some announcement is expected by late January or early February.

Medi-Cal Adult Dental Services Eliminated in 2009 - Though Maintained for Children & Others

• As part of the agreement to close an estimated $41 billion dollar on-going State budget deficit in 2009, the Governor and Legislature agreed to some temporary tax increases, massive spending reductions, including the elimination of 10 Medi-Cal "optional benefits" including adult dental services - though dental services continued for children, adults in long term care facilities and pregnant women.
• The budget related legislation required that adult dental services be provided by the Department of developmental Services through the 21 non-profit regional centers for adults with developmental disabilities who are eligible also for Medi-Cal.  Those eligible adults would obtain adult dental services through their Individual Program Plan (IPP), though the dental services provided would not be under the Medi-Cal program - rather, it would be funded in the developmental services budget through the 21 non-profit regional centers.
• Since that time in 2009, regional centers have provided dental services for adults with developmental disabilities through dentists that are vendored directly with that regional center to provide dental services.
• However because of the fast tracked time-frame of the elimination of the Medi-Cal adult dental benefit and 9 other Medi-Cal benefits approved by the Legislature and signed into law by then governor Arnold Schwarzenegger in February 2009, many adults with developmental disabilities lost some or all of their access to needed dental services since that time - or were forced (or their families were forced) to pay high out of pocket expenses for those services.
• Those problems in obtaining adult dental for eligible adults with developmental disabilities was in part due to the absence of any existing structure in place to transition those adults to other dental services when the Medi-Cal benefit was eliminated.  In addition, many people were not aware or did not fully understand that regional centers could provide those lost dental services for adults with developmental disabilities who were eligible for the eliminated Medi-Cal benefit

SOME QUESTIONS & ANSWERS ABOUT REGIONAL CENTER DENTAL SERVICES

Please send me an email if you have any additional questions about this specific new program- or about any other issue.  I will include your question and a response in a new weekly CDCAN "Questions and Answers" Report.  You can request that your name or full name not be used.  Send questions or comments to: Marty Omoto - martyomoto@rcip.com

Question: Who is eligible for this new regional center adult dental program?

CDCAN:  Adults with developmental disabilities age 21 and older who are eligible for both regional center services and the Medi-Cal program. This would be the same population that lost Medi-Cal adult dental services when that benefit was eliminated as of July 2009.  An adult with developmental disabilities who is eligible for Medi-Cal but is not eligible - or has not been assessed for eligibility for regional center services and supports, would not be eligible at that point for dental services in the Denti-Cal program (or for that matter, any dental services provided through the regional centers as required by the 2009 budget trailer bill).

Question: What about people with developmental disabilities under the age of 21 or adults with developmental disabilities in long term care health facilities?

CDCAN: The Medi-Cal dental benefit for children under the age of 21 - including children with developmental disabilities - was not eliminated in 2009 and still continues.  There is no change to that Medi-Cal benefit for children.  Those children would still go through Medi-Cal for dental benefits.

The Medi-Cal adult dental benefit was never eliminated for adults in long term care health facilities - including people in developmental centers and intermediate care facilities, so this new regional center adult dental program does not impact or apply to them.

Question: How does an eligible adult with developmental disabilities get dental services through a regional center?

CDCAN: That person (or their family member or other advocate) would need to contact their regional center service coordinator (sometimes referred to as a caseworker or counselor) to have the adult dental need included in their Individual Program Plan (IPP).

That service coordinator should be able to explain the process to obtain adult dental services - either through dentists vendored directly with the regional center or through (after January 13th) the Denti-Cal program - and to authorize needed dental services, through the Individual Program Plan.

Given that this is a still new process, it is probably a good idea for everyone involved to have specifics and details - to avoid confusion and unnecessary delays - regarding one's dental needs and services in their Individual Program Plan.

Question: What if an adult with developmental disabilities is eligible for regional center services but is not eligible for Medi-Cal.  Can that person receive dental services through the regional center?

CDCAN:  The 2009-2010 State Budget that eliminated the Medi-Cal adult dental benefit did require that people with developmental disabilities eligible for regional center services AND eligible for Medi-Cal be provided with needed dental services, using the Individual Program Plan process to obtain those services.  So the new Denti-Cal program that goes into effect January 13th will cover only those adults with developmental disabilities who are eligible for regional center services AND are also eligible for Medi-Cal.

Children with developmental disabilities (under age of 21 years) eligible for regional center services and Medi-Cal would - as mentioned before - continue to receive needed dental services in the Medi-Cal program since the benefit was not eliminated for them - or for adults in the Medi-Cal program in long term care health facilities.

For others in the regional center system who don't fall into those categories, any needed dental services would need to be identified and requested through the Individual Program Plan process.

One can also contact their own state senator and/or assemblymember for help in identifying dental services and information or assistance in eligibility for services.  Various local community organizations should be able to provide information including family resource centers, independent living centers. area agencies on aging.  Like the weather, the quality of information and response will vary depending on where you are.  And what day it is.

Question: Can an adult with developmental disabilities currently using a dentist directly vendored through a regional center continue to use that same dentist after January 13, 2012 (when the Denti-Cal program goes into effect for regional center eligible adults with developmental disabilities)?

CDCAN: Yes, according to the Department of Developmental Services.

The Denti-Cal program that goes into effect January 13th gives regional centers another option or way to provide dental services.  A regional center can continue to use a dentist vendored directly with them (and pay them directly) for an individual or they can decide to provide those dental services for an individual using the Denti-Cal program.

It is also possible that the same dentist vendored directly with a regional center is also part of the Denti-Cal program in which case the regional center would have to decide the best way to access that dentist's services.

Question: How will the adult Denti-Cal program work through the regional centers?

CDCAN:  The regional center adult dental services will use the services - and follow the rules and payment policies - under the existing Denti-Cal program overseen by the Department of Health Care Services (the state agency that oversees the Medi-Cal program).

As mentioned, regional centers will still have the ability to go outside the Denti-Cal program to use dental services from dentists who are directly vendored with regional centers. (And as mentioned before, the Medi-Cal dental benefit for children was not eliminated in 2009 - and continues, so eligible children would go through Medi-Cal to obtain their dental services.)

Eligible adults with developmental disabilities may receive the same dental services in the Denti-Cal previously available through the Medi-Cal adult dental benefit - however, those eligible adults are not subject to the $1,800 annual benefit cap, according to the Department of Developmental Services.

Question: Is there any changes in State law needed first before the new regional center adult Denti-Cal program goes into effect?

CDCAN:  No changes in state law is needed but a relatively minor change in state regulations is required, to permit regional centers to use dentists in the Denti-Cal program (that is overseen by the Department of Health Services).

The Department of Developmental Services submitted on December 16, 2011 proposed emergency regulations to the Office of Administrative Law (OAL) to make a change to section 54310 of California Code of Regulations, Title 17 regarding Denti-Cal dentists. The emergency regulations, when it goes into effect likely next week, will mean that regional centers will not need to take any action to vendorize those dentists providing services under the existing Denti-Cal program (though this does not apply to those dentists who are vendored and receive payment directly from a regional center).

To view the 27 page emergency regulation package go to:  http://www.oal.ca.gov/res/docs/pdf/emergency_postings/2011-1216-02E.pdf

Question: How does a eligible adult with developmental disabilities obtain a list of Denti-Cal dentists in their county?

CDCAN:  That person, as mentioned before, would need to contact their regional center service coordinator (sometimes referred to as a caseworker or counselor) to have their dental needs included in their Individual Program Plan and to identify how that dental need will be met (either through a dentist vendored directly with the regional center or through - after January 13th - the adult Denti-Cal program). A person doesn't need to have a list of dentists before contacting their regional center service coordinator though it might be helpful for some to have that information before hand.

However anyone can obtain a list of Denti-Cal dentists by county, by going to the Denti-Cal's home page at:  www.denti-cal.ca.gov  Once there, click on the "Beneficiaries" tab, then click on the "Help in locating a Medi-Cal dentist" link. That list is updated weekly by the Department of Health Care Services.

Question: What if a dentist in the Denti-Cal program wants to verify a person's eligibility?

CDCAN: If a dentist in the Denti-Cal needs to verify eligibility of an adult with developmental disabilities referred by a regional center, the dentist may do so by calling Denti-Cal's Provider Telephone Service Center,at (800) 423-0507.

Question: Is there a fair hearing process for the regional center adult dental services?

CDCAN: Yes.  Rights to Fair Hearing exist whether for dental services vendored directly with a regional center or for dental services through the Denti-Cal program.

If an adult with developmental disabilities feels there has been a denial of their rights or eligibility, nature, scope of the dental services, that person can file for a Fair Hearing or if appropriate, go through the Consumer Complaint Process Forms and information are available at the Department of Developmental Services website at:  www.dds.ca.gov/Complaints/Home.cfm

If an individual with developmental disabilities is denied a service for which a dentist in the Denti-Cal program has requested prior authorization, that individual has a right to a Fair Hearing through the Department of Social Services. Information regarding the process for filing for a Fair Hearing is also contained on the Denti-Cal website at:  www.denti-cal.ca.gov

Depending on the circumstances and urgency, a person may also want to refer to additional information about fair hearings and consumer rights available through family resource centers, family empowerment centers, specific regional center websites and various disability advocacy groups and organizations such as Disability Rights California (DRC).  A person should also be able to get fair hearing and related information from their own elected state senator or assemblymember (they are there in their district offices for many reasons, but one of them is to help constituents navigate through the government process - and to help provide information about government funded programs and services).

UPCOMING CDCAN REPORTS AND ALERTS:

• Remembering Jana Overbo
• Update on Medi-Cal provider lawsuits
• Update on Developmental Services cuts, changes (regional centers and developmental centers)
• Update on federal issues impacting people with disabilities, mental health needs, the blind, seniors