To improve beneficiary utilization rates and provider participation under the program's fee-for-service delivery system, Health Care Services should immediately take the following actions: require Delta Dental to develop a dental outreach and education program and to submit an annual plan by the end of each calendar year.
The Department of Health Care Services (DHCS) is in receipt of Delta Dental's provider and beneficiary outreach and education plans (outreach plans). The outreach plans specifically outline how dental access issues will be addressed in underserved areas within California and the border communities. DHCS will conduct ongoing monitoring of the outreach plans to ensure beneficiary needs are addressed and that all contract provisions are satisfied. Delta Dental's annual submission of outreach plans has been made a condition of precedent to payment.
Health Care Services provided copies of the 2015 provider and beneficiary outreach and education plans. These plans include information such as goals, objectives, processes, tasks, deadlines, and responsible parties. Health Care Services stated that workgroups will be convened in September 2015 and that revisions to the plans will be based on workgroup input. Plan approval by Health Care Services will then follow. Health Care Services also stated that Delta Dental will be directed to implement the plans immediately after finalization.
DHCS has received an initial draft of the proposed outreach plan submitted by Delta Dental for calendar year 2015. DHCS will meet with Delta Dental to discuss the execution of the proposed outreach plan to ensure all contractual provisions are accounted for. DHCS will continue to require Delta Dental to submit a dental outreach and education plan each calendar year, which serves the diverse beneficiary population and includes measurable objectives. DHCS will implement this recommendation by June 1, 2015.
Agency responses received are posted verbatim.