Pay-for-Performance: Continuity of Care
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The overall goal of this initiative is to establish a dental home for all Medi-Cal members, to increase patients' return to the same dental office year-after-year for continuity of care, and improved health/dental outcomes. Services billed with CDT D0150 (comprehensive oral evaluation - new or established patient), D0145 (oral evaluation for a patient under three years of age and counseling with primary caregiver), and D0120 (periodic oral evaluation - established patient) for dental exam/evaluation will count towards a continuity of care and a flat rate performance payment of $55. This performance payment is provided to dental provider service office locations that maintain dental continuity of care by establishing a dental home for each patient and perform at least a yearly dental exam/evaluation for two or more years in a row.
As an example, if a patient visited a dental office and received an exam/evaluation billed with a qualifying code during calendar year (CY) 2021 and returns to the same dental office to receive an exam/evaluation billed with a qualifying code in CY 2022, that dental office will receive an annual flat rate performance payment for the continuity of care for that patient. Continuity of care payments will begin in 2022 for returning patients seen in CY 2021. This performance payment is available to enrolled Medi-Cal dental providers in Fee-for-Service (FFS) and Safety Net Clinics (SNCs) statewide starting January 1, 2022.
Safety Net Clinic (SNC) Resources for Data Submission
