In this Share & Learn session, we highlighted promising dental care coordination models and covered resources from Medi-Cal Dental. The COHTAC team shared findings from interviews with a subset of LOHPs about their care coordination strategies, successes, and barriers, and you heard more from three LOHPs that leverage different partners to coordinate care: Contra Costa County, Ventura County, and Alameda County. Each LOHP shared details about their program and the successful approaches they have used to coordinate care in their counties. We ended the session with a presentation and Q&A with the Medi-Cal Dental Services team on resources they have rolled out this year to support dental care coordination: the care coordination referral form and the new CHW dental benefit (D9994).

Learning objectives:

1. Learn real-world best practices from LOHPs implementing dental care coordination strategies in their counties.
2. Understand how to utilize the Medi-Cal Dental care coordination referral form and CHW dental benefit (D9994).
3. Consider how to adopt strategies, tools, and resources to strengthen care coordination locally.

Speaker bios

Slides

Recording (1:45:39)

Resources shared:

• Ventura County's care coordination workflow, consent form, and documentation/tracking spreadsheet
• Alameda County's general care coordination workflow, and modified workflow to coordinate care for pregnant and postpartum people
• FAQs about Medi-Cal Dental CHWs

Q & A: 

1. For the Contra Costa program, how is your program funded and how do you share information with your partners? Our services are free (no reimbursement activities) with funding from OOH, MCAH, and local partner funding. We belong to a dental collaborative run by John Muir Health (Ronald McDonald Care Mobile) with partners La Clínica de La Raza and Lifelong. These two partners agree to take our urgent cases and patients are referred to either one depending on the area of the county they are in.
2. Are the care coordination workflows available on the COHTAC site? See resources above shared by Ventura and Alameda counties.
3. Are the providers Alameda County contracts with Medi-Cal Dental providers? Yes.
4. Who can submit the DHCS care coordination referral form? I would suggest adding school secretaries or staff since many rural schools have high nurse turnover or no nurse at all. Thank you for this suggestion – DHCS will investigate this. There is a long list of identified roles; however, anyone can select the “other” field and enter their specific title there. Please be specific and consistent when entering titles in the “other” field – this is key for data collection to better understand trends for additional outreach and interventions.
5. Medi-Cal members used to be able to request care coordination over the phone by calling the 1-800-#; can they still do this or do they have to complete the form? Anyone can still call; submitting the referral form streamlines the process for everyone and offers and additional modality to navigate members to the care they need.
6. For an LOHP to refer a child, do we need verbal or written authorization from the parent? Also, what is the process for the care coordinators? Do they make a certain number of phone calls or mailing attempts? What happens is a parent doesn't answer? Parent authorization is not needed to move forward, though it is best to keep them informed and in the loop because DHCS will call and coordinate with them. DHCS make the outreach to the parent/caregiver several times and will work with a local provider to set up the appointment.

7. Can the DHCS care coordination system provide information back to the requestor about whether the member was able to receive services (to close the referral loop)? Typically, no, due to protected health information (PHI) requirements; however, if the correct authorizations are on file, this information can be shared and should be included as a request in your submission (something like “requesting closed loop referral”). Be sure to include your contact information to enable this. When DHCS see this, they will reach out to confirm the authorizations are on file in order to provide member information and/or work with the member representative or their authorized legal guardian to release their medical information. Authorizations can include any authorization form that meets HIPAA compliance for the release of medical information.

8. Can DHCS share aggregate data from the care coordination referral form with counites (e.g., total forms received, by requestor type, total resolved, etc.)? Not at the moment. This is a workload and capacity issue – right now, there’s a lot of manual processing of data and information, but the DHCS team can discuss what is possible in the future.

9. How are CHWs trained and tested, and how can we get a staff member qualified as a CHW? There are specific DHCS standards for CHWs, which includes trainings and requirements. Page 3 on this CHW FAQ outlines the qualifications to become a CHW for the Medi-Cal Program: https://www.dhcs.ca.gov/services/medi-cal/Documents/CHW-FAQs.pdf.

10. Could a Medi-Cal Dental provider who completes kindergarten oral health assessment (KOHA) forms for a school assign a CHW for children that are identified as high urgency or would you recommend using the care coordination form instead to assure that children with urgent needs are going to be seen by a dental provider? To leverage the CHW benefit, the Medi-Cal Dental provider needs be able to leverage the CHW's services (i.e., set up to bill for CHW services, see slides 76-77 above) and the children need to meet specific criteria to be eligible for CHW services (see slides 75-76 above, among other checks like whether they already have an Enhanced Care Management or ECM Provider or existing CHW relationship). This would require the provider to ensure alignment across several DHCS policies. In this case, it’s a good idea to use the care coordination form, which takes under 2 minutes to complete and is a more streamlined way to connect people to dental homes. We understand wanting to use all the tools at your disposal to get children into care that they need – you can ask the DHCS team specific questions and run scenarios by them by reaching out to [email protected].

11. Can CHWs bill D9994 for large group education more than once a day (e.g., morning and afternoon large groups)? Yes, the billing is based on 30-minute blocks (i.e., each unit is a 30-min block). Be mindful that members have caps on the number of CHW services per year, so you need to ensure that it does not conflict with other limitations (e.g., 12 units a year for a member). There are specific rates for the size of the group of Medi-Cal members – the CHW would report the group schedule (e.g., 9-9:30am) and number of members (e.g., 5 Medi-Cal members). They would individually bill each member, but you are able to have multiple groups a day as part of your practice.

12. Will there ever be a state EHR system (clearinghouse, billing software) that LOHPs can use to bill Medi-Cal Dental for services? There are major barriers for oral health programs to bill. There will be infrastructure set up with Gainwell Technologies to bill Medi-Cal Dental directly if you are a Medi-Cal Dental provider (will work and operate like a clearinghouse), but there is not an overarching system that works for all (e.g., if you are billing like an FQHC). Partnering with an FQHC is a better option for LOHPs since FQHCs are already set up to bill Medi-Cal Dental. However, FQHCs are not eligible to bill for CHW services unless they do a scope of change services in which they would add CHW services to their daily rate. To leverage the CHW benefit, lean on other groups/organizations (individual dentists, CBOs, schools, and local health departments).