| Old | New | Differences | |
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| 1 | - | Amended IN | |
| 1 | + | Amended IN Assembly May 16, 2024 CALIFORNIA LEGISLATURE 20232024 REGULAR SESSION Assembly Bill No. 2701Introduced by Assembly Member VillapuduaFebruary 14, 2024 An act to amend Section 14132.88 of the Welfare and Institutions Code, relating to Medi-Cal.LEGISLATIVE COUNSEL'S DIGESTAB 2701, as amended, Villapudua. Medi-Cal: dental cleanings and examinations.Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services, including certain dental services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.Under existing law, one dental prophylaxis cleaning per year and one initial dental examination by a dentist are covered Medi-Cal benefits for beneficiaries 21 years of age or older. Under existing law, 2 dental prophylaxis cleanings per year and 2 periodic dental examinations per year are covered Medi-Cal benefits for beneficiaries under 21 years of age. Existing law conditions implementation of those provisions on receipt of any necessary federal approvals and approvals, the availability of federal financial participation and participation, and, for beneficiaries 21 years of age or older, funding in the annual Budget Act.This bill would restructure those provisions so that 2 cleanings and 2 examinations per year, as specified, would be covered Medi-Cal benefits for all beneficiaries, regardless of age. expand the above-described dental benefits, for beneficiaries 21 years of age or older, to 2 cleanings and 2 examinations per year when medically necessary, as specified in the Medi-Cal Dental Manual of Criteria.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO Bill TextThe people of the State of California do enact as follows:SECTION 1. Section 14132.88 of the Welfare and Institutions Code is amended to read:14132.88. (a) Notwithstanding subdivision (h) of Section 14132 and to the extent that funds are made available in the annual Budget Act for this purpose, the following are covered benefits for beneficiaries 21 years of age or older under this chapter:(1) Except as specified in paragraph (2), the following benefits:(1)(A) One dental prophylaxis cleaning per year.(2)(B) One initial dental examination by a dentist.(2) When medically necessary, as specified in the Medi-Cal Dental Manual of Criteria, the following benefits:(A) Two dental prophylaxis cleanings per year.(B) Two periodic dental examinations per year.(b) The following are covered benefits for beneficiaries under 21 years of age under this chapter:(1) Two dental prophylaxis cleanings per year.(2) Two periodic dental examinations per year.(c) For persons 21 years of age or older, laboratory-processed crowns on posterior teeth are a covered benefit when medically necessary to restore a posterior tooth back to normal function based on the criteria specified in the Medi-Cal Dental Manual of Criteria.(d) Any prefabricated crown made from ADA-approved materials may be used on posterior teeth and may be reimbursed as a stainless steel crown.(e) Covered dental benefits and accompanying criteria for receipt of those dental benefits under the Medi-Cal program shall be identified in the Medi-Cal Dental Manual of Criteria. Notwithstanding subdivision (h) of Section 14132, the department shall evaluate all covered dental benefits, including those listed in this section and in the Medi-Cal Dental Manual of Criteria, for evidence-based practices consistent with the American Academy of Pediatric Dentistry and the American Dental Association guidelines.(f) (1) Except as provided in paragraph (2), the department shall require pretreatment radiograph documentation on posttreatment claims to establish the medical necessity for dental restorations. The pretreatment documentation required under this subdivision is intended to reduce fraudulent claims for unnecessary dental fillings. In order to avoid any undue barriers to accessing dental care, the department shall stipulate that the pretreatment radiograph documentation for posttreatment claims will be required only when there are four or more dental fillings being completed in any 12-month period.(2) For any beneficiary who is under four years of age, or who, regardless of age, has a developmental disability, as defined in subdivision (a) of Section 4512, radiographs or photographs that indicate decay on any tooth surface shall be considered sufficient documentation to establish the medical necessity for treatment provided.(3) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this section, in whole or in part, by means of provider bulletins, plan letters, or other similar instructions, without taking regulatory action.(g) This section shall be implemented only to the extent that any necessary federal approvals are obtained and federal financial participation is available.SECTION 1.Section 14132.88 of the Welfare and Institutions Code is amended to read:14132.88.(a)Notwithstanding subdivision (h) of Section 14132 and to the extent funds are made available in the annual Budget Act for this purpose, the following are covered benefits for all beneficiaries under this chapter:(1)Two dental prophylaxis cleanings per year.(2)Two periodic dental examinations per year.(b)For persons 21 years of age or older, laboratory-processed crowns on posterior teeth are a covered benefit when medically necessary to restore a posterior tooth back to normal function based on the criteria specified in the Medi-Cal Dental Manual of Criteria.(c)Any prefabricated crown made from ADA-approved materials may be used on posterior teeth and may be reimbursed as a stainless steel crown.(d) Covered dental benefits and accompanying criteria for receipt of those dental benefits under the Medi-Cal program shall be identified in the Medi-Cal Dental Manual of Criteria. Notwithstanding subdivision (h) of Section 14132, the department shall evaluate all covered dental benefits, including those listed in this section and in the Medi-Cal Dental Manual of Criteria, for evidence-based practices consistent with the American Academy of Pediatric Dentistry and the American Dental Association guidelines.(e)(1)Except as provided in paragraph (2), the department shall require pretreatment radiograph documentation on posttreatment claims to establish the medical necessity for dental restorations. The pretreatment documentation required under this subdivision is intended to reduce fraudulent claims for unnecessary dental fillings. In order to avoid any undue barriers to accessing dental care, the department shall stipulate that the pretreatment radiograph documentation for posttreatment claims will be required only when there are four or more dental fillings being completed in any 12-month period.(2)For any beneficiary who is under four years of age, or who, regardless of age, has a developmental disability, as defined in subdivision (a) of Section 4512, radiographs or photographs that indicate decay on any tooth surface shall be considered sufficient documentation to establish the medical necessity for treatment provided.(3)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this section, in whole or in part, by means of provider bulletins, plan letters, or other similar instructions, without taking regulatory action.(f)This section shall be implemented only to the extent that any necessary federal approvals are obtained and federal financial participation is available. | |
| 2 | 2 | ||
| 3 | - | ||
| 3 | + | Amended IN Assembly May 16, 2024 CALIFORNIA LEGISLATURE 20232024 REGULAR SESSION Assembly Bill No. 2701Introduced by Assembly Member VillapuduaFebruary 14, 2024 An act to amend Section 14132.88 of the Welfare and Institutions Code, relating to Medi-Cal.LEGISLATIVE COUNSEL'S DIGESTAB 2701, as amended, Villapudua. Medi-Cal: dental cleanings and examinations.Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services, including certain dental services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.Under existing law, one dental prophylaxis cleaning per year and one initial dental examination by a dentist are covered Medi-Cal benefits for beneficiaries 21 years of age or older. Under existing law, 2 dental prophylaxis cleanings per year and 2 periodic dental examinations per year are covered Medi-Cal benefits for beneficiaries under 21 years of age. Existing law conditions implementation of those provisions on receipt of any necessary federal approvals and approvals, the availability of federal financial participation and participation, and, for beneficiaries 21 years of age or older, funding in the annual Budget Act.This bill would restructure those provisions so that 2 cleanings and 2 examinations per year, as specified, would be covered Medi-Cal benefits for all beneficiaries, regardless of age. expand the above-described dental benefits, for beneficiaries 21 years of age or older, to 2 cleanings and 2 examinations per year when medically necessary, as specified in the Medi-Cal Dental Manual of Criteria.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO | |
| 4 | 4 | ||
| 5 | - | ||
| 5 | + | Amended IN Assembly May 16, 2024 | |
| 6 | 6 | ||
| 7 | - | Amended IN Senate June 17, 2024 | |
| 8 | 7 | Amended IN Assembly May 16, 2024 | |
| 9 | 8 | ||
| 10 | 9 | CALIFORNIA LEGISLATURE 20232024 REGULAR SESSION | |
| 11 | 10 | ||
| 12 | 11 | Assembly Bill | |
| 13 | 12 | ||
| 14 | 13 | No. 2701 | |
| 15 | 14 | ||
| 16 | 15 | Introduced by Assembly Member VillapuduaFebruary 14, 2024 | |
| 17 | 16 | ||
| 18 | 17 | Introduced by Assembly Member Villapudua | |
| 19 | 18 | February 14, 2024 | |
| 20 | 19 | ||
| 21 | 20 | An act to amend Section 14132.88 of the Welfare and Institutions Code, relating to Medi-Cal. | |
| 22 | 21 | ||
| 23 | 22 | LEGISLATIVE COUNSEL'S DIGEST | |
| 24 | 23 | ||
| 25 | 24 | ## LEGISLATIVE COUNSEL'S DIGEST | |
| 26 | 25 | ||
| 27 | 26 | AB 2701, as amended, Villapudua. Medi-Cal: dental cleanings and examinations. | |
| 28 | 27 | ||
| 29 | - | Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services, including certain dental services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.Under existing law, one dental prophylaxis cleaning per year and one initial dental examination by a dentist are covered Medi-Cal benefits for beneficiaries 21 years of age or older. Under existing law, 2 dental prophylaxis cleanings per year and 2 periodic dental examinations per year are covered Medi-Cal benefits for beneficiaries under 21 years of age. Existing law conditions implementation of those provisions on receipt of any necessary federal approvals, the availability of federal financial participation, and, for beneficiaries 21 years of age or older, funding in the annual Budget Act.This bill would expand the above-described dental benefits, for beneficiaries 21 years of age or older, to | |
| 28 | + | Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services, including certain dental services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.Under existing law, one dental prophylaxis cleaning per year and one initial dental examination by a dentist are covered Medi-Cal benefits for beneficiaries 21 years of age or older. Under existing law, 2 dental prophylaxis cleanings per year and 2 periodic dental examinations per year are covered Medi-Cal benefits for beneficiaries under 21 years of age. Existing law conditions implementation of those provisions on receipt of any necessary federal approvals and approvals, the availability of federal financial participation and participation, and, for beneficiaries 21 years of age or older, funding in the annual Budget Act.This bill would restructure those provisions so that 2 cleanings and 2 examinations per year, as specified, would be covered Medi-Cal benefits for all beneficiaries, regardless of age. expand the above-described dental benefits, for beneficiaries 21 years of age or older, to 2 cleanings and 2 examinations per year when medically necessary, as specified in the Medi-Cal Dental Manual of Criteria. | |
| 30 | 29 | ||
| 31 | 30 | Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services, including certain dental services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. | |
| 32 | 31 | ||
| 33 | - | Under existing law, one dental prophylaxis cleaning per year and one initial dental examination by a dentist are covered Medi-Cal benefits for beneficiaries 21 years of age or older. Under existing law, 2 dental prophylaxis cleanings per year and 2 periodic dental examinations per year are covered Medi-Cal benefits for beneficiaries under 21 years of age. Existing law conditions implementation of those provisions on receipt of any necessary federal approvals, the availability of federal financial participation, and, for beneficiaries 21 years of age or older, funding in the annual Budget Act. | |
| 32 | + | Under existing law, one dental prophylaxis cleaning per year and one initial dental examination by a dentist are covered Medi-Cal benefits for beneficiaries 21 years of age or older. Under existing law, 2 dental prophylaxis cleanings per year and 2 periodic dental examinations per year are covered Medi-Cal benefits for beneficiaries under 21 years of age. Existing law conditions implementation of those provisions on receipt of any necessary federal approvals and approvals, the availability of federal financial participation and participation, and, for beneficiaries 21 years of age or older, funding in the annual Budget Act. | |
| 34 | 33 | ||
| 35 | - | This bill would expand the above-described dental benefits, for beneficiaries 21 years of age or older, to | |
| 34 | + | This bill would restructure those provisions so that 2 cleanings and 2 examinations per year, as specified, would be covered Medi-Cal benefits for all beneficiaries, regardless of age. expand the above-described dental benefits, for beneficiaries 21 years of age or older, to 2 cleanings and 2 examinations per year when medically necessary, as specified in the Medi-Cal Dental Manual of Criteria. | |
| 36 | 35 | ||
| 37 | 36 | ## Digest Key | |
| 38 | 37 | ||
| 39 | 38 | ## Bill Text | |
| 40 | 39 | ||
| 41 | - | The people of the State of California do enact as follows:SECTION 1. Section 14132.88 of the Welfare and Institutions Code is amended to read:14132.88. (a) Notwithstanding subdivision (h) of Section 14132 and to the extent that funds are made available in the annual Budget Act for this purpose, the following are covered benefits for beneficiaries 21 years of age or older under this chapter:(1) Except as specified in paragraph (2), the following benefits:(A) One dental prophylaxis cleaning per year.(B) One initial dental examination by a dentist.(2) When medically necessary, as specified in the Medi-Cal Dental Manual of Criteria, the following benefits:(A) Two | |
| 40 | + | The people of the State of California do enact as follows:SECTION 1. Section 14132.88 of the Welfare and Institutions Code is amended to read:14132.88. (a) Notwithstanding subdivision (h) of Section 14132 and to the extent that funds are made available in the annual Budget Act for this purpose, the following are covered benefits for beneficiaries 21 years of age or older under this chapter:(1) Except as specified in paragraph (2), the following benefits:(1)(A) One dental prophylaxis cleaning per year.(2)(B) One initial dental examination by a dentist.(2) When medically necessary, as specified in the Medi-Cal Dental Manual of Criteria, the following benefits:(A) Two dental prophylaxis cleanings per year.(B) Two periodic dental examinations per year.(b) The following are covered benefits for beneficiaries under 21 years of age under this chapter:(1) Two dental prophylaxis cleanings per year.(2) Two periodic dental examinations per year.(c) For persons 21 years of age or older, laboratory-processed crowns on posterior teeth are a covered benefit when medically necessary to restore a posterior tooth back to normal function based on the criteria specified in the Medi-Cal Dental Manual of Criteria.(d) Any prefabricated crown made from ADA-approved materials may be used on posterior teeth and may be reimbursed as a stainless steel crown.(e) Covered dental benefits and accompanying criteria for receipt of those dental benefits under the Medi-Cal program shall be identified in the Medi-Cal Dental Manual of Criteria. Notwithstanding subdivision (h) of Section 14132, the department shall evaluate all covered dental benefits, including those listed in this section and in the Medi-Cal Dental Manual of Criteria, for evidence-based practices consistent with the American Academy of Pediatric Dentistry and the American Dental Association guidelines.(f) (1) Except as provided in paragraph (2), the department shall require pretreatment radiograph documentation on posttreatment claims to establish the medical necessity for dental restorations. The pretreatment documentation required under this subdivision is intended to reduce fraudulent claims for unnecessary dental fillings. In order to avoid any undue barriers to accessing dental care, the department shall stipulate that the pretreatment radiograph documentation for posttreatment claims will be required only when there are four or more dental fillings being completed in any 12-month period.(2) For any beneficiary who is under four years of age, or who, regardless of age, has a developmental disability, as defined in subdivision (a) of Section 4512, radiographs or photographs that indicate decay on any tooth surface shall be considered sufficient documentation to establish the medical necessity for treatment provided.(3) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this section, in whole or in part, by means of provider bulletins, plan letters, or other similar instructions, without taking regulatory action.(g) This section shall be implemented only to the extent that any necessary federal approvals are obtained and federal financial participation is available.SECTION 1.Section 14132.88 of the Welfare and Institutions Code is amended to read:14132.88.(a)Notwithstanding subdivision (h) of Section 14132 and to the extent funds are made available in the annual Budget Act for this purpose, the following are covered benefits for all beneficiaries under this chapter:(1)Two dental prophylaxis cleanings per year.(2)Two periodic dental examinations per year.(b)For persons 21 years of age or older, laboratory-processed crowns on posterior teeth are a covered benefit when medically necessary to restore a posterior tooth back to normal function based on the criteria specified in the Medi-Cal Dental Manual of Criteria.(c)Any prefabricated crown made from ADA-approved materials may be used on posterior teeth and may be reimbursed as a stainless steel crown.(d) Covered dental benefits and accompanying criteria for receipt of those dental benefits under the Medi-Cal program shall be identified in the Medi-Cal Dental Manual of Criteria. Notwithstanding subdivision (h) of Section 14132, the department shall evaluate all covered dental benefits, including those listed in this section and in the Medi-Cal Dental Manual of Criteria, for evidence-based practices consistent with the American Academy of Pediatric Dentistry and the American Dental Association guidelines.(e)(1)Except as provided in paragraph (2), the department shall require pretreatment radiograph documentation on posttreatment claims to establish the medical necessity for dental restorations. The pretreatment documentation required under this subdivision is intended to reduce fraudulent claims for unnecessary dental fillings. In order to avoid any undue barriers to accessing dental care, the department shall stipulate that the pretreatment radiograph documentation for posttreatment claims will be required only when there are four or more dental fillings being completed in any 12-month period.(2)For any beneficiary who is under four years of age, or who, regardless of age, has a developmental disability, as defined in subdivision (a) of Section 4512, radiographs or photographs that indicate decay on any tooth surface shall be considered sufficient documentation to establish the medical necessity for treatment provided.(3)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this section, in whole or in part, by means of provider bulletins, plan letters, or other similar instructions, without taking regulatory action.(f)This section shall be implemented only to the extent that any necessary federal approvals are obtained and federal financial participation is available. | |
| 42 | 41 | ||
| 43 | 42 | The people of the State of California do enact as follows: | |
| 44 | 43 | ||
| 45 | 44 | ## The people of the State of California do enact as follows: | |
| 46 | 45 | ||
| 47 | - | SECTION 1. Section 14132.88 of the Welfare and Institutions Code is amended to read:14132.88. (a) Notwithstanding subdivision (h) of Section 14132 and to the extent that funds are made available in the annual Budget Act for this purpose, the following are covered benefits for beneficiaries 21 years of age or older under this chapter:(1) Except as specified in paragraph (2), the following benefits:(A) One dental prophylaxis cleaning per year.(B) One initial dental examination by a dentist.(2) When medically necessary, as specified in the Medi-Cal Dental Manual of Criteria, the following benefits:(A) Two | |
| 46 | + | SECTION 1. Section 14132.88 of the Welfare and Institutions Code is amended to read:14132.88. (a) Notwithstanding subdivision (h) of Section 14132 and to the extent that funds are made available in the annual Budget Act for this purpose, the following are covered benefits for beneficiaries 21 years of age or older under this chapter:(1) Except as specified in paragraph (2), the following benefits:(1)(A) One dental prophylaxis cleaning per year.(2)(B) One initial dental examination by a dentist.(2) When medically necessary, as specified in the Medi-Cal Dental Manual of Criteria, the following benefits:(A) Two dental prophylaxis cleanings per year.(B) Two periodic dental examinations per year.(b) The following are covered benefits for beneficiaries under 21 years of age under this chapter:(1) Two dental prophylaxis cleanings per year.(2) Two periodic dental examinations per year.(c) For persons 21 years of age or older, laboratory-processed crowns on posterior teeth are a covered benefit when medically necessary to restore a posterior tooth back to normal function based on the criteria specified in the Medi-Cal Dental Manual of Criteria.(d) Any prefabricated crown made from ADA-approved materials may be used on posterior teeth and may be reimbursed as a stainless steel crown.(e) Covered dental benefits and accompanying criteria for receipt of those dental benefits under the Medi-Cal program shall be identified in the Medi-Cal Dental Manual of Criteria. Notwithstanding subdivision (h) of Section 14132, the department shall evaluate all covered dental benefits, including those listed in this section and in the Medi-Cal Dental Manual of Criteria, for evidence-based practices consistent with the American Academy of Pediatric Dentistry and the American Dental Association guidelines.(f) (1) Except as provided in paragraph (2), the department shall require pretreatment radiograph documentation on posttreatment claims to establish the medical necessity for dental restorations. The pretreatment documentation required under this subdivision is intended to reduce fraudulent claims for unnecessary dental fillings. In order to avoid any undue barriers to accessing dental care, the department shall stipulate that the pretreatment radiograph documentation for posttreatment claims will be required only when there are four or more dental fillings being completed in any 12-month period.(2) For any beneficiary who is under four years of age, or who, regardless of age, has a developmental disability, as defined in subdivision (a) of Section 4512, radiographs or photographs that indicate decay on any tooth surface shall be considered sufficient documentation to establish the medical necessity for treatment provided.(3) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this section, in whole or in part, by means of provider bulletins, plan letters, or other similar instructions, without taking regulatory action.(g) This section shall be implemented only to the extent that any necessary federal approvals are obtained and federal financial participation is available. | |
| 48 | 47 | ||
| 49 | 48 | SECTION 1. Section 14132.88 of the Welfare and Institutions Code is amended to read: | |
| 50 | 49 | ||
| 51 | 50 | ### SECTION 1. | |
| 52 | 51 | ||
| 53 | - | 14132.88. (a) Notwithstanding subdivision (h) of Section 14132 and to the extent that funds are made available in the annual Budget Act for this purpose, the following are covered benefits for beneficiaries 21 years of age or older under this chapter:(1) Except as specified in paragraph (2), the following benefits:(A) One dental prophylaxis cleaning per year.(B) One initial dental examination by a dentist.(2) When medically necessary, as specified in the Medi-Cal Dental Manual of Criteria, the following benefits:(A) Two | |
| 52 | + | 14132.88. (a) Notwithstanding subdivision (h) of Section 14132 and to the extent that funds are made available in the annual Budget Act for this purpose, the following are covered benefits for beneficiaries 21 years of age or older under this chapter:(1) Except as specified in paragraph (2), the following benefits:(1)(A) One dental prophylaxis cleaning per year.(2)(B) One initial dental examination by a dentist.(2) When medically necessary, as specified in the Medi-Cal Dental Manual of Criteria, the following benefits:(A) Two dental prophylaxis cleanings per year.(B) Two periodic dental examinations per year.(b) The following are covered benefits for beneficiaries under 21 years of age under this chapter:(1) Two dental prophylaxis cleanings per year.(2) Two periodic dental examinations per year.(c) For persons 21 years of age or older, laboratory-processed crowns on posterior teeth are a covered benefit when medically necessary to restore a posterior tooth back to normal function based on the criteria specified in the Medi-Cal Dental Manual of Criteria.(d) Any prefabricated crown made from ADA-approved materials may be used on posterior teeth and may be reimbursed as a stainless steel crown.(e) Covered dental benefits and accompanying criteria for receipt of those dental benefits under the Medi-Cal program shall be identified in the Medi-Cal Dental Manual of Criteria. Notwithstanding subdivision (h) of Section 14132, the department shall evaluate all covered dental benefits, including those listed in this section and in the Medi-Cal Dental Manual of Criteria, for evidence-based practices consistent with the American Academy of Pediatric Dentistry and the American Dental Association guidelines.(f) (1) Except as provided in paragraph (2), the department shall require pretreatment radiograph documentation on posttreatment claims to establish the medical necessity for dental restorations. The pretreatment documentation required under this subdivision is intended to reduce fraudulent claims for unnecessary dental fillings. In order to avoid any undue barriers to accessing dental care, the department shall stipulate that the pretreatment radiograph documentation for posttreatment claims will be required only when there are four or more dental fillings being completed in any 12-month period.(2) For any beneficiary who is under four years of age, or who, regardless of age, has a developmental disability, as defined in subdivision (a) of Section 4512, radiographs or photographs that indicate decay on any tooth surface shall be considered sufficient documentation to establish the medical necessity for treatment provided.(3) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this section, in whole or in part, by means of provider bulletins, plan letters, or other similar instructions, without taking regulatory action.(g) This section shall be implemented only to the extent that any necessary federal approvals are obtained and federal financial participation is available. | |
| 54 | 53 | ||
| 55 | - | 14132.88. (a) Notwithstanding subdivision (h) of Section 14132 and to the extent that funds are made available in the annual Budget Act for this purpose, the following are covered benefits for beneficiaries 21 years of age or older under this chapter:(1) Except as specified in paragraph (2), the following benefits:(A) One dental prophylaxis cleaning per year.(B) One initial dental examination by a dentist.(2) When medically necessary, as specified in the Medi-Cal Dental Manual of Criteria, the following benefits:(A) Two | |
| 54 | + | 14132.88. (a) Notwithstanding subdivision (h) of Section 14132 and to the extent that funds are made available in the annual Budget Act for this purpose, the following are covered benefits for beneficiaries 21 years of age or older under this chapter:(1) Except as specified in paragraph (2), the following benefits:(1)(A) One dental prophylaxis cleaning per year.(2)(B) One initial dental examination by a dentist.(2) When medically necessary, as specified in the Medi-Cal Dental Manual of Criteria, the following benefits:(A) Two dental prophylaxis cleanings per year.(B) Two periodic dental examinations per year.(b) The following are covered benefits for beneficiaries under 21 years of age under this chapter:(1) Two dental prophylaxis cleanings per year.(2) Two periodic dental examinations per year.(c) For persons 21 years of age or older, laboratory-processed crowns on posterior teeth are a covered benefit when medically necessary to restore a posterior tooth back to normal function based on the criteria specified in the Medi-Cal Dental Manual of Criteria.(d) Any prefabricated crown made from ADA-approved materials may be used on posterior teeth and may be reimbursed as a stainless steel crown.(e) Covered dental benefits and accompanying criteria for receipt of those dental benefits under the Medi-Cal program shall be identified in the Medi-Cal Dental Manual of Criteria. Notwithstanding subdivision (h) of Section 14132, the department shall evaluate all covered dental benefits, including those listed in this section and in the Medi-Cal Dental Manual of Criteria, for evidence-based practices consistent with the American Academy of Pediatric Dentistry and the American Dental Association guidelines.(f) (1) Except as provided in paragraph (2), the department shall require pretreatment radiograph documentation on posttreatment claims to establish the medical necessity for dental restorations. The pretreatment documentation required under this subdivision is intended to reduce fraudulent claims for unnecessary dental fillings. In order to avoid any undue barriers to accessing dental care, the department shall stipulate that the pretreatment radiograph documentation for posttreatment claims will be required only when there are four or more dental fillings being completed in any 12-month period.(2) For any beneficiary who is under four years of age, or who, regardless of age, has a developmental disability, as defined in subdivision (a) of Section 4512, radiographs or photographs that indicate decay on any tooth surface shall be considered sufficient documentation to establish the medical necessity for treatment provided.(3) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this section, in whole or in part, by means of provider bulletins, plan letters, or other similar instructions, without taking regulatory action.(g) This section shall be implemented only to the extent that any necessary federal approvals are obtained and federal financial participation is available. | |
| 56 | 55 | ||
| 57 | - | 14132.88. (a) Notwithstanding subdivision (h) of Section 14132 and to the extent that funds are made available in the annual Budget Act for this purpose, the following are covered benefits for beneficiaries 21 years of age or older under this chapter:(1) Except as specified in paragraph (2), the following benefits:(A) One dental prophylaxis cleaning per year.(B) One initial dental examination by a dentist.(2) When medically necessary, as specified in the Medi-Cal Dental Manual of Criteria, the following benefits:(A) Two | |
| 56 | + | 14132.88. (a) Notwithstanding subdivision (h) of Section 14132 and to the extent that funds are made available in the annual Budget Act for this purpose, the following are covered benefits for beneficiaries 21 years of age or older under this chapter:(1) Except as specified in paragraph (2), the following benefits:(1)(A) One dental prophylaxis cleaning per year.(2)(B) One initial dental examination by a dentist.(2) When medically necessary, as specified in the Medi-Cal Dental Manual of Criteria, the following benefits:(A) Two dental prophylaxis cleanings per year.(B) Two periodic dental examinations per year.(b) The following are covered benefits for beneficiaries under 21 years of age under this chapter:(1) Two dental prophylaxis cleanings per year.(2) Two periodic dental examinations per year.(c) For persons 21 years of age or older, laboratory-processed crowns on posterior teeth are a covered benefit when medically necessary to restore a posterior tooth back to normal function based on the criteria specified in the Medi-Cal Dental Manual of Criteria.(d) Any prefabricated crown made from ADA-approved materials may be used on posterior teeth and may be reimbursed as a stainless steel crown.(e) Covered dental benefits and accompanying criteria for receipt of those dental benefits under the Medi-Cal program shall be identified in the Medi-Cal Dental Manual of Criteria. Notwithstanding subdivision (h) of Section 14132, the department shall evaluate all covered dental benefits, including those listed in this section and in the Medi-Cal Dental Manual of Criteria, for evidence-based practices consistent with the American Academy of Pediatric Dentistry and the American Dental Association guidelines.(f) (1) Except as provided in paragraph (2), the department shall require pretreatment radiograph documentation on posttreatment claims to establish the medical necessity for dental restorations. The pretreatment documentation required under this subdivision is intended to reduce fraudulent claims for unnecessary dental fillings. In order to avoid any undue barriers to accessing dental care, the department shall stipulate that the pretreatment radiograph documentation for posttreatment claims will be required only when there are four or more dental fillings being completed in any 12-month period.(2) For any beneficiary who is under four years of age, or who, regardless of age, has a developmental disability, as defined in subdivision (a) of Section 4512, radiographs or photographs that indicate decay on any tooth surface shall be considered sufficient documentation to establish the medical necessity for treatment provided.(3) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this section, in whole or in part, by means of provider bulletins, plan letters, or other similar instructions, without taking regulatory action.(g) This section shall be implemented only to the extent that any necessary federal approvals are obtained and federal financial participation is available. | |
| 58 | 57 | ||
| 59 | 58 | ||
| 60 | 59 | ||
| 61 | 60 | 14132.88. (a) Notwithstanding subdivision (h) of Section 14132 and to the extent that funds are made available in the annual Budget Act for this purpose, the following are covered benefits for beneficiaries 21 years of age or older under this chapter: | |
| 62 | 61 | ||
| 63 | 62 | (1) Except as specified in paragraph (2), the following benefits: | |
| 64 | 63 | ||
| 64 | + | (1) | |
| 65 | + | ||
| 66 | + | ||
| 67 | + | ||
| 65 | 68 | (A) One dental prophylaxis cleaning per year. | |
| 69 | + | ||
| 70 | + | (2) | |
| 71 | + | ||
| 72 | + | ||
| 66 | 73 | ||
| 67 | 74 | (B) One initial dental examination by a dentist. | |
| 68 | 75 | ||
| 69 | 76 | (2) When medically necessary, as specified in the Medi-Cal Dental Manual of Criteria, the following benefits: | |
| 70 | 77 | ||
| 71 | - | (A) | |
| 78 | + | (A) Two dental prophylaxis cleanings per year. | |
| 72 | 79 | ||
| 73 | - | (B) Two At least two periodic dental examinations per year. | |
| 74 | - | ||
| 75 | - | (3) For purposes of this subdivision, medically necessary includes an individuals inability to maintain daily oral hygiene habits, susceptibility to oral health disease or decay, preoperative dental care, or as otherwise required by Section 14059.5. | |
| 76 | - | ||
| 77 | - | (4) The department shall update the Medi-Cal Dental Manual of Criteria to conform with the description of medically necessary in paragraph (3). | |
| 80 | + | (B) Two periodic dental examinations per year. | |
| 78 | 81 | ||
| 79 | 82 | (b) The following are covered benefits for beneficiaries under 21 years of age under this chapter: | |
| 80 | 83 | ||
| 81 | 84 | (1) Two dental prophylaxis cleanings per year. | |
| 82 | 85 | ||
| 83 | 86 | (2) Two periodic dental examinations per year. | |
| 84 | 87 | ||
| 85 | 88 | (c) For persons 21 years of age or older, laboratory-processed crowns on posterior teeth are a covered benefit when medically necessary to restore a posterior tooth back to normal function based on the criteria specified in the Medi-Cal Dental Manual of Criteria. | |
| 86 | 89 | ||
| 87 | 90 | (d) Any prefabricated crown made from ADA-approved materials may be used on posterior teeth and may be reimbursed as a stainless steel crown. | |
| 88 | 91 | ||
| 89 | 92 | (e) Covered dental benefits and accompanying criteria for receipt of those dental benefits under the Medi-Cal program shall be identified in the Medi-Cal Dental Manual of Criteria. Notwithstanding subdivision (h) of Section 14132, the department shall evaluate all covered dental benefits, including those listed in this section and in the Medi-Cal Dental Manual of Criteria, for evidence-based practices consistent with the American Academy of Pediatric Dentistry and the American Dental Association guidelines. | |
| 90 | 93 | ||
| 91 | 94 | (f) (1) Except as provided in paragraph (2), the department shall require pretreatment radiograph documentation on posttreatment claims to establish the medical necessity for dental restorations. The pretreatment documentation required under this subdivision is intended to reduce fraudulent claims for unnecessary dental fillings. In order to avoid any undue barriers to accessing dental care, the department shall stipulate that the pretreatment radiograph documentation for posttreatment claims will be required only when there are four or more dental fillings being completed in any 12-month period. | |
| 92 | 95 | ||
| 93 | 96 | (2) For any beneficiary who is under four years of age, or who, regardless of age, has a developmental disability, as defined in subdivision (a) of Section 4512, radiographs or photographs that indicate decay on any tooth surface shall be considered sufficient documentation to establish the medical necessity for treatment provided. | |
| 94 | 97 | ||
| 95 | 98 | (3) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this section, in whole or in part, by means of provider bulletins, plan letters, or other similar instructions, without taking regulatory action. | |
| 96 | 99 | ||
| 97 | 100 | (g) This section shall be implemented only to the extent that any necessary federal approvals are obtained and federal financial participation is available. | |
| 101 | + | ||
| 102 | + | ||
| 103 | + | ||
| 104 | + | ||
| 105 | + | ||
| 106 | + | (a)Notwithstanding subdivision (h) of Section 14132 and to the extent funds are made available in the annual Budget Act for this purpose, the following are covered benefits for all beneficiaries under this chapter: | |
| 107 | + | ||
| 108 | + | ||
| 109 | + | ||
| 110 | + | (1)Two dental prophylaxis cleanings per year. | |
| 111 | + | ||
| 112 | + | ||
| 113 | + | ||
| 114 | + | (2)Two periodic dental examinations per year. | |
| 115 | + | ||
| 116 | + | ||
| 117 | + | ||
| 118 | + | (b)For persons 21 years of age or older, laboratory-processed crowns on posterior teeth are a covered benefit when medically necessary to restore a posterior tooth back to normal function based on the criteria specified in the Medi-Cal Dental Manual of Criteria. | |
| 119 | + | ||
| 120 | + | ||
| 121 | + | ||
| 122 | + | (c)Any prefabricated crown made from ADA-approved materials may be used on posterior teeth and may be reimbursed as a stainless steel crown. | |
| 123 | + | ||
| 124 | + | ||
| 125 | + | ||
| 126 | + | (d) Covered dental benefits and accompanying criteria for receipt of those dental benefits under the Medi-Cal program shall be identified in the Medi-Cal Dental Manual of Criteria. Notwithstanding subdivision (h) of Section 14132, the department shall evaluate all covered dental benefits, including those listed in this section and in the Medi-Cal Dental Manual of Criteria, for evidence-based practices consistent with the American Academy of Pediatric Dentistry and the American Dental Association guidelines. | |
| 127 | + | ||
| 128 | + | ||
| 129 | + | ||
| 130 | + | (e)(1)Except as provided in paragraph (2), the department shall require pretreatment radiograph documentation on posttreatment claims to establish the medical necessity for dental restorations. The pretreatment documentation required under this subdivision is intended to reduce fraudulent claims for unnecessary dental fillings. In order to avoid any undue barriers to accessing dental care, the department shall stipulate that the pretreatment radiograph documentation for posttreatment claims will be required only when there are four or more dental fillings being completed in any 12-month period. | |
| 131 | + | ||
| 132 | + | ||
| 133 | + | ||
| 134 | + | (2)For any beneficiary who is under four years of age, or who, regardless of age, has a developmental disability, as defined in subdivision (a) of Section 4512, radiographs or photographs that indicate decay on any tooth surface shall be considered sufficient documentation to establish the medical necessity for treatment provided. | |
| 135 | + | ||
| 136 | + | ||
| 137 | + | ||
| 138 | + | (3)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this section, in whole or in part, by means of provider bulletins, plan letters, or other similar instructions, without taking regulatory action. | |
| 139 | + | ||
| 140 | + | ||
| 141 | + | ||
| 142 | + | (f)This section shall be implemented only to the extent that any necessary federal approvals are obtained and federal financial participation is available. |