DATE: June 20, 2017
TO: Board of Supervisors
SUBMITTED BY: David Pomaville, Director, Department of Public Health
SUBJECT: Revenue Agreement with the California Department of Health Care Services for the Local Dental Pilot Project
RECOMMENDED ACTION(S):
TITLE
Approve and authorize the Chairman to execute a revenue Agreement with the California Department of Health Care Services for grant funding to support Denti-Cal Oral Health Outreach and Provider Enrollment activities, effective July 1, 2017 through December 31, 2020 ($11,127,285).
REPORT
Approval of the recommended action will allow the Department to accept funding from the California Department of Health Care Services’ (DHCS) Dental Transformation Initiative (DTI) Local Dental Pilot Project (Pilot Project) to provide Denti-Cal client oral health outreach and dental provider enrollment services to the Fresno County community.
ALTERNATIVE ACTION(S):
Should your Board not approve the recommended action, the grant application would be withdrawn and the award declined.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended action. The recommended revenue agreement will provide $11,127,285 through December 31, 2020 to contract with key partners including Fresno Economic Opportunities Commission - Health Services Education (EOC) and Reading and Beyond - Health Services Education (RAB) for administrative and staffing services; University of the Pacific School of Dentistry for training and consultation services; dental providers to participate in Virtual Dental Home (VDH) training sessions; Department staff hours devoted to the Pilot Project; and, a media campaign. The grant allocation does not require matching funds and the Department will return to your Board on a later date for approval of the related subcontracts. Sufficient appropriations and estimated revenues will be included in the Department of Public Health Org 5620 FY 2017-18 Recommended Budget and in subsequent budget requests for the term of the agreement. The recommended revenue agreement allows for full recovery of direct costs, but limits indirect cost recovery to 20% of Department personnel salary or $29,387 for the term. The grant allocation does not require matching funds.
DISCUSSION:
California’s Section 1115(a) Medicaid Waiver Renewal, entitled Medi-Cal 2020, was approved by the Centers for Medicare and Medicaid Services (CMS) on December 30, 2015. Within the Medi-Cal 2020 Waiver, the Dental Transformation Initiative (DTI) represents a critical mechanism to improve dental health for Medi-Cal children by focusing on high-value care, improved access, and utilization of performance measures to drive delivery system reform. More specifically, this strategy aims to increase the use of preventive dental services for children, prevent and treat more early childhood caries, and increase continuity of care for children.
The funding opportunity of $740 million for the DTI was made available by DHCS in mid-2016 for:
1. Increased utilization of preventative dental services among children;
2. Prevention and treatment of more early childhood caries;
3. Increased dental continuity of care for children; and
4. Local Dental Pilot Projects.
The goals of Domain 4 encompass the first three domain objectives and seeks to implement innovative pilot projects through alternative programs, potentially using strategies focused on urban or rural areas, care models, delivery systems, workforce, local case management initiatives and/or education. Per the California Department of Health Care Services (DHCS), qualified Pilot Project applicants were limited to a:
1. County;
2. City and County;
3. Consortium of Counties;
4. Tribe;
5. Indian Health Services Program; or
6. University of California or California State University Campus.
On September 30, 2016, the Department submitted a proposal on behalf of the County as the lead entity to coordinate the Pilot Project and serve as the single point of contact. DHCS identified 15 Pilot Projects as awardees; Fresno County was awarded $11,127,285 for a term of three and one half consecutive years.
The Pilot Project strategy will utilize a multidisciplinary outreach collaboration among diverse providers and health teams focused on changing the County residents’ outlook on oral health care. The project will coordinate data in oral health programs, oral health education, patient engagement, self-management, goal setting guidance, and continuity of care. VDH’s utilize a relatively new technology, known as Tele-Dentistry, for a small group of dentists to review Electronic Dental Records (EDR) from different community sites. The VDH creates a community-based oral health delivery system in which people receive preventive and simple therapeutic services, educational, social, or general health services in the community settings they live in.
The strategies proposed in the Pilot Project are significantly different from the activities that are currently being utilized in the traditional dental setting in Fresno County. Of which, an overwhelming 56% of Medi-Cal enrolled children age 0-20 receive restorative oral health services while only 44% receive preventive services. Worse yet, less than 25% of Medi-Cal enrolled children age 0-5 receive preventive services.
The Department plans to target Medi-Cal enrolled children 0-20 years old with a concentrated effort planned in the zip code areas of 93701, 93702 and 93722, selected to leverage prior community organizational commitments. Partners and stakeholders will leverage their community programs and infrastructure to engage the community, including workspace required for staff to deliver oral care prevention, education and oral hygiene treatment.
EOC, RAB, UOP, and two local dental providers collaborated in the formation of the County’s Pilot Project proposal as key partners. During DHCS’s DTI application opportunity posted on their website from December 2015 through September 2016, no other entities, outside of the key partners, contacted the Department to express interest in participating in the Pilot Project proposal. Furthermore, the Department is the only entity in the County area that applied for DTI Pilot Project funds.
As part of the County’s proposal, it is projected the number of Denti-Cal providers will increase in the County by 8% to 12 providers during the term of the Pilot Project. The preventive services delivered to children never seen by a dentist is projected to increase by 19.65% (11,126). Children receiving continuity of care is projected to increase by 9.51% (3,648). Additionally, the County’s proposal projects 1,170 training and consultation hours to implement and maintain the VDHs throughout the project’s term.
The VDH concept creates a community-based oral health delivery system in which people receive preventive and simple therapeutic services in the community settings where they live or receive educational, social, or general health services. The concept utilizes the latest technology to link practitioners in the community with dentists at remote office sites. The VDH can keep people healthy in community settings by collecting diagnostic records, providing preventive procedures and interim therapeutic restorations, education, and case management. When more complex dental treatment is needed, the dental providers may transition the client into their respective private practices, if unable; the VDH’s will connect clients with other area dentists.
The Department will be responsible for purchasing the equipment, and subsequent inventory management, needed to implement the VDH’s which is fully reimbursable through the grant. Other Department responsibilities will include monitoring the DHCS provided performance metrics in order to ensure the success of the Pilot Project, which include hosting a monthly advisory committee designed to address any issues that arise while conducting the Pilot Project during the first year thereafter, the Department will host bi-monthly advisory committee meetings. Serving as DHCS’s single point of contact, the Department will also be responsible for the Pilot Project’s data management needs and oversight of invoice submittal from subcontractors and release of funds from DHCS that will flow through the Department to the subcontractors.
REFERENCE MATERIAL:
BAI #34 - April 4, 2017 - Retroactive Dental Transformation Initiative - Local Dental Pilot Project Grant Application
BBR - December 22, 2016 - Dental Transformation Initiative Grant Application
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Revenue Agreement with California Department of Health Care Services
On file with Clerk - Revised Dental Transformation Initiative Grant Application
CAO ANALYST:
Sonia De La Rosa