Beneficiary Dental Exception(BDE)
Assembly Bill 1467 (Chapter 23, Statutes of 2012) was enacted July 1, 2012 to improve access to oral health and dental care services provided to Medi-Cal members enrolled in Dental Managed Care (DMC) plans in Sacramento County. The intent of the Legislature through the statute was to improve access to dental care by implementation of the Member Dental Exception (BDE) process by the Department of Health Care Services (DHCS). The BDE process was implemented September 2012 and is available to Medi-Cal DMC members in Sacramento County who are unable to secure access to services through their dental plan, in accordance with applicable contractual timeframes and the Knox-Keene Health Service Plan Act of 1975 (Chapter 2.2 (commencing with Section 1340) of Division 2 of the Health and Safety Code).
What is the BDE?
The BDE allows a member to request to opt-out of Medi-Cal DMC and move into Fee-For-Service (FFS) Medi-Cal Dental where the member may select his or her own dental provider on an ongoing basis, by mail, fax, email, or utilization of the BDE line (855-347-3310). The statute also allows DHCS staff to work with the DMC plans on behalf of the member to schedule an appropriate appointment within specified time frames, based on the identified needs of the member. If no such appointment is secured, the member will be transferred into FFS Medi-Cal Dental where he/she will remain until such time that he/she chooses to opt back into a DMC arrangement.
If the BDE is submitted by mail/fax/email, DHCS staff will contact the member within three (3) business days to work with the member and the dental plan/provider to schedule an appointment within the applicable timeframes.
- If the member does not respond to the first initial contact, he/she will be contacted an additional time before a letter is sent to notify the member of intent to close the case, and for him/her to contact BDE if he/she needs to submit a new file.
If the BDE is submitted via the designated BDE phone line, 1-855-347-3310, a DHCS BDE representative will assist through a conference call to resolve/set an appointment with the member and provider/plan within the appropriate timeframes
- Appointments are scheduled through a conference call with a DHCS BDE representative, the member, and the dental plan/provider to ensure the appropriate timeframes are met and to follow-up with any questions or concerns including any additional details. Any other additional issues are resolved during the call as well.
When an appointment is scheduled, the BDE case will be placed on hold pending follow-up calls from DHCS staff to the member after the appointment and inquire about his/her dental visit and satisfaction. If the appointment was successful and no additional access issues were identified, the BDE case will be closed, indicating no further action is needed.
All "In Progress" cases are case managed until they are closed, including cases with pending initial dental appointments and/or subsequent follow-up appointments.
BDE Reports can be accessed on the Department of Health Care Services website: www.dhcs.ca.gov/services/Pages/BDE-Reporting.aspx