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Critical Access Dental Payment Program (CADPP)

Revised: 07-24-2017

  • Overview
  • Eligible Providers
  • CADPP Dental Practice Designation Request
  • Reimbursement for Services
  • Billing
  • References
  • Overview

    The goals of the CADPP are to:

  • • Support dental practices with a high volume of active MHCP recipients
  • • Increase access to dental services for our recipients
  • Practices that meet the eligibility criteria must submit a request for designation with all other required documentation.

    All aspects of the CADPP are subject to change by the Minnesota Legislature.

    Eligible Providers

    Dentists and dental clinics must meet one of the following criteria (if criteria has multiple components, providers must meet all components under the given criteria and submit the documentation as verification with the request for designation):

  • 1. Nonprofit community clinic that meets the following:
  • • Nonprofit status in accordance with chapter 317A
  • • Tax exempt status in accordance with the Internal Revenue Code, section 501(c)(3)
  • • Was established to provide oral health services to patients who are low income, uninsured, have special needs and are underserved
  • • Professional staff are familiar with the cultural background of the clinic’s patients
  • • Provides services that are charged on a sliding fee scale designed to provide assistance to low-income patients based on federal poverty income guidelines and family size
  • • Does not restrict access or services because of a patient’s financial limitations or public assistance status
  • • Has free care available as needed
  • Nonprofit community clinics, including those currently enrolled with MHCP, must complete the Community Clinic Applicant Assurance Statement (DHS-5732) (PDF) and any other required documentation before MHCP can consider the clinic for CADPP designation.

  • 2. Federally qualified health center (FQHC), rural health clinic (RHC) or public health clinic (PHC)
  • 3. City or county-owned and operated hospital-based dental clinic who has a Disclosure of Ownership and Control Interest of an Entity (DHS-5259) (PDF) on file with MHCP and meets requirements in the Code of Federal Regulations (CFR) for Definition of a provider-based clinic and Condition of participation
  • 4. Dental clinic or dental group owned and operated by a nonprofit corporation that has:

  • • Nonprofit status in accordance with chapter 317A
  • • More than 10,000 patient encounters per year with patients who are uninsured or covered by Medical Assistance or MinnesotaCare
  • 5. A dental clinic associated with an oral health or dental education program owned and operated by the University of Minnesota or an institution within the Minnesota State Colleges and Universities (MNSCU) system
  • 6. Private practicing dentists if the following are met:
  • • The dentist's office is located within the seven-county metropolitan area and more than 50 percent of the dentist's patient encounters per year are with patients who are uninsured or covered by Medical Assistance or MinnesotaCare
  • • For dentist offices located outside the seven-county metropolitan area, more than 25 percent of the dentist's patient encounters per year must be with patients who are uninsured or covered by Medical Assistance or MinnesotaCare
  • MHCP will track provider performance per Provider Requirements to determine eligibility for continued participation.

    CADPP Dental Practice Designation Request

    To request CADPP designation, complete the appropriate MHCP designation request form:

  • • Private practicing dentists – CADPP Private Practice Designation Request (DHS-2669a) (PDF)
  • • All other eligible providers – CADPP Designation Request (DHS-2669) (PDF)
  • If a practice has:

  • • More than one federal employer identification number (FEIN), complete one application for each FEIN
  • • Multiple locations, complete one application for each separate practice location
  • Note: Private practicing dentists must have a MHCP enrolled practice or clinic FEIN.

    To complete the CADPP designation process:

  • • Include any additional forms that are required for your practice type (for example, assurance statements or disclosure of ownership forms)
  • • Fax the Designation Request form and documentation to 651-431-7462
  • You only need to complete this process once. MHCP will not require subsequent annual requests for designation. If MHCP designates you as a CADPP provider, you are responsible for informing MHCP if the status of the clinic changes or no longer meets the criteria for CADPP designation.

    Reimbursement for Services

    Providers designated as CADPP receive add-on payments for services for Medical Assistance (MA) and MinnesotaCare recipients, including those enrolled in a managed care organization (MCO), as follows:

  • • For MA services provided on or after July 1, 2016, 37.5 percent above the MHCP maximum allowable rate
  • • For MinnesotaCare services provided on or after July 1, 2017, 20 percent above the MHCP maximum allowable rate
  • • For FQHC, RHC and Indian Health Service (IHS) clinics, critical access payments will be made only for MinnesotaCare dental services that are not eligible for cost-based reimbursement
  • Fee-for-service (FFS) CADPP add-on payments are included in the reimbursement for each paid claim and appear on the provider’s remittance advice with a group code CO and adjustment reason 144.

    Effective January 1, 2017, how CAD payments are calculated will change. The MCO CADPP will be included in the capitation payments paid to the MCOs. with an exception for Medica health plan providers. Each MCO will calculate and determine how the CAD payments are made to designated providers for MA and MinnesotaCare recipients. Contact the MCO with whom you have a provider agreement with any questions or concerns.

    For all Medica providers, MHCP will calculate the payment amount based on total payments from January 1, 2017, to April 30, 2017, as Medica reports them to us for each participating provider. Medica will remit the payments for the first four months of 2017 directly to each participating provider.

    Billing

    Follow these guidelines for billing:

  • • Use the electronic 837D format or MN–ITS Direct Data Entry (DDE) 837D
  • • Providers must bill using the NPI of the CADPP designated practice
  • • For practices with multiple locations, each separate practice location must submit claims with the NPI correlated to the treatment location
  • References

    Minnesota Statutes 256B.76, Subd. 4 (Physician and Dental Reimbursement - Critical access dental providers)
    Minnesota Statutes 256L.11, Subd. 7
    (Provider Payment - Critical access dental providers)
    Minnesota Statutes 256B.76, Subd. 3c (b)
    (Dental subcommittee)
    Minnesota Statutes 256B.0625, Subd. 30
    (Covered Services, Other clinic services)

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    Updated: 7/24/17 9:51 AM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 7/24/17 9:51 AM