HPSM Dental Corrective Action Plan

This web page describes the corrective action plan the Health Plan of San Mateo (HPSM) has been given by the California Department of Health Care Services (DHCS). Please read this information carefully. This corrective action plan will remain in place for at least six (6) months.

Mandates

1. Continuity of Care – HPSM must meet the continuity of care requirements as outlined in Health and Safety Code 1373.96. In addition as result of the CAP, HPSM must grant all members automatic continuity of care to their existing dental providers, to the extent they have one, for all scheduled services through March 31, 2022. HPSM must coordinate with members and dental providers to ensure access to covered services.
2. Authorizations – HPSM must authorize and pay all claims for covered Medi-Cal Dental services for the CAP period, regardless of whether the dental provider is in or out-of-network.
3. Website Updates – HPSM must update its website with a current list of contracted dental providers and dental clinics, as their contracts are executed. Contracting information and in-network dental provider information must be updated and current as HPSM continues to build its dental network.

HPSM will provide covered Medi-Cal Dental services from out-of-network providers, where applicable, until all network deficiencies are corrected.