Beginning October 1, 2023, the Agency for Health Care Administration initiated the Dental Provider Incentive Program (“DPIP”). This program is designed to provide bonus reimbursements for those providers treating Medicaid patients who have prioritized the improvement of oral health in Florida.
Below is an excerpt from the Agency for Health Care Administration (Agency) DPIP website. To learn more about this program, please refer to the agency website, where you can find additional information about the included Services and Enhanced Payments.
DPIP Covered Physician Types:
Providers eligible to participate in the DPIP are the dentist types below:
- General Dentists
- Pediatric Dentists
To qualify for enhanced payments beginning October 1, 2024, eligible dental providers must achieve particular DPIP Qualifying Criteria for calendar year 2023 services.
DPIP Qualifying Criteria:
A dental provider must achieve or exceed the benchmarks for each of the following metrics:
| Metric | Incentive Threshold Rate | Metric Description |
| Preventive Dental Services | 65% | Percentage of children ages 1 to 20 who are eligible for at least 90 continuous days, are eligible for EPSDT services, and who received at least one preventive dental service during the measurement period. |
| Oral Evaluation – Total | 65% | Percentage of enrolled children under age 21 who received a comprehensive or periodic oral evaluation within the reporting year. |
| Caries Risk Assessment – Total | 70% | Percentage of enrolled children under age 21 years who have caries risk documented in the reporting year. |
| Sealant Receipt of Permanent 1st Molars – at least one | 60% | Percentage of enrolled children who have ever received sealants on permanent first molar teeth: at least one by the 10th birthdate. |
| Topical Fluoride for Children (Total) | 65% | Percentage of children aged 1-21 years who received at least 2 topical fluoride applications within the reporting year. |
Qualified providers will receive enhanced payments for specific preventive and diagnostic services provided to children under the age of 21 years. All Statewide Medicaid Managed Care dental health plans participate in this program and are responsible for issuing enhanced payments to qualified providers.
Should you have any questions regarding the above, please contact the author, the Garfunkel Wild attorney with whom you regularly work, or contact us at [email protected].