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State of Calitomia—Health and Human Services Agency Department of Health Care Services

June 5, 2019

Richard C. Allen, Director Western Regional Operations Group Centers for Medicare & Medicaid Services San Francisco Regional Office 90 Seventh Street, Suite 5-300 (5W) San Francisco, CA 94103-6706

2019 ANNUAL DENTAL MANAGED CARE NETWORK CERTIFICATION

Dear Mr. Allen: The Department of Health Care Services (D H C S) submits the enclosed Centers for Medicare & Medicaid Services Dental Managed Care Network Adequacy Certification confirming that the Medi-Cal Dental Managed Care plans contracted with D H C S are compliant with the network certification requirements found under the Medicaid Managed Care Final Rule C M S 2390-F. and the state requirements for availability of services. as set forth in Title 42. Code of Federal Regulations, Sections 438.206. 438.207. and 438.68. Should you have any questions or concerns regarding this summary, please contact Alani Jackson, Chief, Medi-Cal Dental Services Division, by phone at (916) 345-8629 or by email at Alani.Jackson@dhcs.ca.gov.

Alani.Jackson@dhcs.ca.gov

Mari Cantwell Chief Deputy Director Health Care Programs State Medicaid Director Enclosure: Dental Managed Care Network Adequacy Certificationcc: See Next Page

Director’s Office 1501 Capital Avenue. MS 0000 P .0. Box 997413. Sacramento. CA 95899-7413 Phone (918) 440-7400 Internet Address: http://www.DHCS.ca.gov

Mr. Richard AllenPage 2June 5. 2019

CC: Rene Mollow, MSN, RN Deputy Director Health Care Benefits and Eligibility Department of Health Care Services Rene.Mollow@dhcs.ca.gov

Alani Jackson, M P A Chief, Medi-Cal Dental Services Division, Health Care Benefits and Eligibility, Department of Health Care Services, Alani.Jackson@dhcs.ca.gov