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Major Issues & Priorities

1. COVID-19’s Impact on Dentistry

Vaccinations

The state initially included dental staff in Phase 1a, Tier 3 of its vaccination plan and has since recommended that counties begin vaccinating all Phase 1a personnel, making all dental staff and other health care professionals eligible to receive the vaccine now. CDA continues to advocate for the state to prioritize dental staff in the current vaccination efforts, given their proximity to unmasked patients during treatment and so they can be protected as they join the ranks of the state’s vaccinators. The California Department of Consumer Affairs recently issued an emergency authorization for dentists to administer the vaccine, and CDA is eager to be an active partner in providing dentists to vaccination sites.

PPE Costs/Dental Benefits Plans

Approximately 97% of California dental offices completely closed or were only seeing emergency patients from March through May 2020. Since dental practices reopened, they have continued to face significantly increased overhead costs combined with decreased patient volume due to COVID-19 safety guidelines and lingering public weariness around receiving health care treatment. The high cost of personal protective equipment (PPE) is exacerbated by product scarcity and supply chain disruptions. CDA is advocating that all dental plans share in the costs of these necessary infection control measures, without which dental care is not currently possible, by providing a minimum PPE payment per patient visit through the end of 2021. During the period of closure and reduced patient volume, dental benefits plans continued to collect millions in premiums from employers and enrollees without pause, resulting in record net profits. After several months of advocacy, the California Department of Insurance and the Department of Managed Health Care have both acknowledged that health care providers are in economic distress and that health insurance plans have some responsibility to ensure they support distressed practices as a part of maintaining an adequate provider network. Both regulators have requested information from plans about types of assistance they are offering (such as grants, supplemental payments or PPE reimbursement) but have stopped short of mandating. CDA is advocating for targeted, time-limited relief that will help keep provider networks intact and prevent massive disruption to dental care access in California.

COVID-19 Testing

CDA is working with the California Department of Public Health and the legislature to ensure that once reliable rapid testing technology is available, dentists can obtain and use COVID-19 test kits to identify positive, asymptomatic patients and route them to the appropriate venue for care, obtain all applicable lab licenses and receive reasonable reimbursement for administering tests.

Dental Student Licensure

CDA staff, in coalition with the California dental school deans and dental school student leadership, advocated throughout spring 2020 for a pathway to timely dental licensure after patient-based licensure examinations were postponed indefinitely due to the pandemic. The Western Regional Examination Board and the American Board of Dental Examiners, the only testing agencies accepted by the Dental Board of California, announced that newly developed mannikin-based exam formats would be offered during the summer instead of patient-based exams.

After CDA advocacy to the DBC, the governor’s office and legislative staff, including multiple grassroots letter writing campaigns by dental students, the dental board approved the new exam formats as a pathway to licensure. Effective May 28, 2020, the DBC began to accept mannikin-based WREB and ADEX examinations on a permanent basis, allowing all six California dental schools to offer the tests and more than 800 graduating dental students across the country to take the requisite clinical examinations throughout summer 2020. This advocacy effort has resulted in California becoming one of the first states in the country to begin to move away from patient-based licensure examinations.

Continuing Education

In late March, after advocacy from CDA, the California Department of Consumer Affairs temporarily waived the license-renewal continuing education requirements for dental professionals whose licenses expired between March 31 and June 30, giving them until Sept. 30 to satisfy any waived C.E. requirements. That waiver was extended to include licenses expiring through Oct. 31 and gave affected licenses until Feb. 27, 2021, to complete the needed C.E., although licensure renewals must still be paid for on their original renewal dates. At the beginning of September, CDA advocated and successfully obtained a third waiver to ensure that live C.E. courses that incorporated prerecorded lectures would be accepted by the dental board, as a way to counter any technological or internet provider shortages that could affect the quality of the course offerings.

CDA’s consistent advocacy efforts helped to secure all three C.E. waivers for dental professionals after cancellations of required in-person courses and testing because of the COVID-19 pandemic.

2. Proposition 56 and the Medi-Cal dental program

CDA applauds Gov. Newsom for his recent budget proposal, which invests in greater health equity through workforce development, oral health care improvements, and vaccine distribution. We also applaud the continuation of Proposition 56 funding (tobacco tax increase approved in 2016 and co-sponsored by CDA) that maintains supplemental Medi-Cal provider reimbursements, student loan repayment grants and the state Office of Oral Health. Proposition 56 funds have led to a steady increase of over 1,600 newly enrolled Medi-Cal dental providers since 2017, after decades of declining participation.

3. MICRA Repeal Ballot Measure — Oppose

The Medical Injury Compensation Reform Act allows injured patients to receive unlimited economic damages for all past and future medical costs, lost wages and lifetime earning potential. MICRA also allows up to $250,000 in noneconomic damages and includes a limit on attorneys’ fees, stabilizes liability costs and reduces incentives for frivolous lawsuits against health care providers. A group of trial lawyers have qualified a ballot measure for the November 2022 election that would essentially eliminate MICRA’s protections. This measure would undeniably raise health care costs and reduce access to care for those who need it most, including people who use Medi-Cal, county health programs, safety-net providers and school-based health centers.

CDA is part of Californians to Protect Patients and Contain Health Care Costs, a broad coalition including physicians, nurses, hospitals, safety-net clinics and other health care providers who are committed to fighting this initiative.

4. AB 1998: Direct-to-Consumer Orthodontic Protections — Support 

AB 1998 by Assemblymember Evan Low (D-Silicon Valley) sought to build upon direct-to-consumer orthodontic consumer protections in last year’s dental board sunset review bill by refining X-ray requirements for orthodontic treatment, codifying dental record retention requirements, clarifying when a patient must be given contact information for their treating dentist, expanding the prohibition for any person to enter into a contract that limits their ability to file a complaint with a regulator and establishing explicit rights for patients to request copies of any documents they have signed.

Providing dental care that involves the movement of teeth without a proper evaluation can lead to serious patient harm, including loose or cracked teeth, bleeding tongue and gums, gum recession or a misaligned bite. With the emergence of new DTC business models offering various dental services that are ordered without an in-person clinical examination, it is imperative that dental treatment continues to meet a uniform standard of care regardless of whether a dentist provides treatment through telehealth or in person. CDA continues to advocate for consumer protections that ensure that DTC orthodontic business models have the same level of dentist oversight and patient safety as the virtual dental home model and in-person dental care. AB 1998 stalled in the Senate Business & Professions Committee and did not move forward. CDA will continue to work with the appropriate enforcement entities, including the dental board, to push for increased patient safety while pursuing improved statutory and regulatory enforcement.

5. SB 793: Flavored Vaping/Tobacco Ban — Support

CDA is a strong supporter of SB 793 (Hill), which prohibits the sale of flavored tobacco products, including electronic cigarettes. Flavored products, especially e-cigarettes, have the potential to reverse years of declining tobacco usage in the state. Of greatest concern is the alarming rise in vaping and e-cigarette use among youth, who often use these flavored nicotine-filled products. According to the California Department of Public Health, youth who would otherwise not have smoked cigarettes or used other tobacco products are still choosing to use flavored, electronic smoking devices. The tobacco industry is funding a referendum for the November 2022 ballot to repeal SB 793 and has submitted signatures to qualify the measure. If it qualifies, the law would be suspended until the election, allowing tobacco companies to continue selling these addictive products for two more years.

6. SB 1383: Expands California Family Rights Act — Oppose

The California Family Rights Act (CFRA) and the federal Family Medical Leave Act (FMLA) have provided eligible employees up to 12 work weeks of protected, unpaid leave. CFRA only applies to employers with 50 or more employees, and this leave can be taken for the birth, adoption or foster care placement a child or for the employee’s own serious health condition or that of a child, parent or spouse. SB 1383 will reduce the CFRA employee threshold to businesses with five or more employees, applying CFRA’s provisions to nearly all employers, including a large percentage of dental practices.

CDA worked in coalition with other employer organizations to oppose the bill and express the unique concerns of dental practices. Approximately 80% of dental practices have 10 or less employees, and unlike larger businesses where staff duties can be adjusted to cover the work of an employee on a leave of absence, there is often little cross over between roles in a dental office. Dental assistants are not licensed to do the work of a dental hygienist, nor can an office manager, who is not already trained, take over the duties of a dental assistant. This specialization makes it very difficult to continue to see the existing volume of patients without hiring a new employee to fill the role of the employee on leave. Expansion of parental and family leave has been a high priority of Governor Newsom, and SB 1383 narrowly passed the legislature before being signed into law. CDA Practice Support will be preparing resources to ensure CDA members are prepared when the law takes effect in January 2021.

7. AB 2164: Improving Access to Care Through Telehealth — Co-Sponsor

CDA was a co-sponsor of AB 2164 by Assemblymembers Robert Rivas (D-Hollister) and Rudy Salas (D-Bakersfield) which aimed to facilitate access to dental care through telehealth, specifically in federally qualified health centers using the virtual dental home model. This bill would have clarified that an FQHC can establish a new patient and bill for a virtual dental home visit when a billable Medi-Cal provider employed by the FQHC supervises or provides the services for the patient via telehealth either in real time or with store-and-forward technology. Recent guidance published by the Department of Health Care Services would significantly hinder the continuation and expansion of virtual dental homes in FQHCs. CDA was a co-sponsor of previous legislation that authorized the virtual dental home model and supports its continued use to increase access to care among some of the most vulnerable populations in California. AB 2164 passed out of the legislature with unanimous support but was vetoed by Governor Newsom due to potential state costs.

8. SB 653: Dental Hygienists — Support

CDA supported SB 653 by Senator Ling Ling Chang (R-Diamond Bar), which permits registered dental hygienists to apply fluoride varnish without the supervision of a dentist. It will also allow RDHs to provide services in medical offices through the virtual dental home model of care and in a larger variety of public health programs. Additionally, this bill expands the settings where registered dental hygienists in alternative practice can provide local anesthesia and soft tissue curettage when following specified safety protocols, including the collaboration of a dentist, in order to increase access to dental care in underserved areas and populations throughout California. SB 653 is the result of significant negotiations and collaboration efforts between Senator Chang, CDA and the bill sponsor, the California Dental Hygienists’ Association. SB 653 passed out of the legislature and was signed by the governor.

9. Dental Plan Transparency

Over the past several years, CDA has worked to improve transparency of dental plans for dentists and consumers. AB 1962 (2014) required commercial dental plans to annually disclose to the state how much premium revenue they spend on patient care versus administrative costs, which is known as a dental loss ratio (DLR). The reported data show a wide range of premium revenue spent on patient care, with a quarter of all California dental plans spending less than 50% of premiums on care and some plans even falling below 10%. SB 1008 (2018) built upon this by requiring all dental plans to use a uniform matrix to disclose their benefits directly to consumers, similar to the one used by medical plans. This provides plan beneficiaries with a uniform summary of plan details, including covered services, reimbursement levels, estimated enrollee cost share, limitations and exceptions. In 2019, CDA successfully sponsored AB 954 (Wood, D-Santa Rosa) which requires dental benefit plans to be more transparent about the common practice of “leasing” access to a network of contracted dentists from another dental benefit plan to provide clarity for patients and providers, reduce confusion and help preserve trust in the dentist-patient relationship. These transparency measures help level the playing field for consumers and providers, are consistent with standards that apply to medical plans and help hold dental plans accountable for how they spend premium dollars.

Updated January 2021