Major Issues & Priorities

COVID-19's Impacts on Dentistry 

CDA continues to urge Governor Newsom and legislators to protect access to dental care in their response to the COVID-19 pandemic. Specifically, we are asking the governor and legislature for: 

  • Economic relief from dental plans
    • Require or provide incentives for dental plans and insurers to offer supplemental financial assistance or stabilization grants to keep their dental provider networks intact. Dental practices are faced with greatly increased costs combined with decreased patient volumes in order to comply with new COVID-19 requirements (additional PPE, strengthened infection controls and physical distancing of patients). Forty percent of dental offices in California are seeing less than 5% of their typical patient volume and nearly 60% of dental offices are seeing less than 25% of their typical patient volume according to the latest survey data. In California, total dental office employment in April was down 61% since March, compared to a drop of 12% in all nonfarm employment. Dentists and dental plans have a mutual interest in maintaining provider networks and short-term grants will help reduce the possibility of widespread, permanent closures of dental practices that would devastate access to dental care in California
  • Reverse proposed May Revise cuts to Proposition 56 and the Medi-Cal dental program
    • In the midst of a global pandemic, the governor’s May Revise budget will devastate access to health care for millions of Californians and the provider networks that serve them. The budget proposes redirecting $1.2 billion in Prop. 56 provider rate increases into Medi-Cal’s general fund to pay for anticipated growth in the program. The Prop. 56 funds have led to a steady, double-digit increase of Medi-Cal dental providers since 2017, after decades of decline. These cuts result in a 40% rate cut to dental reimbursements and will worsen the damage already done to Medi-Cal dentists as a result of the pandemic.

      The budget also proposes pulling back all future rounds of Prop. 56 funding for student loan repayment grants for dentists and physicians who commit to serving underserved communities, which will further worsen the access crisis at the worst possible time. Furthermore, the budget proposes cutting adult dental benefits in Medi-Cal to 2014 levels, which means eliminating essential services like periodontal care, partial dentures and posterior root canals.

      While CDA recognizes the record budget deficit and that these are trigger cuts that can be avoided with more federal relief, the proposed budget violates the statute approved by voters in Prop. 56 on top of eroding nearly a decade’s worth of progress on access to dental care. CDA supports the Assembly and Senate for their leadership and commitment to protect Prop. 56’s Medi-Cal funding.

  • Testing: Once reliable rapid testing technology is available, dentists must be able to obtain COVID-19 test kits so they can identify asymptomatic patients and route them to the appropriate venue for care. Dentists must also be able to receive reasonable reimbursement for administering tests.

AB 1998: Direct-to-Consumer Orthodontic Protections – Support 

AB 1998 by Assemblymember Evan Low (D-Silicon Valley) builds upon direct-to-consumer orthodontic consumer protections in last year’s dental board sunset review bill by: refining diagnostic record requirements for orthodontic treatment; codifying dental record retention requirements; further defining at what point during treatment a patient must be given contact information about their treating dentist; expanding the prohibition for any person, including an employee, to enter into a contract that limits their ability to submit complaints to a regulator; and establishing explicit rights to request copies of any documents signed by a patient.

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 has a long history of sponsoring and advocating for the funding of various telehealth policies, including the implementation of the virtual dental home that established a new model of dental care through telehealth where specially trained dental auxiliaries provide care to patients under the remote supervision of licensed dentists. CDA believes AB 1998 ensures 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.

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. This year, a group of wealthy trial lawyers began collecting signatures to qualify a ballot measure for the November 2020 election that would essentially eliminate the MICRA law’s protections. Due to the COVID-19 pandemic, they have now submitted the initiative for the November 2022 ballot and are awaiting official qualification. Regardless of when it appears, 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.

AB 2164: Improving Access to Care Through Telehealth – Support

CDA is supporting AB 2164 by Assemblymembers Rudy Salas (D-Bakersfield) and Robert Rivas (D-Hollister). AB 2164 supports access to dental care through telehealth, specifically in federally qualified health centers using the virtual dental home model. This bill clarifies 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.

SB 793: Flavored Vaping/Tobacco Ban – Support

CDA supports SB 793 by Senator Jerry Hill (D-San Mateo) which will prohibit the sale of all flavored tobacco products, including electronic cigarettes, in California. CDA is supportive of measures aimed at reducing the negative health impacts that are caused by tobacco use. Flavored products, especially e-cigarettes, have the potential to reverse years of decline in tobacco usage in the state. Of greater 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. While research is still in process on vaping devices, we know that traditional tobacco use is estimated to account for over 90% of cancers in the oral cavity and pharynx and represents the greatest single preventable risk factor for oral cancer. It also contributes to periodontal disease, heart disease and other cancers of the body.  

In conjunction with CDA’s support of SB 793, we also support Governor Newsom’s budget proposal to create parity in taxation between combustible nicotine products, like traditional cigarettes and cigars and e-cigarettes.

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) builds 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 will provide 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 June 2020