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Major Issues and Priorities

2014
Updated – April 1, 2014

CDA-Sponsored Legislation (AB 1962): Medical Loss Ratio – Dental Plans.  CDA is sponsoring AB 1962 (Skinner) this year to require dental plans to adhere to a medical loss ratio (MLR), which will require more of patients’ insurance premium dollars to be spent directly on dental care rather than dental plans’ overhead and administrative costs. Under state law and the Affordable Care Act, all medical plans must adhere to an MLR, however, no such standard exists for dental plans. AB 1962 would provide patients with the same protections that they currently receive with their medical plans, requiring dental plans to spend a minimum percentage – 80% for small group and individual plans, 85% for large group plans – directly on patient care. Dental plans that fail to meet the MLR standards would be required to provide rebates or lower premiums to dental plan purchasers as medical plans currently do. As a result of the MLR for medical plans, enrollees have already seen billions of dollars in benefits through rebates and reduced premiums. This legislation will help ensure that dental patients are getting adequate value for their insurance premium dollars.

Dental Hygiene Committee Sunset Review.  Established by legislation in 2008, the Dental Hygiene Committee of California (DHCC) will be going through its first legislative sunset review process this year. The DHCC submitted a report to the Senate Business, Professions, and Consumer Protection Committee, coupled with an accompanying report from the California Dental Hygienists Association, that includes a series of substantial policy change recommendations, which CDA believes are unjustified. The changes include: formally removing the committee from the Dental Board’s jurisdiction and changing the committee to a Board; eliminating the requirement that any recommendations by the DHCC for scope of practice changes be submitted to the Dental Board; reducing oversight of certain dental hygienist duties by moving local anesthesia, nitrous oxide, and soft tissue curettage from direct to general supervision duties; and deleting the requirement that registered dental hygienists in alternative practice (RDHAPs) obtain a dentist’s prescription in order to continue providing services to new patients after 18 months. Based on the first sunset review hearing, all indications are that the Legislature will extend the committee for another four years but will not support expanding the committee’s authority or the hygiene profession’s scope of practice as proposed by the DHCC and the California Dental Hygienists Association. SB 1245 (Lieu) has been introduced as a “spot” bill for the DHCC sunset review legislation. Any proposed statutory changes will be amended into that bill and moved through the legislative process later this year. CDA will continue to be an active participant in that process.   

MICRA.  In the mid-1970’s, health care practitioners were experiencing increases in professional liability insurance at the rate of 300% or greater. Additionally, numerous companies would no longer even write insurance policies in California. As a result of this crisis, the Legislature enacted MICRA (Medical Injury Compensation Reform Act). This law enacted a number of provisions including limiting attorney fees, allowing for periodic payments and putting a cap of $250,000 on non-economic damages. There is no cap on economic damages (e.g. lost wages, health care costs). Consumer Watchdog and its trial lawyer allies have launched a renewed campaign to raise MICRA’s cap on non-economic damages. No substantive legislation has emerged yet, although a “spot” bill – SB 1429 (Steinberg) – has been introduced to serve as a vehicle for legislative action. MICRA’s opponents have also filed a ballot measure for the November 2014 general election that would more than quadruple the cap on non-economic damages, raising it approximately $1.1 million, plus annual increases for inflation going forward. The initiative also contains provisions regarding drug testing of physicians and places infeasible requirements on the state’s prescription drug database, which proponents have said were only included because they polled well and are the “ultimate sweetener.” The main objective of the measure would make it more lucrative for trial lawyers to file lawsuits against doctors, hospitals, community clinics and other health care providers. The initiative will triple the legal fees lawyers can collect for bringing a lawsuit and increase healthcare costs by billions of dollars annually, seriously threatening patient access to care. CDA is part of a broad-based coalition that will be opposing the initiative as well as any accompanying legislative efforts.

Dental Director/State Oral Health Plan.  CDA’s access to care plan prioritizes above all else the need for a comprehensive state oral health program led by a state dental director. Since the development of that plan over two years ago, CDA has actively engaged the governor’s administration about the importance of hiring a licensed dentist with strong experience in state oral health programs to organize and execute essential dental public health functions; someone who has experience in leveraging state resources, securing federal funding and improving the delivery of dental disease prevention to vulnerable Californians. These advocacy efforts were successful and the governor’s 2014-15 budget revisions released in April call for ongoing funding for a state dental director and an epidemiologist in the Department of Public Health to establish a state oral health program. In the governor’s outline, which is modeled after CDA’s proposal, the dental director will be specifically charged with developing a burden of disease report, leading the collaborative process to create a state oral health plan and managing ongoing implementation of that plan. The dental director’s role will also include establishing prevention and oral health literacy projects, and working to secure funding for prevention-focused oral health and essential disease prevention services, particularly for children. The funding will now be incorporated into the 2014-15 state budget package that the legislature must approve by June 15, before going into effect July 1.

Medi-Cal/Denti-Cal Provider Rates.  Last year the state began implementing the 10% Medi-Cal provider rate cut adopted in the 2011 budget, which had been delayed due to a legal challenge mounted by CDA and other health care organizations. CDA worked to prevent implementation of the devastating “clawback” of provider payments that would be retroactively applied dating back to June 2011 and, in the Governor’s January budget release, the Administration announced that the state would not apply the rate cut retroactively. The state will forgive retroactive recoupments for all dental services, in addition to other specified medical services and providers. In total, this will save providers including dentists $217 million. However, providers will still face the 10% rate cut for future services. This comes at a time when the state is trying to accommodate millions of new patients as a part of healthcare reform. CDA is continuing to work toward a legislative reversal of the prospective rate cut.

Denti-Cal Benefits.  The 2013-14 state budget package included a partial restoration of Medi-Cal dental benefits (Denti-Cal) for adults and more than 3 million Californians are expected to be eligible to receive care as a result. Basic preventive and restorative services, along with full dentures, will be brought back beginning May 1, 2014. The intervening time period is being used to attempt to rebuild the adult provider network and address longstanding administrative issues within the program. Senate President Darrell Steinberg, who visited the “CDA Cares” program in Sacramento in August of 2012, made restoration of adult Denti-Cal benefits a top priority during budget negotiations with Governor Jerry Brown and legislative leaders. Steinberg stated it was the volunteer work of the CDA dentists he witnessed that inspired him to make the restoration of adult Denti-Cal benefits a top priority. 

Health Care Reform.  California has moved rapidly towards full implementation of the Affordable Care Act (ACA). The open enrollment period for the new California Health Benefit Exchange (Covered California) is October 1 – March 31, when most Americans need to have health insurance coverage or pay a penalty.  Pediatric dental services are one of the Essential Health Benefits that will be offered in the Exchange, and CDA worked to ensure families could purchase those benefits from stand-alone dental plans, which results in more choice for families. Adult dental services are slated to be available for purchase through the Exchange in 2015, and are likely to be bundled with the pediatric dental benefit in a family dental plan. CDA continues to advocate with the California Health Benefit Exchange Board and the Legislature to ensure that the Exchange is a competitive marketplace for dental benefits, that consumers are provided a transparent set of options and that they can maintain a relationship with their current dentist when purchasing dental coverage for their families.

Virtual Dental Home Pilot Project/AB 1174.  AB 1174 (Bocanegra), which was introduced in 2013, would establish primary elements of the “Virtual Dental Home” health workforce pilot project in law. Specifically, the legislation would allow certain expanded duties (determining radiograph need and placing interim therapeutic restorations under the diagnosis and direction of a dentist) for registered dental hygienists and registered dental assistants in extended functions. CDA has taken a “Support if Amended” position on the bill and is working with the author and other stakeholders on those amendments.

Proposition 65 Reform.  Approved by voter initiative in 1986, Prop. 65 requires businesses with 10 or more employees to provide “clear and reasonable warning” if the product or business location may expose employees or customers to a chemical known to the state to cause cancer or reproductive toxicity. Last year, Governor Brown announced an effort to develop reforms to “strengthen and restore the intent of Proposition 65”.  The Brown Administration held formal negotiating sessions with an invitation-only group of stakeholder organizations in an attempt to reach agreement on a reform package that would improve Prop. 65’s warning notice and litigation provisions. CDA was the only health care organization invited to participate in these meetings, actively negotiating with the Governor’s office, the Legislature, and a variety of business, legal, and consumer stakeholders. Ultimately, the Administration was unable to reach consensus and dropped the legislative effort for 2013. However, agency-level regulatory efforts are continuing this year. CDA’s primary concern is to ensure that any reforms to Prop. 65 do not create new threats or re-open the existing restorative materials warning notice which has protected dentists from litigation for the past 10 years. CDA is also working to ensure that any Prop. 65 reforms do not unduly restrict legitimate health care treatment discussions between providers and patients.

Kindergarten Oral Health Assessment.  CDA remains committed to the Kindergarten Oral Health Assessment program created in 2006 through AB 1433 (Emmerson). The program requires students to have an oral health assessment during their first year of school.  As a part of the Governor’s school funding reform efforts, jurisdiction of the program, along with all other state mandates, was shifted to the local level. CDA is working to ensure that this program is maintained and that the governing statute for the program is protected.

Dental Licensure Fees.  The Dental Board of California has adopted regulations that on July 1, 2014 will raise the initial licensure and biennial renewal fees for dentists from $365 to $450, the maximum currently allowable by state law.  The regulations also increase several other fees that are linked by law to the biennial renewal amount. These fees have not been increased since 1998, and the increase was proposed primarily as a result of increased enforcement expenses mandated (but not funded) by the Department of Consumer Affairs for all state licensing boards.  CDA provided written comment on the regulations in September 2013, acknowledging the length of time that these fees had remained the same, but emphasizing CDA’s expectation that the board’s level of customer service and responsiveness must be demonstrably improved as a result of any increase. CDA also urged the board to improve the clarity of the documentation of its fiscal condition, and to consider making smaller, more incremental changes in the future. Because the board’s budget forecasts indicate a continued deficit condition even with the July 1 increase, the board is sponsoring SB 1416 (Block), which aims to allow for an additional increase to $525 in 2015. CDA’s position on SB 1416 is pending further discussions with the board and the legislature as it moves through the process.    

For more information contact: Jason Bryant at jason.bryant@cda.org/916.554.5931 or Nicette Short at nicette.short@cda.org/916.601.7373.