Updated – November 12, 2013
Dental Plan Accountability/AB 18. Originally introduced to address key issues dealing with the implementation of the dental components of the Affordable Care Act, CDA’s sponsored legislation, AB 18 (Pan), is set to be amended in 2014 to expand the bill to require all dental plans sold in the state to adhere to a medical loss ratio. This will ensure that a larger portion of patient premiums are appropriated directly to care and would limit the amount dental plans can use for administrative costs. The bill will also make dental plans subject to key patient protection laws that currently only apply to health plans, including network adequacy requirements, timely access to care standards, and premium rate review.
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 write premiums 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 (pain and suffering) damages. There is no cap on economic damages (e.g. lost wages, health care costs, etc.). Consumer Watchdog and its trial lawyer allies have launched a renewed campaign to raise MICRA’s cap on non-economic damages. No MICRA bill emerged in the Legislature this year, but a ballot measure has been filed for the November 2014 general election. The measure includes a retroactive cost-of-living adjustment to MICRA’s $250,000 cap on non-economic damages, raising it to over $1.2 million, plus annual increases for inflation going forward. The measure also includes provisions that would mandate drug testing for physicians, but the main objective is to make it easier for trial lawyers to file lawsuits against doctors, hospitals, community clinics and other health care providers in order to generate larger paydays. The measure will increase costs for consumers by billions of dollars annually while reducing patient access to health care providers.
Denti-Cal Adult Program. The 2013-14 state budget package includes a partial restoration of Medi-Cal adult dental benefits and more than 3 million Californians are expected to receive care as a result. Basic preventive and restorative services, along with full dentures, will be brought back beginning May 1, 2014. CDA anticipates that the intervening time period will be used 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 dental 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 restoration of adult dental a top priority. This agreement came on the heels of the “CDA Cares” event held in San Jose in May of this year where volunteer dentists and dental professionals provided more than 11,000 dental procedures serving 2,200 patients in need of care.
Medi-Cal/Denti-Cal Provider Rates. The 2013-14 state budget also included the full implementation of the 10% Medi-Cal provider rate cut adopted in 2011 that had not yet been implemented due to a legal challenge mounted by CDA and other health care organizations. CDA and its coalition partners continue to pursue a petition at the U.S. Supreme Court. Despite that ongoing effort, the Administration began implementing the rate cut for Medi-Cal dentists on September 5th and will begin working on the process for implementing the “clawback” of payments paid to providers dating back to June 2011. The Administration is required to monitor the impact of the cuts on patient care and CDA is actively working to ensure that any impact is appropriately captured and responded to. CDA is also advocating for the repayments to be spread out over many months or years to minimize the amount recouped each month. In 2014, we will continue advocating for the Legislature to reverse these cuts.
State Oral Health Plan/Dental Director. Although state law calls for the maintenance of a state office of oral health within the Department of Public Health, it has been many years since the state actually had in place a comprehensive oral health program managed by a state dental director. A dental director who is a licensed dentist would provide the leadership necessary to establish the core elements of a state oral health program including developing a state oral health plan, monitoring and evaluating oral health treatment, prevention and literacy projects, and applying for and managing federal and private grant programs to support oral health. For example, when funding was eliminated in 2009 for the Children’s Dental Disease Prevention Program (CDDPP), California was left without any organized program to deliver essential services to California’s neediest children. A dental director could work to reinstate funding to deliver prevention focused, school based oral health and essential disease prevention services to California’s schoolchildren. CDA is engaged in ongoing discussions with key administrative officials on how such a position could be established and funded.
Health Care Reform. California moved rapidly towards implementation of the Affordable Care Act (ACA) this year and the open enrollment period for the new California Health Benefit Exchange (Covered California) began October 1 offering coverage that will begin January 1, 2014. CDA worked to ensure the availability of dental plans in the Exchange. Pediatric dental services are one of the Essential Health Benefits that will be offered in the Exchange. Adult dental services are slated to be available for purchase in 2015. 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.
Reduce barriers to volunteer dental care/AB 836. The ability to utilize retired dentists on a volunteer basis is an important component of improving access to oral health care for underserved populations. Current law allows dentists to shift their licensure status to “retired” when they are only providing free care, but still requires them to complete 50 hours of continuing education courses, even though many of those courses will not be relevant to a non-practicing dentist. This year CDA sponsored AB 836 (Skinner), which would encourage experienced, retired dentists to be voluntary providers of needed dental services by reducing the continuing education requirement to 30 hours for maintaining retired license status solely for the purpose of providing pro bono care. AB 836 received unanimous support in the Legislature and the Governor signed the bill into law.
Improve quality and continuity-of-care of mobile/portable dental programs/SB 562. Current law requires mobile dental vans to be registered and regulated by the Dental Board of California, but does not require similar regulation of a growing practice model of transporting compact, portable dental equipment from setting to setting. CDA sponsored SB 562 (Galgiani) this year, which would require that portable dental providers meet the same Dental Board registration requirements as mobile dental providers, and be held to the same continuity of care and patient/parent information standards as all practicing dentists. SB 562 also received unanimous support in the Legislature and was signed by the Governor.
Virtual Dental Home Pilot Project. As part of the larger issue of access to care, the Legislature in recent years has considered proposals to modify scope of practice for various categories of allied dental health professionals. This year CDA held discussions with stakeholders on the provisions of AB 1174 (Bocanegra), which 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 that are being tested as part of the Virtual Dental Home based Health Workforce Pilot Project #172. The author made AB 1174 a two-year bill while stakeholder discussions continue and it will be taken up next year.
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. In May, Governor Brown announced an effort to develop reforms to “strengthen and restore the intent of Proposition 65”. Throughout the summer 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. Agency-level regulatory efforts are expected to continue, however. 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 stressing that Prop. 65 should not unduly restrict legitimate health care treatment discussions between providers and patients.
Kindergarten Oral Health Assessment. CDA is committed to retaining 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, the program, along with all other state mandates, was set to be eliminated. CDA is working to maintain access to this program. Legislation will be introduced next year aimed at protecting the program in statute. CDA will be actively involved in this legislation.
Dental Amalgam. Dental amalgam is a safe, affordable, and durable material used to restore teeth. It contains a mixture of silver, copper, tin and elemental mercury. The FDA and other major organizations have repeatedly reaffirmed that amalgam is a safe and effective restorative option; however, despite its proven safety, in recent years there has been an increase in anti-amalgam activity at the local level, including several city councils, most recently in the City of Berkeley. CDA supports the continued availability of dental amalgam as a restorative option, opposes local efforts to independently regulate dentists’ treatment discussions with patients, and supports the use of best practices to minimize release of mercury into wastewater.
Dental Licensure Fees. The Dental Board of California has released proposed regulations that will raise the initial licensure and biennial renewal fees for dentists from $365 to $450, the maximum currently allowable by state law. These fees have not been increased since 1998, and are being proposed for this increase 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, acknowledging the length of time that these fees have 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, and that CDA would be unable to support any future proposed increase to the statutory fee cap without such a demonstration. 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 instead of relying on dramatic increases after 15 years. Due to the remaining formal process for approving regulations, dentists are unlikely to see any increase in their renewal fees until 2014.
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