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• Legislative Issues
• Major Legislative Issues - 2004

Major Legislative Issues - 2004

Updated 10/04/04

Following are brief summaries of bills and issues supported and opposed by CDA in 2004.

Instructions for using this page:

Click on a bill number to find out more; this will take you to the California Legislative Counsels Legislative Information Page. Once youre there:

• Select either "Assembly" or "Senate" in the "HOUSE" box;
• Type the number of the bill in the "BILL NUMBER" box; and
• Hit the "SEARCH" button.

Once youre there, you can read the most recent version in either browser (HTML) or Adobe Acrobat Reader (*.pdf) format. You may also check the measures status and history. To learn more about the author, click on the surname after the bill number. Youll be taken to the members official legislative web site, where the choices are self-explanatory.

Denti-Cal State Budget: Due to the severe budget deficit crises of recent years, the Medi-Cal dental program (known as Denti-Cal) is often an annual target for proposed funding reductions. Last year, Governor Davis initial budget proposal called for the elimination of adult dental benefits, which are one of a number of optional benefits under federal law, along with provider rate reductions. CDA opposed both actions, on the grounds that they would ultimately cost the state more money by reducing access to needed dental care, thereby forcing patients to go to the far more costly emergency room. Ultimately, after extensive negotiations, the final 2003-04 budget retained adult dental benefits, reduced all provider rates by 5 percent, and enacted several cost-containment measures, including allowing only prefabricated crowns and requiring pre-treatment submission of X-rays for patients exceeding four restorations in a calendar year.

This year, the state again faced a significant budget deficit, and the new Governor, Arnold Schwarzenegger, was again looking for cost-containment options. However, in his proposed 2004 budget, Governor Schwarzenegger did not propose the elimination of adult dental benefits. Instead, the Governor proposed a broader federal Medicaid waiver which could give the state the flexibility to implement new concepts such as tiered benefits, premiums for certain ancillary services, expanded use of co-payments, and expansion of managed care. Initially, the Governor also proposed an additional 10 percent across-the-board provider rate reduction. In 2003, CDA joined a coalition of health care organizations in a lawsuit seeking to nullify last years 5 percent rate cut, which received a favorable initial court ruling in December 2003. Fortunately, when the Governor released his May Revision, he had withdrawn the 10 percent rate reduction proposal in recognition of the ongoing litigation. Ultimately, the Governor also decided to postpone release of the Medi-Cal waiver proposal until next year, when it will be incorporated into his 2005-2006 budget proposal. Therefore, no significant changes to the Denti-Cal program have been made for the current budget year.

AB 539 (Laird) Dental Students Taking Dental Hygiene Exam: Last year, Assembly Member Laird introduced AB 539 on CDAs behalf. AB 539 is intended to provide debt-relief assistance to interested dental students while helping to alleviate the statewide shortage of dental hygienists, by allowing 3^rd and 4^th year dental students to take the state dental hygiene licensure exam and, upon passage, to practice hygiene until they become licensed dentists. The bill passed out of both houses by nearly unanimous votes, despite the steady opposition of the California Dental Hygienists Association, but was held in the Assembly at the end of last year because the Department of Consumer Affairs was recommending a veto at that time. The bill received final passage in January, but was held along with all other bills that have potential fiscal impact due to the overall budget situation. Discussions with the administration resulted in amendments that resolved their fiscal concerns and limited the duration of the dental student hygiene license to two years following passage of the hygiene exam. The bill then was passed again by both houses and was signed by the Governor on August 25.

AB 1467 (Negrete McLeod) Restorative Technique Exam Extension: AB 1467 was introduced last year at the request of Western Dental Services. The bills original intent was to extend by two years the statutory sunset date for the states restorative technique exam, which is a basic clinical exam performed on a mannequin that currently must be passed by graduates of foreign dental schools before they are eligible to take the full dental board exam. They currently must take two years of coursework at an accredited dental school if they fail the RT exam four times. CDA supported the creation of the original January 1, 2003 (extended to January 1, 2004 in 2002) sunset date for the RT exam as part of a broader effort to equalize the education and training standards for all licensure applicants, and therefore was opposed to AB 1467 in its original form. Subsequent negotiations between this bills sponsors and the Dental Board have resulted in an agreement between the Legislature and the Dental Board, under which applicants must have passed parts I and II of the national boards by December 31, 2003 and will be given until January 1, 2009 to actually pass the RT exam. The latter provision is designed to allow the Board adequate time to offer enough RT exam slots, while also providing all applicants the maximum four opportunities to pass the exam that they are presently allowed. With those amendments, CDA moved to a neutral position on AB 1467. The bill was expected to be passed and sent to the Governor at the end of the 2003 session, but unrelated legislative politics caused it to be held up until this year. Therefore, the official sunset date for the RT exam passed, meaning that until AB 1467 was signed by the Governor, the board did not have the authority to schedule future RT exams. The bill was signed on April 12, 2004, and took effect immediately, thereby allowing the board to resume scheduling RT exams.

Unfair Competition Lawsuit Reform: The business community (including CDA) has in recent years been the victim of a raft of unfair competition lawsuits, filed by plaintiffs attorneys taking advantage of the overly broad Section 17200 of the state Business and Professions Code. Negative media attention focused on law firms that were filing thousands of Section 17200 lawsuits against businesses large and small focused significant media attention a number of reform proposals last year that have been introduced over the years by pro-reform forces and routinely killed by the Consumer Attorneys of California and their allies. CDA supported those legislative efforts, all of which were again defeated. The only remaining major reform bill was AB 95 (Corbett), which was opposed by CDA unless amended because it contained a number of provisions that actually enhanced the plaintiffs attorneys position; it ultimately was gutted and used for another purpose. A number of new bills were introduced this year coming from varying perspectives, including AB 2369 (Correa), which has not been moved this year, and AB 2604 (Pacheco), which was supported by the business community but which had to substantially reduced in scope in order to move. Meanwhile, a CDA-supported coalition successfully gathered signatures to place a reform measure on the November 2004 ballot. As the legislative session neared a close there were last-minute efforts to negotiate a legislative compromise with the Governor, but those efforts did not come to fruition. CDA will continue to support all efforts to limit frivolous and abusive lawsuits.

Workers Compensation Reform: Over the past two years, workers compensation has emerged as an important issue for dentists as well as the entire business community in California. Like many other employers, dentists statewide have seen their workers compensation costs increase dramatically, with virtually no improvements to the injury evaluation, claims, or benefits processes to make up for those increased premiums. Last year, a significant legislative package was enacted, emphasizing reform of the outpatient surgery fee-setting process and the establishment of clearer medical guidelines. These reforms are expected to have at least a modest impact on costs this year, but it is widely understood that more needs to be done to bring the system under control. CDA has supported the efforts of the business community and the Administration to force enactment of broader cost-containment reforms in the coming year. After intensive negotiations between all interested parties, and with the deadline for submission of signatures for business and Governor supported ballot initiative looming, a comprehensive reform package was passed and signed by the Governor in mid-April. SB 899 (Poochigian) was the primary component of the legislative package. While the legislative package was a compromise and will not have quite the projected cost savings of the proposed initiative, it nevertheless is hoped to lower workers comp insurance premiums once it is fully implemented.

Amalgam: CDA continues to support the availability of amalgam fillings as a safe and cost-effective restorative material, and to oppose legislative, regulatory, and legal attempts by anti-amalgam organizations to restrict the use of amalgam without a legitimate scientific justification. Last year, Assembly Member Negrete-McLeod introduced AB 611 at the request of an anti-amalgam organization, Consumers for Dental Choice, which would have mandated that every dentist install an amalgam separator in their office and provide annual reports to the state on their mercury discharges. CDA believed this approach was excessive and unnecessarily restrictive given the lack of scientific evidence that amalgam presents a significant hazard, and was able to negotiate with the author on an alternative approach for her bill, emphasizing the use of comprehensive statewide best management practices which give dentists a wider range of options for handling amalgam waste. The amended bill ended up being held in the Assembly Appropriations Committee due to opposition from environmental organizations. Although it will not occur during this legislative session, CDA will continue to work with all interested parties on a constructive, consensus legislative approach to the amalgam wastewater issue.

Environment/Hazardous Waste: A small number of bills were introduced this year which, while not targeted directly at dentistry, could have had an impact on the profession due to their potential affect in further regulating the use of mercury. AB 2943 (Pavley), entitled the Mercury Pollution Prevention Act, in its original form called for the gradual phase-out of the use of all mercury-containing products in California, which presumably would have included amalgam fillings. After considerable discussions with the author resulted in an agreement to exempt pre-encapsulated amalgam from the bill, the Assembly Appropriations Committee deleted all of the language related to mercury products, and the bill now deals only with restricting mercury in childrens vaccines. In addition, Senator Deborah Ortiz introduced SB 1168, which would have created a Healthy Californians Biomonitoring Program pilot project to study the levels of numerous potentially toxic chemicals (including mercury) in individuals blood. The program would be funded through a fee assessed on manufacturers of the relevant chemicals, and it remains unclear whether a dentist would be defined as a manufacturer for purposes of the fee assessment. SB 1168, which passed the Senate and the Assembly Environmental Safety and Toxic Materials Committee, was defeated in the Assembly Health Committee on June 22.

Dental Assisting Scope of Practice: CDA spent nearly two years actively engaged in negotiations with key legislators, the Dental Assisting Alliance, the Dental Board of California, and other interested parties to develop new scope of practice provisions for dental assistants, registered dental assistants (RDAs) and registered dental assistants in extended function (RDAEFs). CDAs goal in these discussions has been to develop a new career path for dental assistants that is more flexible while still providing appropriate public protections. As agreed to by all parties, the reforms would create dental assisting specialties in the areas of orthodontia, surgery, and restoration to give candidates for dental assisting licensure more flexibility and choices. Negotiations were conducted with oversight by the Senate Business and Professions Committee, in response to the Joint Legislative Sunset Review Committee discussions of two years ago. Last years negotiations ultimately stalled, primarily over the extent to which RDAEFs should be allowed by regulation to place composite restorations. An agreement has now been reached on that issue, under which RDAEFs will be allowed to place class 1, 3, and 5 composite restorations if the dentist permits them to do so. The agreed upon provisions were amended earlier this year into SB 1546 (Figueroa), an omnibus Senate Business and Professions Committee bill. SB 1546 has passed both houses and was signed by the Governor on September 21.

SB 1336 (Burton) -- Oral and Maxillofacial Surgeons Scope of Practice: CDA co-sponsored SB 1336 (Burton) with the California Association of Oral and Maxillofacial Surgeons this year to create a permitting process that would allow oral surgeons who met certain criteria to perform specified elective procedures in accredited outpatient facilities. Presently there is an anomaly in state law, whereby certain oral surgeons are permitted to perform complete facial reconstructions in a hospital trauma care setting, but cannot perform the same or similar procedures on an elective basis in their offices. Rather than trying to broadly redefine dentistry in statute for this purpose, the bill as introduced proposed to create a process by which oral surgeons could obtain a permit from the Dental Board of California after having demonstrated and documented specific credentials. SB 1336 passed out of the Senate with unanimous votes, despite the opposition of the California Medical Association, the California Society of Plastic Surgeons, and the California College of Emergency Physicians, who argued that the bill would be an inappropriate and potentially unsafe expansion of oral surgery scope of practice. The bill was passed unanimously by the Assembly Business and Professions Committee on June 22, after a three-hour negotiating session with the opposition, Senator Burton, and committee chair Assembly Member Lou Correa resulted in amendments creating a proctorship process for demonstration of the permit holders skills in a hospital setting before the permit holder could be authorized to practice in all accredited settings. Despite those amendments, the same organizations remained in opposition as the bill moved forward. Nevertheless, the bill received final votes of 67-2 in the Assembly and 30-0 in the Senate and was sent to the Governor. However, the Governor vetoed the bill on August 27, stating that he was not yet comfortable that these practitioners were sufficiently qualified. In his veto message, the Governor requested his Director of Consumer Affairs to conduct an occupational analysis of the oral and maxillofacial surgeon profession to determine if the procedures in question could be performed safely and competently on an elective basis. CDA will monitor the occupational analysis process and provide information and comment wherever appropriate.

SB 1865 (Aanestad) Dental Licensure Examination: Early in 2004, the deans of the five California dental schools expressed increasing concerns about whether, in the current budget environment, the Dental Board has the resources and staff needed to maintain the California examination as the sole available means for a graduate from a state dental school to become licensed. The board currently has only two individuals administering the examination, whereas in the past it had been determined that the board needed at least five full-time staff members in order to run the exams efficiently and effectively. The deans believe that the exam offered by the Western Regional Examination Board (WREB) provides a clinically equivalent and viable alternative that should be made available as an option to California graduates. CDA policy recognizing other state licensing boards was developed when the organization sponsored licensure by credential in 2001. At least 29 other states currently are either members of WREB or recognize their exam for licensure purposes. Senator Aanestad introduced SB 1865 to give dental students the option of taking the WREB exam instead of the California clinical exam. While still supportive of the California exam, CDA agrees with the deans and the author that this is an appropriate time to expand licensure options for dental students, and therefore the CDA Board of Trustees voted to support SB 1865. Once enacted, an occupational analysis and a state evaluation of the WREB exam will be necessary before that exam would be recognized; the bill requires the process to be completed by September 30, 2004. Opposition was registered early on in the Senate by members of the Dental Board, current examiners, and representatives of several ethnic dental societies, who were concerned that the bill might be too restrictive. Many of those concerns were addressed as the bill moved through the process, including a recent amendment that will allow the board to conduct exams, including but not limited to WREB, prior to graduation if the dental school certifies that the examinee is expected to graduate within one year. The bill has passed both houses of the legislature and was signed by the Governor on September 21.

AB 2056 (Aghazarian) Dental Board Enforcement Statute of Limitations: Currently, Californias Dental Practice Act gives the Dental Board broad authority to discipline dentists for acts of unprofessional conduct. However, current law does not place any time limitation for ultimate Board action in response to a complaint. CDA believes that dentists who are under investigation should not have to be left in an uncertain situation for years on end while the Board completes its process. CDA therefore sponsored AB 2056 (Aghazarian), which will add language to the Dental Practice Act that is largely identical to current law that places limits on the duration of investigations by the Medical Board of California and two other health-care regulators. The bill will generally require the Board to file any disciplinary action within three years after the board discovers the act or omission, or within seven years after the act occurs, whichever comes first. Various exceptions to those deadlines are provided for fraud, willful misrepresentation, and for incompetence, gross negligence, or repeated negligent acts if the licensee is proven to have intentionally concealed the act from discovery. AB 2056 has passed both houses of the legislature and was signed by he Governor on September 14.

AB 2390 (Reyes/Chan) Mobile Dental Units: This bill, sponsored by the California Primary Care Association, would exempt mobile dental units operated by state-licensed community, rural, and specialty clinics from current registration requirements in the Dental Practice Act. (TDIC now owns a mobile unit and has run afoul of the same restrictions experienced by CPCA clinics.) It would also permit those clinics to hire dental licensees as employees and to charge for their services. AB 2390 passed the Assembly on consent on April 29. CDA had asked to work with the sponsor and authors, both to resolve TDICs problem simultaneously and also to try to remove impediments in existing law that prevent nonprofit and charitable entities from operating dental clinics or mobile units absent a dentist willing to assume responsibilities for all operations; those discussions did not lead to a complete agreement, and therefore language to address those additional issues was incorporated into SB 928 (Aanestad), discussed below. Meanwhile, CDA maintained a Neutral position on AB 2390, which passed both houses and was signed by the Governor on August 30.

SB 928 (Aanestad) Licensure By Credential Cleanup: CDA sponsored legislation in 2001 that created a licensure by credential (LBC) process in California, whereby dentists wishing to come to California from other states can become licensed without having to take the California licensure exam if they demonstrate specific educational and practice credentials. SB 928 (Aanestad) was introduced last year as a vehicle to make refinements to the LBC process. Among other things, the bill makes the clinical practice requirements for LBC somewhat more flexible, allows the board to contract with a third party to evaluate applications, and clarifies that dentists granted licensure by credential are subject to all relevant continuing education requirements. Recently, SB 928 was amended to also incorporate clarifying language allowing certain mobile dental units and non-profit freestanding facilities to utilize licensed dentists on a part-time basis without being in violation of existing law prohibiting the unlicensed practice of dentistry. This new language is designed to provide a more far-reaching alternative to similar provisions contained in AB 2390 (Reyes), discussed above. SB 928 passed both houses of the legislature and was signed by the Governor on September 10.

SB 96 (Alpert) Water Fluoridation: In 1995, the legislature passed and the Governor signed AB 733 (Speier), which required water agencies with more than 10,000 connections to fluoridate their drinking water, but only upon the availability of a private, non-taxpayer funding source. Since that bills passage, the state has moved from 17 percent to approximately 37 percent fluoridated, which is positive movement that nevertheless leaves California far behind the rest of the nation. At least a portion of the relative lag in the number of communities fluoridated has been due to legal challenges filed by local and/or national anti-fluoridation groups, using language in the AB 733 law that is open to interpretation. These legal challenges have never been successful ultimately, but they have been costly and time-consuming, and have had a chilling effect on local agencies willingness to move forward. The city of San Diego is one of the local entities that have been entangled in legal and political difficulties for a number of years. In order to clear a path for San Diego and other cities to more easily proceed toward fluoridation, Senator Alpert agreed to carry legislation near the end of the 2004 session to clarify the original intent of AB 733. SB 96 (Alpert) makes clear that water fluoridation is a matter of statewide public health importance, and that local agencies are legally obligated to fluoridate their drinking water once funding has been formally offered, except under certain specified conditions. The bill passed both houses and was signed by the Governor on September 24.