Major Legislative Issues - 2008
Updated – 10/08/08
Following are brief summaries of bills and issues supported and opposed by CDA in 2008.
Instructions for using this page:
Click on a bill number to find out more; this will take you to the California Legislative Counsel’s Legislative Information Page. Once you’re 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 you’re there, you can read the most recent version in either browser (HTML) or Adobe Acrobat Reader (*.pdf) format. You may also check the measure’s status and history. To learn more about the author, click on the surname after the bill number. You’ll be taken to the member’s official legislative web site, where the choices are self-explanatory.
Dental Board Sunset and Reconstitution: Last year, Governor Arnold Schwarzenegger vetoed SB 534 (Perata), which would have created a new Dental Hygiene Committee of California under the jurisdiction of the Dental Board of California, while eliminating the Committee on Dental Auxiliaries and placing responsibility for licensing and regulation of dental assistants with the board. Although after months of negotiations CDA had adopted a Support position on SB 534, the governor vetoed the bill based on a concern that the need for the bill and its potential for increased licensure fees for dental hygienists had not been fully justified. SB 534 also contained a statutory extension of the July 1, 2008 sunset date for the Dental Board, and thus the governor’s veto meant that the board would cease to exist mid-year, and its functions would be transferred to a bureau of the Department of Consumer Affairs. Because the California Constitution does not allow state bodies to be created or modified using “urgency” legislation, it was not possible to pursue legislation in early 2008 that would prevent the July 1st sunset from taking effect.
After many weeks of further discussion among CDA, the California Dental Hygienists’ Association, key legislative staff, and the governor’s staff, agreement was reached in the late spring on a three-bill legislative package to restore the Dental Board and create the Dental Hygiene Committee. SB 797 (Ridley-Thomas) creates a six-month interim process under which the prior members of the Dental Board can act as an advisory committee to the temporary Dental Bureau, and allows the board’s executive officer to act as the executive officer of the bureau. AB 1545 (Eng) reestablishes the Dental Board effective January 1, 2009, and allows the prior board members to serve immediately on the new board beginning January 1st, until new appointments are made by the governor and legislative leaders. SB 853 (Perata) creates the Dental Hygiene Committee and eliminates COMDA effective July 1, 2009. All three bills were passed by the legislature and signed by the governor in June, and the administrative functions of the Dental Board transferred to the new bureau as scheduled on July 1st. CDA will continue to work with all parties in an effort to assure a smooth transition back to the Dental Board in January, and to the new Dental Hygiene Committee next July. The Dental Hygiene Committee will have administrative autonomy similar to what the board has delegated to COMDA, but will not have authority to make independent policy changes in areas such as scope of practice.
State Budget/Denti-Cal: With the state facing at least a $14 billion budget deficit as 2008 began, CDA anticipated that it was likely to be a challenging year for Denti-Cal and other state dental programs. In his January budget proposal for the 2008-09 fiscal year, the governor proposed the elimination of all federally optional Medi-Cal benefits, including adult dental, as well as an across-the-board, 10 percent reimbursement rate reduction for all Medi-Cal providers, including dentists. CDA, while acknowledging the magnitude of the state’s deficit situation and offering to assist in developing reasonable ways to achieve the 10 percent cost reduction goal, strongly opposed the combined program reductions, which if enacted in their entirety would largely destroy an already severely compromised Denti-Cal program.
In January, the governor, using authority granted him by a 2004 ballot initiative, declared a fiscal emergency requiring the legislature to respond within 45 days to his proposed remedies. In response, in February the legislature passed a legislative package that included adoption of the 10 percent Medi-Cal rate reduction, but delayed its effective date until July 1, 2008. Subsequent legislative budget discussions over the course of the spring and early summer resulted in a conference report, adopted by a party-line vote, that rejected the elimination of adult dental benefits along with the provider rate reduction, but which would have delayed the restoration of current Medi-Cal rates until September 1st. While CDA was pleased with the results of this initial conference committee process, the two parties’ respective caucuses and the governor have since remained at an impasse in negotiating a final budget, and thus the ultimate future of the Denti-Cal program remains uncertain. The legislature and governor then remained at an impassed until mid-September, when they finally reached a budget agreement that retains adult dental benefits while preserving the 10 percent rate reduction until March 1, 2009, when it will revert to a 1 percent reduction. In addition, the final budget includes an annual $1,500 cap on dental benefits in the state’s Healthy Families Program, along with a 10 percent funding reduction for the Children’s Dental Disease Prevention Program.
While participating actively in the legislative budgetary process, CDA has also provided financial support and cosponsorship for two separate legal challenges to the 10 percent rate reduction that went into effect July 1st. One action filed in state court resulted in an initial ruling upholding the reductions, while the federal court case resulted in an initial ruling to overturn the rate reductions. Although the state is appealing the federal ruling, the judge refused to grant the state’s request for stay, and therefore rates have been restored to their former level as of August 18th. So long as this ruling continues to be upheld, current rates will remain in place in spite of the budget language. CDA will continue its involvement with these efforts to obtain a final ruling that continued provider rate reductions are reducing access to care by taking providers out of the system.
Dental Assisting Licensure Reform: In 2004, SB 1546 (Figueroa) was passed by the legislature and signed by the governor. Sponsored by CDA, SB 1546, along with subsequent clean-up legislation, was designed to create a new career path for dental assistants by, among other things, creating three new specialty licensure categories of registered restorative assistant, registered orthodontic assistant, and registered surgical assistant. After several years of postponements of the effective date of the new categories while the Dental Board tried to develop consensus regulations governing the educational and training requirements, in January of 2008 the board concluded that the proposed structure had proven to be more complicated than anyone had anticipated, and decided to suspend its regulatory process while the interested parties discussed substantially revamping the entire proposed structure. CDA then commenced an intensive round of discussions with the Dental Assisting Alliance in an effort to reach consensus on an alternative to the SB 1546 structure. Those discussions fairly quickly resulted in an alternative framework, which became contained in AB 2637 (Eng).
AB 2637 deletes nearly all of the changes to dental assisting licensure laws that had been made by SB 1546 and its follow-up bills. Instead of creating three new dental assisting licensure categories, AB 2637 streamlines the structure by instead creating two new permit categories: an orthodontic assisting permit and a dental sedation permit, with specified educational and examination requirements for each. The bill also places into law some additional functions for existing dental assisting categories, which it is hoped will further enhance the career opportunities for dental assistants without making the process overly burdensome for assistants or dentist employers. In spite of late opposition from the California Nurses Association to the dental sedation permit provisions of the bill, AB 2637 was passed easily by both houses in August, and was signed by the governor on September 28th. Its provisions, including the two new permit categories, will take effect January 1, 2010.
Dental Plan Collection of Overpayments: Current law requires health care providers, when notified by an insurer or health plan about an alleged overpaid claim, to either contest the overpayment or reimburse the plan within 30 days of receiving the notice. If the provider is unsatisfied with the result of the plan’s dispute resolution process, he or she is allowed to appeal the decision to the relevant regulatory agency (the Department of Managed Health Care or the Department of Insurance). In recent years, CDA has heard increasingly of dental plans deducting the alleged overpayment amount from dentists’ future claims, before the dentist’s appeal to DMHC or DOI has been resolved. CDA believes that this is an unfair violation of dentists’ due process rights, and therefore is sponsoring SB 1387 (Padilla) in an effort to improve the situation. SB 1387, as introduced, would have required dental plans to provide clear notice to dentists of their appeal rights with the plan, and would prohibit plans from beginning to collect overpayments if the dentist has further contested the alleged overpayment to DMHC or DOI, until that process has been completed. Late in the session, after concerns were expressed by the Department of Managed Health Care, the language prohibiting collection prior to completion of all appeals was removed from the bill, leaving only the notice requirement. SB 1387 passed the Senate and Assembly without a dissenting vote, and was signed by the governor on September 27th.
Dentistry – Medical Care During Declared Emergencies: In the aftermath of 9/11 and Hurricane Katrina, state and local entities are making increasing efforts to organize and enhance their emergency response capabilities, which includes establishing extensive networks of health care providers. Although dentists through their training are able to perform many services such as vaccinations, placing sutures, etc., the Dental Practice Act is not clear that dental licensees are protected from potential penalties or liability when they provide such services. CDA this year sponsored AB 2210 (Price), which provides specific immunity from liability to a dental licensee who voluntarily and without compensation or expectation of compensation provides emergency medical care consistent with his or her dental education and emergency training during a declared state of emergency. The bill also authorizes the Dental Board, for the duration of the emergency, to suspend compliance with any provision of the Dental Practice Act that would adversely affect a licensee’s ability to provide emergency services. AB 2210 passed both the Assembly and Senate with unanimous votes, and was signed by the governor on September 27th.
Tissue Bank Licensure: In April of 2008, many dentists began receiving a letter from a major tissue bank from which the dentists purchased pre-packaged, freeze-dried bone (known as allograft) for use in treating patients. The letter was intended to inform the dentists that the state Department of Public Health (DPH) was interpreting a 1992 tissue bank licensure law to require that any health care provider that stores tissue in their office for more than one calendar day be licensed as a tissue bank. CDA had not previously been aware of this interpretation, which could potentially require thousands of dentists to provide DPH with extensive documentation and a $975 annual licensure fee (nearly three times the biennial fee for their license to practice dentistry). Believing that the original law gave little if any consideration to including dentists and other “end-users” of tissue, CDA quickly began discussions with DPH and the legislature. Those discussions resulted in the mid-year introduction of AB 1060 (Laird), which exempts from the tissue bank licensure requirement dentists who utilize freeze-dried bone or dermis that has been purchased from a licensed tissue bank and is used in accordance with manufacturer’s directions. AB 1060 was then passed unanimously by both the Assembly and Senate and was signed by the governor on September 27th, taking effect immediately.
Dental Credit Arrangements: In February 2008, Senator Sheila Kuehl (D-Santa Monica) introduced SB 1633 at the request of the Western Center on Law and Poverty. The bill was intended to address issues involving the offering of credit cards, credit lines, or loans by dentists to their patients as a way for the patients to finance dental care. The sponsors cited specific examples of abuses of these types of credit arrangements, such as signing patients up for credit and charging them for treatment that ultimately was not provided, and coercing patients into signing up for credit arrangements while under anesthesia. As the bill was first introduced, CDA recognized that the author and sponsor had identified some abuses that needed to be dealt with, but that the bill as written was unnecessarily restrictive on all dentists’ use of products that can be offered legitimately and ethically to help patients finance needed care. CDA worked closely with Senator Kuehl and the Western Center over several, and ultimately reached agreement on a bill that the association could comfortably support. SB 1633 in its final form would have allowed dentists to continue offering credit products to their patients, but would have required them to first provide a detailed written treatment plan including estimated costs, and to provide the patient with a specific written notice, signed by the patient, outlining the nature of the credit product being offered and the patient’s rights and responsibilities. The bill also would have prohibited dentists from offering credit products to patients while they were under the influence of general anesthesia, conscious sedation, or nitrous oxide, and required dentists to refund to the lender within 15 days of the patient’s request any payment for treatment that was not rendered. Although SB 1633 in its final form received near-unanimous votes in both houses, it was vetoed by the governor on September 27th; the veto message only indicated in a general way that the bill was not a high priority.
Mercury/Dental Amalgam Regulation: Earlier this year, Assemblyman Mike Feuer (D-Los Angeles) introduced AB 1879, which was intended to allow the state Department of Toxic Substances Control to begin regulating “chemicals of concern” that are potentially hazardous to health. As amended in April, mercury was included as a chemical of concern that could be regulated by the state. Because mercury is one of the elements contained in encapsulated form in dental amalgam fillings, CDA was concerned that this bill could result in duplicative state regulation of dental amalgam that could needlessly drive up the cost of restorative materials to patients. Because chemicals such as mercury already are regulated by the federal Food and Drug Administration, CDA opposed AB 1879 unless it was amended to exempt dental restorative materials. In response to CDA’s opposition, when the bill was taken up for a vote on the Assembly floor, the author pledged to amend the bill in the Senate to exempt dental restorative materials. That amendment was made on June 17th, at which point CDA removed its opposition to the bill, which then passed both houses and was signed by the governor in late September.
Advertising Restrictions: In February, Assembly Member Paul Krekorian (D-Burbank) introduced AB 2734 at the request of the Los Angeles City Attorney, Rocky Delgadillo. The bill was intended to help health care consumers verify the licensure status of their providers, by requiring providers (including dentists) to include in all “public communications” their license number, the web site and telephone number of their licensing agency, and a notice that the consumer can contact that agency for more information. While sympathetic to the author’s and sponsor’s intentions, CDA expressed serious concern that the bill’s definitions were overly broad in scope and impractical, potentially requiring, for example, dentists to include their license number and the Dental Board’s web site and telephone number on toothbrushes that they provide at community health fairs. Although CDA offered several amendments to modify the bill’s practical impact on providers, agreement was not reached with the author and sponsor as the bill moved through the Assembly, and CDA was forced to actively oppose the bill on the Assembly floor, where it was defeated on May 29th by a vote of 16-36.