With a new legislative session under way, CDA’s volunteer leaders and its Sacramento advocacy team are simultaneously on offense and defense on a wide range of legislative and regulatory issues impacting dentists and patients across the state. The issues range from dental insurance and malpractice reforms to state oral health policy leadership and regulation of dental hygienists.
“CDA is constantly taking the pulse of its members to identify the key issues facing our profession, and to take those concerns directly to policy leaders in Sacramento,” said William L. Marble, DDS, chair of CDA’s Government Affairs Council. “With the slow economic recovery in California, dentists and their patients continue to be impacted in many ways, and CDA is working vigilantly to make things better and ward off changes that would make things worse.”
Here are just a few of the key issues that CDA is working on this year:
CDA-Sponsored Legislation – Premium Protection (MLR)
CDA is sponsoring legislation, AB 1962, this year to require dental plans to adhere to a minimum loss ratio (MLR), which will protect patients’ insurance premium dollars. The legislation will require that dental plans spend a minimum percentage of premium revenues directly on patient care and will limit the amount that can be used for plans’ administrative costs. Under current law, all medical plans must adhere to an MLR, but dental plans have no minimum standard. The legislation will help ensure that dental patients are getting adequate value for their insurance premium dollars.
Dental Hygiene Committee Sunset Review
The Dental Hygiene Committee of California (DHCC) will be going through its first legislative sunset review process in 2014 and has submitted a report to the Senate Business, Professions, and Consumer Protection Committee. The Committee’s report, combined with an accompanying report from the California Dental Hygienists Association include a series of substantial policy change recommendations, which CDA believes are unjustified.
The proposed 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 obtain a dentist’s prescription in order to continue providing services to new patients after 18 months. The sunset hearings will likely begin in March and CDA is actively expressing its concerns about the above issues.
MICRA (Medical Injury Compensation Reform Act)
Trial lawyers have filed a ballot measure for the November 2014 general election that includes a retroactive a cost-of-living adjustment to MICRA’s $250,000 cap on non-economic damages in medical malpractice cases, raising it to approximately $1.1 million, plus annual inflation adjustments going forward. The measure would also mandate drug testing for physicians, but the main objective is to make it more lucrative for trial lawyers to file lawsuits against dentists, physicians, community clinics and other health care providers. The measure will triple the legal fees lawyers can collect for bringing a lawsuit and increase health care costs by billions of dollars annually, seriously threatening patient access to care. CDA is part of a broad-based coalition that will be fighting the initiative as well as any accompanying legislative efforts.
Dental Director / State Oral Health Plan
Although state law calls for the maintenance of a state office of oral health, it has been many years since the state actually had 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, 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 actively pursuing with key administrative officials how such a position could be established and funded.
Health Care Reform
California has moved rapidly toward implementation of the Affordable Care Act (ACA) and the California Health Benefit Exchange (Covered California) is now offering health care coverage options. CDA continues to advocate with the California Health Benefit Exchange Board and the Legislature to ensure a strong offering of pediatric dental benefits (as well as the future offering of optional adult benefits) 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.
Medi-Cal/Denti-Cal Provider Rates
Last year, the state began implementing the 10 percent 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 percent rate cut for future services despite the fact that California’s provider reimbursement rates already rank among the lowest in the nation. This comes at a time when the state is also trying to accommodate millions of new patients as a part of health care reform. CDA is continuing to work toward a legislative reversal of this rate cut.