06/30/2014

CDA leading statewide effort to address dental anesthesia coverage crisis


CDA and local dental advocacy efforts in recent weeks have prompted action from the state, led by Sen. President Pro Tem Darrell Steinberg and the Department of Health Care Services, to ensure access to dental care performed under anesthesia when medically necessary.

Inadequate Medi-Cal reimbursement rates for facility, anesthesia and dental services have forced many facilities statewide to either reduce or discontinue dental services for patients who need to be treated under general anesthesia.

The most recent example is in Sacramento, where Sutter Memorial Hospital and its Capitol Pavilion Surgery Center recently announced they would no longer provide dental services after July 31. Sutter has been the primary service provider in the Sacramento region for Medi-Cal patients despite the low reimbursement rates. More than 1,100 medically fragile and cognitively impaired patients were treated last year at the Sutter facilities, including special needs patients from six of California's 21 Regional Centers.

CDA's advocacy and media efforts resulted in articles in The Sacramento Bee on June 19 and June23 and California Healthline, as well as a Los Angeles Times editorial highlighting the inadequate reimbursements for pediatric dental care that are having a devastating impact on access to services.

CDA has also been in direct talks with DHCS about administrative procedures the department could use to address the crisis and is strongly advocating that the state revisit the completely inadequate reimbursement structure for dental care, including care offered under anesthesia in dental offices.

"This is clearly an access to care crisis for our state's most vulnerable citizens," said CDA President James Stephens, DDS. "With the closing of yet more facilities to dental care for Medi-Cal recipients, the state must recognize that reimbursement rates need to be addressed, not only at hospital facilities but for care offered under anesthesia in dental offices."

CDA participated in a stakeholder meeting convened in late June by Steinberg at which time Sutter agreed to delay the termination of dental services to at least Sept. 30. At this meeting, CDA was designated as a convener of a working group of stakeholders to develop solutions, including protocols to ensure there is access for patients at the appropriate care facility, identifying administrative changes that are needed to simplify billing procedures and appropriate reimbursement rates for the program, and identifying legislative changes that would be needed to change the reimbursement rate structure. The working group is expected to have recommendations by Sept. 1.

"CDA believes addressing the protocols that will require patients to be seen in hospitals, clinics and dental offices with sustainable payment structures at all levels of care is essential to any solution, said Stephens. "We will continue to advocate that a statewide solution is needed to address this issue across California."