Major Legislative Issues - 2002

Last Updated: October 8, 2002

Following are brief summaries of bills and issues supported and opposed by CDA in 2002.

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.

(NOTE: Only bills that were active this session are included. Click here to research past legislation if you know the bill's number, author, or subject. The content and status of legislation changes constantly. Please call the Public Policy Division at 1-800-736-7071, Ext. 5200, for more information.)

Access to Care

Denti-Cal: No cuts in recently-increased rates.

Abstract: After working all year with legislators and legislative budget staff, we are pleased to report that Governor Davis signed AB 3006 which preserves the Denti-Cal provider rate increases we received in July 2000. The adult program, as well as provider rates and benefits, were the subject of ongoing discussions during joint budget hearings, and CDA continued to lobby for no cuts to the program. As news of looming budget deficits for the next several years were discussed in the press, we were not optimistic; however the Governor responded to our concerns.

Since late last year, its been apparent that a combination of loss of significant income-tax revenues attributable to "dot-com" failures, a sluggish economic recovery, and three years of increased legislative spending would produce shortfalls in both the current and coming fiscal years. On January 10, Governor Davis estimated the aggregate deficit at $17.2 billion in proposing current-year cuts and his tentative budget. The dental "share of pain" at that time took the form of proposals to:

Partially roll back provider rate increases;
Increase patient copayments; and
Terminate the Child Health and Disability Prevention Program (CHDP) by shifting those beneficiaries into Healthy Families and Medi-Cal generally.

On May 15, actual revenue losses and economic reassessments pushed the deficit figure to $23.6 billion, moving the Governor to amend his plan to call for:

A full rollback of provider fee increases to July 2000 rates;
Elimination of adult dental services (which are considered option under federal Medicaid program requirements);
Halving dental cleaning and exams to one per year; and
"Borrowing" $5 million of the Dental Board's $8 million surplus and transferring it to the General Fund.

CHDP was restored in the amended plan. The Senate budget subcommittee restored adult dental benefits. The only additional cuts in the Denti-Cal budget adopted by the conference committee are a limitation on adult preventive services (prophy and cleaning) to one visit per year. Access Dental and Health Net pushed the conference committee to authorize mandatory managed care for Denti-Cal in Los Angeles County but never found the requisite two "Aye" votes on each side to get that language into a budget "trailer" bill.

On August 5, Assembly Speaker Herb Wesson gave the body's Republican members the opportunity to debate their proposed budget cuts (including the elimination of adult Denti-Cal benefits) and put them to a vote. They failed on a party-line vote. The following evening, the Speaker moved the bill increasing the vehicle license fee (AB 433)--strenuously opposed by the minority party--to the inactive file and offered amendments to another Senate revenue-raising measure (SB 1849) to raise the per-pack tax on cigarettes by $2.13. Those amendments were adopted, 50-24, but the revised tax-increase bill failed to attract the necessary four Republican votes the following day, 50-21. Another three weeks of stalemate ensued.

On August 31, in the waning hours of the session, Assembly Democrats came to terms with enough Republicans to produce the 54 votes necessary to approve the Senate's amendments to AB 425, its own budget bill. (Three of the four Assembly Republicans--Mike Briggs, Dick Dickerson, and Dave Kelley--are "termed out" in November; the fourth, Keith Richman, won Democrats' support for a constitutional amendment (ACA 11) that would dedicate a percentage of future General Fund revenues to infrastructure development.) Proposed increases in the tobacco tax and Vehicle License Fee were shelved in favor of a temporary spending cap (AB 593) and an amalgam of "revenue enhancements" in the form of tax credit and deduction suspensions (AB 2065). The package ultimately presented to the Governor included an additional $1.6 billion in spending cuts and an "agreement" requiring the Governor to find another $750 million in current-year savings.

The Assembly also sent AB 442, the health services "trailer" bill, to the Governor without additional changes. As passed, the bill reduces adult Denti-Cal benefits to one initial exam per beneficiary and one prophy per year and preserves children's exams and cleanings at present levels--two each per year. A section of the bill "rolls back" all but a few Medi-Cal provider rates to their pre-July 2000 levels, negating the last two increases. Another approved measure supported by CDA, AB 3006, repeals Section 103, effectively restoring provider rates fully to pre-existing levels.

On September 5, Governor Davis signed the budget bill and issued his line-item veto messages for those appropriations he was reducing, or "blue-penciling." Included among those cuts were legislative expansions of the Child Health and Disability Prevention (CHDP) and Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) programs, amounting to $7.9 million, and the provider rate reductions supported by the health "trailer" bill. The Governor left a glimmer of hope for partial rate restoration by regulation, if the revenue picture improves:

"Partially restoring the rates paid to Medi-Cal providers is a priority of my Administration as well as the Legislature. In order to accomplish the intent of the Legislature, the Director of the Department of Health Services will be reducing the provider rates to the pre-August 2000 level, pursuant to AB 442. I am sustaining funding to allow exemptions, as prescribed in AB 442, from provider rate reductions for the following services: California Children's Services, non-emergency medical transportation, home health services, shift nursing, and family planning physician services. However, the Director can then use existing authority to develop regulations that would partially restore Medi-Cal provider rates by implementing my January 10 budget proposal and rescinding the May Revision rate reductions. The rescission of the May Revision provider rate reductions would take effect retroactively to the date of my signing AB 442, the omnibus health trailer bill. Any funding adjustments needed to effectuate these outcomes will be addressed in my revised 2002-03 budget submitted to the Legislature in January 2003."

Thus, Gov. Davis made it explicit that he would sign the "trailer" bill as described above and implied that he would veto AB 3006. He did not, however; on the last day of the bill-signing period, September 30, the Governor approved the "repealer" bill, effectively killing the Medi-Cal/Denti-Cal provider rate rollbacks. (Statutes of 2002, Chapter 1164.)

Related Legislation: None.

Foreign-trained Dental Professionals: Limited pilot program to allow dentists from Mexico succeeds – but so does loan repayment program.

Abstract: What began in 1999 as an extensive program to allow dentists and physicians from Mexico and the Caribbean to acquire a license and practice in underserved communities has become, after two years of meetings with legislators and agency leaders, AB 1045, by Assembly Member Marco Firebaugh. The new law creates a three-year pilot program to allow a maximum of 30 dentists from Mexico, after receiving specific remedial training in a program affiliated with a dental school, to obtain a "permit" to practice under the supervision of a California licensed dentist, in a clinic providing care to underserved populations. CDA remained opposed to the bill and expressed concerns about protecting the integrity of our licensing process. Our concerns were balanced with the real need for practitioners in some of the more remote and lower-income areas of the state. To the author's credit, Mr. Firebaugh was willing to accept all the amendments suggested by CDA to assure responsibility and accountability for the pilot program dentists. His companion proposal provides a longer-term approach to the access issue. AB 982 will provide several million dollars in loan repayment funds to recent graduates of dental and medical school interested in working for two to three years in a clinic in an underserved community. Mr. Firebaugh recognized that the solution to this very complex issue requires more than a single solution.

As introduced AB 1045 incorporated draft recommendations of the Department of Consumer Affairs' Task Force on Culturally and Linguistically Competent Physicians and Dentists and developed into a pilot program allowing 30 Mexican trained and licensed physicians and dentists to practice in nonprofit community health centers in medically underserved areas under the supervision of a California-licensed dentist. (The task force's recommendations are scheduled to become final sometime this Fall.) Rather than being issued a license, these dentists will be granted a temporary permit. CDA, the California Medical Association, and the Latino Health Care Caucus joined in supporting Firebaugh's other initiative, AB 982, to create a state-funded, student loan assumption and repayment program for medical and dental students who agree to treat low-income groups or practice in specified underserved areas for fixed periods following graduation. Both bills were signed by the Governor on September 30. (Statutes of 2002, Chapters 1131 (AB 982) and 1157 (AB 1045)

Related Legislation: AB 447 (chaptered); AB 2872; SB 492.

Medi-Cal: Emergency Dental Care: DHS will help CDA analyze how services are provided to the developmentally disabled.

Abstract: AB 275, sponsored by CDA and authored by Assembly Member Dion Aroner, was enacted as a directive to the Department of Health Services to provide the Legislature with information on utilization, procedures, and time periods for this population. CDA believes this information will be helpful as the organization attempts to improve the Denti-Cal program for both patients and providers

The CDA measure began as an attempt to improve care for developmentally disabled Medi-Cal patients. This segment of the dental-patient population has difficulty finding care because their treatment is often challenging, time-intensive, and traumatic. Patients' treatment may require multiple visits to meet prior authorization requirements when, in fact, in the dentist's professional judgment, treatment could be consolidated, minimizing episodic trauma for developmentally disabled patients. Initially, the bill removed these patients from the prior authorization process and directs the Department to establish aid codes for this population which will be very helpful in recognizing their unique needs. This bill is now a directive asking DHS to provide data on utilization, procedures, and time periods for this population. CDA believes this information will be helpful as the organization attempts to improve the Denti-Cal program for both patients and providers. The bill passed both bodies and was signed by the Governor on September 13. (Statutes of 2002, Chapter 522)

Related Legislation: None.

Medi-Cal Provider Rates - Annual Review: Governor thwarts detailed analysis.

Abstract: SB 1644 (Poochigian, Cogdill), supported by CDA, aimed to required the Department of Health Services to come up with a more rational basis for setting Medi-Cal/Denti-Cal provider rates. Despite nearly unanimous legislative support, it fell victim to the Executive Branch's fear of "General Fund cost pressure."

The bill would have required the Department of Health Services in the course of its required annual review of Medi-Cal provider rates, to take into account the adequacy of rates for physicians and dentists in communities with disproportionately higher-than-average numbers of beneficiaries. It is CDAs hope that enactment of this bill will encourage the agency to do the annual rate review required by existing law, which it has yet to do, and to reveal what CDA believes is a gross inadequacy in Denti-Cal reimbursement rates. SB 1644 passed the Assembly Health Committee, 17-0, on June 18 and came off the Assembly Appropriations Committee's suspense file on August 22. Both the Senate and Assembly approved the bill with no "No" votes and sent the bill to the Governor on August 29.

The Governor vetoed the bill on September 30 for the following reasons, as stated in his veto message:

"In order to sustain my commitment to Medi-Cal providers and health care access for California's low income individuals, I have just signed Assembly Bill 3006 which maintains the 10-40% Medi-Cal provider rates increases initiated by this Administration in 2000-01.

While this bill may have merit, it will likely create General Fund cost pressure to increase reimbursement rates above current levels to a specific set of providers which will be very difficult in these times of severe fiscal constraints. Therefore, I cannot support this legislation."

Related Legislation: None.

Childrens Oral Health

Childrens Oral Health - School Readiness: Budget pressures kill prevention and screening bills.

Abstract: An Oakland freshwoman legislator convened a Select Committee to examine the state of California children's health as they prepare to enter the school system. That panel's work resulted in several pieces of legislation, all of which ultimately fell victim to the budget ax.

Last year, the Assembly Select Committee on Californias Childrens School Readiness and Health, chaired by Assemblywoman Wilma Chan (D-Oakland), held a series of hearings and roundtable discussions on the health, including oral health, of the Golden States children aged birth to six years. The Select Committees report, issued this Spring, produced a number of recommendations for improving child health. Three pertaining to oral health are found in AB 2721 (support), AB 2738 (support), and AB 2881 (support if amended), all authored by Chairwoman Chan. The first requires the Department of Health Services - if it can find private funding to do so - to "investigate the extent to which children in the state are covered by employer sponsored dental health plans and individual dental health plans and ways in which more children may be enrolled under employer or private sponsored dental plans." AB 2721 requires the study to examine:

The number of children served by programs operated by federal, state, and local government.
The extent to which existing resources for these programs are being used efficiently to provide the greatest amount of care to children.
Ways in which more children may be enrolled under these programs.
The cost the state bears by not meeting the need for preventive pediatric dental care for children without access to dental services.
The financial toll and the number of children impacted by unmet dental needs.
The cost of providing care under the current system, including emergency services, compared to the cost of funding preventive and regular services.

The Department is further charged to assess the cost of extending preventive dental services to children without access, to explore various options to fund those services, and to report to the Legislature by July 1, 2003.

The second measure, AB 2738, requires the Superintendent of Public Instruction to convene a working group to examine how the current system of school entry health screening/assessments can better fulfill the legislative intent of the program. That group is charged to review the current certificate form used under the program and make recommendations on the health assessments administered in the before-school entry physical examinations. The working group is to consult with various entities, including CDA, and must report to the Legislature, the Governor, the Superintendent of Public Instruction, and the Secretary of Health and Welfare by January 31, 2004.

Finally, AB 2881 requires:

The Superintendent of Public Instruction to convene a working group of school nurses, teachers, administrators, representatives of the School Health Connections offices administered by the State Department of Education, and the State Department of Health Services to develop core competency curriculum on identifying basic health issues that commonly affect pupils' school performance and to develop a related handbook for use by school districts.
The State Board of Education to circulate the proposed curriculum and handbook for public comment and, thereafter, to adopt them at a regularly scheduled public hearing.
That the curriculum and handbook be made available to school districts to use at their discretion.

CDA suggested to the author that dental professionals be added to the working group. AB 2738 and 2881 were held under submission in the Assembly Appropriations Committee for fiscal reasons. AB 2721 was vetoed by the Governor on September 22 and AB 2741 was vetoed on September 27. In both veto messages, Gov. Davis stated that the results of these reports would likely increase costs to the state as his reason..

Related Legislation: None.

Childrens Oral Health - Soda Tax: Capitol failure breeds school action.

Abstract: Though a CDA-supported effort to apply the same policy to refined sugars in carbonated beverages as to tobacco - consumption taxes to offset negative public health consequences - didn't get out of its first house, attention devoted to the issue has spawned on-campus restrictions on their sales.

Early this year, CDA was approached by Senator Deborah Ortiz, Chairwoman of the Senate Health & Human Services Committee, to evaluate a proposal to combat the negative health effects of excessive sugar consumption on childrens oral health and optimum weight, and associated health disorders. Sen. Ortiz proposed to impose a tax on sweetened beverages and syrups implicated in these effects, the revenues from which were to be dedicated to oral and child health education and disease prevention. This Spring, CDAs Joint Policy Council, comprised of the members of the Councils on Community Health, Dental Care, Dental Research, and Legislation, met to discuss the issue. After careful deliberation, the Joint Policy Council voted to support the levy of such a tax to call attention to the epidemic of dental disease and decay attributable to excessive sugar consumption and other childhood maladies, and if at least 15 percent of total revenues were dedicated to childhood oral disease treatment, prevention and education. SB 1520 ultimately met those requirements and representatives of CDA testified in support of the measure in the authors committee on April 10, where it passed, 8-3. The bill was "triple-referred" to two other Senate policy committees. In anticipation of fierce opposition from beverage interests in its second hearing, the bill was gutted in favor of a five-year phase-out of sale of carbonated, sweetened beverages on school campuses. Nonetheless, SB 1520 failed passage in the Senate Education Committee on May 8, 5-4 and again on reconsideration on May 21, 6-1.

Related Legislation: SB 19; SB 56.

Health Plans/Managed Care

Discount Dental Plans: Regulation still unresolved.

Abstract: Whether and how to regulate so-called "discount dental plans," an issue that was hotly debated but unresolved in the last legislative session, was reintroduced - but didn't get much farther.

Recently, the Director of the Department of Managed Health Care issued a formal opinion finding that discount health plans that do not hold themselves out as traditional health insurance plans are neither general nor specialized health care plans, within the meaning of the Knox-Keene Act. This Spring, CDAs Council on Legislation supported in concept legislation that would protect health care consumers by requiring reasonable regulation of discount health plans, including dental plans. Thus far, two bills on the subject have been introduced: SB 1461 (Speier) and SB 2010 (Alpert). In its introduced form, the Speier bill contained a number of provisions that CDA found objectionable in the past. (See SB 173 (Alpert), 1999-2000 Session.) As amended on June 6, Sen. Speiers bill narrows the definition of regulated entities to "medical discount clubs" and transfers the pared-down regulatory scheme for those entities from the Department of Managed Health Care to the Department of Justice. Sen. Alperts bill exempts physician referrals to discount health plans from the general prohibition on medical referrals in current law. The authors announced their intent to join the bills together. SB 1461 was pending hearing in the Assembly Health Committee when the Legislature recessed for the year and SB 2010 was converted to another purpose on August 27.

Related Legislation: None.

Managed Care Contracts: Some provider relief in negotiating with HMOs.

Abstract: After two years of debate over providers' rights in contracting with managed care plans, a bill to subject the fairness and reasonableness of contract terms to judicial process stalled, and another that prohibits unilateral changes to significant contract terms or that ask the doctor to take on an unreasonable number of patients moved to the Governor's desk. The successful bill allows the Department of Managed Health Care take enforcement action against an HMO for violating its requirements.

AB 1600 (Keeley), supported by CDA and sponsored by the California Medical Association, was introduced last year to compel the Department of Managed Health Care (DMHC) to exercise its general grant of authority as regulator of Knox-Keene licensees to determine, on a case-by-case basis, whether contracts between health care plans and providers are "fair" and "reasonable." The idea has been controversial; DMHC has resisted applying that authority more than generally, the bill has been amended in its journey, and interim hearings on it were held by legislative committees. Currently, the bill would give aggrieved parties who have exhausted their administrative remedies with the agency the right to go to court to seek equitable relief against plans. Discussions among parties continue. Meanwhile, CMA also sponsored and CDA supported AB 2907, by Assembly Member Rebecca Cohn, a backstop measure amended recently to establish basic definitions for permissible contracting practices by managed care plans where providers are concerned. AB 1600 was removed from the Assembly Inactive File on June 13 and sent to conference committee on June 20. Conference committee action was not scheduled by the time the Legislature recessed. AB 2907 was approved by Gov. Davis on September 26. (Statutes of 2002, Chapter 925)

Related Legislation: AB 1522; AB 1795; AB 1976; AB 2291; AB 2420; AB 2907; AB 2939.

"Junk" Science

Amalgam: Opponents lose twice.

Abstract: The special-interest group that is suing organized dentistry for "wilfully deceiving" patients about the risks of dental amalgam got two turns at bat this year and struck out twice.

AB 2270 (Dickerson), opposed by CDA and sponsored by Consumers for Dental Choice, phases out the use of amalgam dental fillings containing mercury in California by 2007. The bill is virtually identical to federal legislation (H.R. 4163) introduced by Rep. Diane E. Watson (D-L.A.), also brought to her by Consumers for Dental Choice. Both measures contain the same recitations of supposed dangers to dental and public health posed by the use of dental amalgam in the dental office, none of which is supported by the large body of scientific evidence. The Dickerson bill was the subject of a contentious, late-evening hearing in the Assembly Health Committee on April 23, where it failed passage on a 4-9 vote.

Following the failure of AB 2270, Assemblyman Dickerson introduced a joint resolution (AJR 57) in July espousing the dangers of dental amalgam and petitioning the federal Food and Drug Administration to reconvene an advisory panel to reconsider its proponents' "science." (Most of the time, the subjects of joint resolutions are non-controversial and receive bipartisan support.) The resolution was referred to the Assembly Health Committee—the same policy committee that had heard AB 2270 earlier in the year—where the subject was reheard on August 22 and was defeated, again receiving only four "Aye" votes out of the 20 members on the panel.

Related Legislation: None.

Dental Materials Fact Sheet: Who must provide is clarified.

Abstract: An amendment to an "omnibus professions and vocations bill sponsored by CDA clearly exempts non-restorative procedures without sacrificing the pro-consumer intent of existing law.

A section of SB 1955 (Figueroa) now provides clarification regarding which dentists need to provide the dental materials fact sheet. The language specifies that the DMFS "shall not apply to any surgical, endodontic, periodontic, or orthodontic dental procedure in which dental restorative materials are not used." And that "For purposes of this article, "dental restorative materials" means any structure or device placed into a patient's mouth with the intent that it remain there for an indefinite period beyond the completion of the dental procedure, including material used for filling cavities in, or rebuilding or repairing the organic structure of, a tooth or teeth, but excluding synthesized structures or devices intended to wholly replace an extracted tooth or teeth, such as implants." We believe this language will allow most specialists to be excluded from the requirement.

Related Legislation: None

"Junk Science" Lawsuits: Plaintiffs' bar stymies reform; initiative possible.

Abstract: The latest effort to rein in spurious "unfair competition" lawsuits—such as that filed against CDA and ADA by "Kids Against Pollution"—ran aground once again in its first policy committee under fire from the Consumer Attorneys of California. Lawsuit victims may be forced to go to the voters in the near future.

AB 1884 (Robert Pacheco), supported by CDA and sponsored by the Civil Justice Association of California, seeks to stem the tide of nuisance lawsuits filed against businesses and professions alleging "unfair" or "deceptive" business practices under Californias overly-broad Unfair Competition Law (UCL - Business and Professions Code 17200 et seq.) The class-action lawsuit filed by the Khorrami Law Firm accusing ADA and CDA of "deceiving" consumers about mercury in amalgam fillings is grounded entirely in the UCL. The bill amends existing law to:

Require the person bringing the action to have suffered harm or have relied on a representation of the defendant;
Bar an action when there is no evidence of present harm and the defendant has terminated the activity;
Limit suits to no more than one action against one defendant for the same conduct; and
Provide a mechanism so that no UCL claim is added to another lawsuit for tactical advantage.

The bill failed passage in its first hearing in the Assembly Judiciary Committee, due to strong opposition from the Consumer Attorneys of California, by a vote of 4-4 on May 14.

Related Legislation: AB 2291; AB 2939.

Anti-"SLAPP" Motions: Bill limiting Anti-SLAPP motions is defeated.

Abstract: The Governor vetoed a bill that would have prohibited certain defendants from filing an anti-"Strategic Lawsuit Against Public Participation." If enacted, this measure would have negatively affected CDA, which has filed such a motion in the "Kids Against Pollution" anti-amalgam action.

Ten years ago, the Legislature enacted a law allowing a defendant a special motion to strike a civil complaint against them-an anti-"Strategic Lawsuit Against Public Participation"-on the grounds that his or her actions were in furtherance of the right of petition or free speech under the United States or California Constitution in connection with a public issue. As passed, this law was intended to protect "little guys" against "big guys" with superior litigative resources; in subsequent practice, business defendants have used the motion successfully to blunt what they believe to be nuisance lawsuits, invoking constitutionally recognized and protected "commercial speech."

CDA filed such a motion in the "Kids Against Pollution," anti-amalgam action, which is on appeal. SB 1651 (Kuehl), sponsored by the Consumer Attorneys of California and opposed by ACLU, CDA and various other business and tort-reform interests, would limit the circumstances under which anti-SLAPP motions can be used. The bill's contents were modified slightly and amended into SB 789, by the same author. That measure passed both houses by narrow margins and was vetoed by the Governor on September 30.

Related Legislation: None.

Licensure

Hygienists - Licensure by Credential: Dental hygienists from other states can now practice in California.

Abstract: AB 2818, sponsored by CDA and authored by Assembly Member Sam Aanestad, D.D.S., will permit dental hygienists licensed in other states, meeting certain qualifications, to practice in California without taking the licensure exam. This proposal was introduced in response to CDA member's concern about the shortage of dental auxiliary staff in California. This bill now moves into the regulatory process.

CDA's sponsored bill was the vehicle for establishing a consensus procedure by which registered dental hygienists licensed in other states can be admitted to practice in California without having to take another clinical examination. Like its predecessor applicable to dentists, AB 1428 - also authored by Assemblyman Aanestad - which was signed into law last Fall, this bill is intended to improve access to preventive dental services by alleviating the current shortage of hygienists throughout the state, and to promote recruitment in areas with significant numbers of underserved and in less-populated areas. The measure establishes practice-appropriate, educational and examination prerequisites to licensure. In its present form, the bill reflects agreement among the principal parties interested in the issue, including CDA, the California Dental Hygiene Association, and the California Primary Care Association. [NOTE: The provisions of this bill were amended in their entirety into SB 2022 (see below), to avoid renumbering and "chaptering out" problems.] AB 2818 passed both houses without dissent and was signed by the Governor on September 18 (Statutes of 2002, Chapter 691).

Related Legislation: AB 2302; SB 1589; SB 2022.

Hygienists - Public Clinic Practice: RDHAP primary care clinic role clarified.

Abstract: SB 1589 (Perata), supported by CDA, amends current law to enable certain public, primary care clinics to fulfill their statutory responsibilities to provide care to indigents by employing a Registered Dental Hygienist in Alternative Practice (RDHAP).

RDHAPs may be hired to be an employee of:

A primary care clinic exempt from licensure as a clinic operated by a recognized Indian tribe on tribal land;
A clinic owned and operated by a public hospital or health system; or
A clinic owned and operated by a hospital that maintains a primary contract with county government.

This bill is intended to correct an oversight in the law defining the scope of practice for RDHAPs, enacted five years ago by AB 560 (Chapter 753, Statutes of 1997). [NOTE: The provisions of this bill were amended in their entirety into SB 2022 (see below), to avoid renumbering and "chaptering out" problems.] SB 1589 was signed by the Governor on September 22 (Statutes of 2002, Chapter 811).

Related Legislation: AB 2302; AB 2818; SB 2022.

Hygienists - Scope of Practice: CDA and CDHA come to terms.

CDA and the California Dental Hygiene reached agreement to codify the contemporary practice of dental hygiene in California after two years of negotiations. CDA and CDHA have agreed to language on the following negotiating points:

Clear statutory enumeration of procedures and functions -

Excluded from the practice of dental hygiene;
Required to be performed under direct supervision; and
Permitted to be performed under general supervision.

Clarification of preventive services an RDA may perform without supervision in a public, nonprofit clinic.
A statement that any procedure or service not requiring direct supervision requires only general supervision, as long as its performance "does not give rise to a situation in the dentists operatory requiring immediate services for alleviation of severe pain, or immediate diagnosis and treatment of unforeseeable dental conditions, which, if not immediately diagnosed and treated, would lead to serious disability or death."
Licensure exemptions for enrolled dental and hygiene students, application of topical agents, and clinical demonstrations by hygienists licensed elsewhere.

The entire package, along with provisions harmonizing it with AB 2818 and SB 1589, has been amended into SB 2022. SB 2022, which now includes the contents of AB 2818 and SB 1589 (see above), was signed by the Governor on September 22. (Statutes of 2002, Chapter 810) SB 1955 was signed on September 30. (Statutes of 2002, Chapter 1150)

Related Legislation: AB 2818; SB 1589.

Hygienists – Separate Regulation: Legislature will study issue in sunset review.

Abstract: Based on last year's Joint Legislative Sunset Review Committee recommendation, language expressing the Legislature's intent to "pursue" the issue of a separate regulatory board for hygienists in the next session was amended into SB 1955 (Figueroa).

One of the negotiating points between CDA and the California Dental Hygiene Association was the recommendation to the Joint Legislative Sunset Review Committee by the Committee on Dental Auxiliaries that hygienists have their own regulatory board. CDHA took the position that scope-of-practice recodification legislation should include that provision, while CDA insisted that one would more naturally follow the other, given the realities of the Dental Board's status in the already-mandated, truncated review process. The parties ultimately agreed to include in one of the professions and vocations' "omnibus" bills a statement of legislative intent to pursue the issue in future joint review. SB 1955 was signed on September 30. (Statutes of 2002, Chapter 1150)

Related Legislation: None.

Practice-Related Issues

Family Leave: New legislation could affect dental practices.

Abstract: A bill opposed by virtually every organization representing business in California was signed by Gov. Davis. The original bill placed many of the burdens, including financial, on business, such as allowing 12 weeks of paid leave subsidized half by the employer and half by employee, with a guarantee to hold the position open for the employee. The final bill provides a maximum of 6 weeks of paid leave (incorporating vacation if available), subsidized solely by the employee through SDI, and the guarantee to hold the position open for the employee on leave does not apply to employers with 50 or fewer employees.

SB 1661 (Kuehl), opposed by CDA, creates a mandatory, paid Family Temporary Disability Insurance (FTDI) benefit applicable to all California places of employment, regardless of size. (Current federal law provides for a voluntary, unpaid family leave benefit of up to 12 weeks for all businesses with 50 or more employees.) As finally amended, the bill requires the entire program to be funded by employee contributions. (The final version of the bill did provide one break for small businesses. Firms with fewer than 50 employees will not be required to hold a job open for an employee using the benefit.) For that reason and those given below, CDA maintained its opposition:

It imposes costs on dentists and their employees that neither of them can now afford
It places no restriction on the number of employees in any given workplace that may take FTDI leave at any given time.
It holds the potential for disrupting patient care.
It imposes a mandated benefit requirement on small California businesses and hands control over it to the state.
Unlike current state and federal leave laws, it does not require an employee to work for an employer for a minimum period before applying for FTDI leave
Its "sole family member" certification requirement will force me to invade my employees' privacy.

The bill passed both houses by narrow margins and was signed by Governor Davis on September 23. (Statutes of 2002, Chapter 901.)

Related Legislation: None.

"Junk Faxes": New law should stem tide of unwanted facsimiles.

Abstract: CDA played a role in reviving in the Assembly a Senate bill that will repeal an obsolete state law that stands in the way of tougher federal sanctions that can be used against "junk faxers."

SB 1358 (Bowen), supported by CDA, the Attorney General and a host of business interests, would repeal current state law on the subject, thereby allowing a 10-year-old federal law that contains an outright ban on unsolicited fax messages outside a "pre-existing business relationship" to pre-empt the field. The bill passed the Senate but failed passage twice in the Assembly Business & Professions Committee in June, in the face of opposition from termed-out Assemblyman Tony Cardenas, the author of a competing measure sponsored by fax.com, the primary opponent of the change. Its contents were amended into AB 2944 (Kehoe), which was reheard by the committee and passed by the Assembly on the last regular day of session. AB 2944 was signed by Governor Davis on September 19. (Statutes of 2002, Chapter 700).

Related Legislation: None.

Malpractice: New legislation requires disclosure of certain physician settlement cases.

Abstract: The Medical Board of California and the Joint Legislative Sunset Review Committee joined to pressure physicians' groups and their insurers to negotiation expanded disclosure of disciplinary records and medical malpractice suit settlement agreements. Regulations will determine the level of detail.

SB 1950, by Senator Liz Figueroa, allows patients to see if their physician has been involved in multiple malpractice suits. It will require disclosure on the Internet of three or more settlements of more than $30,000 in 10 years. For high-risk specialties, the threshold will be four or more settlements. The criteria for how covered specialties are categorized—that is, whether they are "low-" or "high-risk"—will be determined by regulation and based on insurer claims data. This bill also adds two public members to the Medical Board, bringing the total to 12 physicians and 9 public members. The bill was signed by the Governor on September 29. (Statues of 2002, Chapter 1085.)

Related Legislation: None.

Student Loans: Boards can now refuse to license practitioners who default.

Abstract: Beginning next year, boards licensing and regulating "health care practitioners" may fine and cite licensees found to have defaulted on specified federal educational loans. They'll be required to take certain extenuating factors into account.

SB 2019, authored by Senator Jackie Speier, authorizes a licensing board or agency having jurisdiction over a licensee to cite and fine a licensed health care practitioner who is in default on a United States Department of Health and Human Services education loan, including a Health Education Assistance Loan. The bill would require a board, prior to issuing a citation, to take into account the population served by the health care practitioner and his or her economic status. It also authorizes the board to deny a license to an applicant to become a health care practitioner or deny renewal of a license if he or she is in default of a loan until the applicant or licensee clears the default or makes satisfactory repayment arrangements. This bill would require that each board that issues citations and imposes fines retain the money from these fines for deposit into its appropriate fund. SB 2019 was signed into law on September 18. (Statutes of 2002, Chapter 683.)

Related Legislation: None.

Public Health & Safety

Advertising of Credentials: Dental Board now has improved guidelines to better regulate dentists advertising as specialists.

Abstract: While maintaining free-speech safeguards, AB 1026, sponsored by CDA and authored by Assembly Member Jenny Oropeza, will provide the Dental Board of California with the ability to regulate advertising methods of dentists who advertise as specialists, ensuring that their credentials are appropriately described.

The bill is designed to clarify advertising guidelines related to specialty practice. This issue surfaced because the Dental Board of California has met with legal challenges in its attempts to address the problem by regulation.

AB 1026 has been amended to reflect the approach taken last year by the Florida Legislature. That law provides that a licensed dentist may not:

Hold him or herself out or advertise as a specialist unless he or she has completed a specialty accreditation program approved by the ADA and the Commission on Dental Accreditation or is examination-eligible by an ADA-recognized specialty board, or is a diplomate of a recognized board.
Represent that his or her practice is limited to a particular specialty without membership in or accreditation by a "bona fide" specialty organization, either as described above or one that conditions membership or credentialing on:

Successful completion of a formal, full-time advanced education program attached to a university-based dental school that is beyond the dental degree, at the graduate or postgraduate level;
Didactic training and clinical experience in the represented area greater than that of other dentists; and
Successful completion of oral and written examinations based on psychometric principles.

If representation that a practice is limited to a particular era and the above criteria are not met, a dentist may still limit his or her practice to a specific area but must include a disclaimer in the advertising that services are being provided by a general dentist.

The new Florida statutes also contain statements of purpose and intent necessary to protect its provisions from running afoul of existing free-speech safeguards.

AB 1026 was signed into law by Gov. Davis on September 3 (Statutes of 2002, Chapter 313).

Related Legislation: None.

Emergency Care: Task Force proposal recognizes importance of dentistry and oral surgery.

Abstract: CDA persuaded the author to put an oral surgeon on a new statewide EMS task force.

Assembly Member Manny Diaz introduced AB 1988, to establish a statewide EMS Task Force which will study the delivery and provision of emergency medical services in California. Initially, the measure made no provision for any representation from the dental arts, despite the often-critical role that dental surgeons play in trauma and restorative care. After CDA's and CAOMS's persistent requests, AB 1988 was amended to include a slot for an oral surgeon nominated by CDA. The bill was signed by the Governor on August 31. (Statutes of 2002, Chapter 333.)

Related Legislation: None.