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• Legislative Issues
• Major Legislative Issues - 2005

Major Legislative Issues - 2005

Updated 10/20/05

Following are brief summaries of bills and issues supported and opposed by CDA in 2005.

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.

SB 438 (Migden) Oral and Maxillofacial Surgery Elective Cosmetic Procedures: In 2004, CDA co-sponsored SB 1336 (Burton) with the California Association of Oral and Maxillofacial Surgeons (CalAOMS) in an effort to create a permitting process that would allow oral and maxillofacial 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 and maxillofacial 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 and maxillofacial surgeons could obtain a permit from the Dental Board of California after having demonstrated and documented specific credentials.

SB 1336 ultimately was passed by the Senate with a final vote of 30-0, after passing out of the Assembly on a 67-2 vote, despite the continuous strong opposition from 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 and maxillofacial surgery scope of practice. 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. That analysis is currently in progress and is expected to be completed later this year. In the meantime, with Senator Burton having left the Legislature last year due to term limits, Senator Carole Migden (D-San Francisco), who was elected to take Senator Burtons seat last November, has introduced SB 438, which is nearly identical to last years SB 1336, and

which can be used as a legislative vehicle to move this issue forward again depending upon the results of the states analysis. Senator Migden and CDA have made clear to all parties that the bill will not be sent to the Governor prior to the release of that analysis. SB 438 passed the Senate Business, Professions, and Economic Development Committee on April 25th on a 5-1 vote, and was passed by the full Senate May 16 on a 30-2 vote. The bill is now in the Assembly, where it will be held until next year pending the completion of the DCA analysis, which is expected sometime this fall.

SB 683 (Aanestad): Licensure Postgraduate Residency Program Recognition: Senator Sam Aanestad (R-Grass Valley) has introduced SB 683 on CDAs behalf. SB 683 is a continuation of last years SB 1865 (Aanestad), which gave California dental licensure applicants the option of taking the Western Regional Examining Board (WREB) exam instead of the state clinical exam. California is one of many states that are beginning to develop alternatives to the traditional, one-time only clinical exam that relies on the use of human subject patients. SB 683 would provide an additional alternative for licensure applicants, by allowing them to instead complete a clinically based, postdoctoral general dentistry or specialty residency program of at least one years duration, at a school or facility accredited by the Committee on Dental Accreditation (CODA) of the American Dental Association. The residency program would be required to include a formal outcome assessment evaluation of each residents competence to practice dentistry. This option would allow licensure applicants to have their clinical competency evaluated over an extended period of time, and would be more in line with the licensure process that has long been in place for physicians. SB 683 passed the Senate with unanimous votes, and was passed unanimously by the Assembly Business and Professions Committee and the Assembly Appropriations Committee. However, the Department of Consumer Affairs has taken an oppose unless amended position on the bill, requesting that language be added requiring that the residency programs be audited by the state. CDA is concerned that it sets a precedent that is not followed on the medical side (medical residency programs are not audited). In order to allow additional time to try to address the Departments concerns, SB 683 was held on the Assembly floor and will not be taken up again until 2006.

Western Regional Examination Board (WREB) Exam Recognition): In 2004, SB 1865 (Aanestad) was passed by the legislature and signed by the Governor. Co-sponsored by CDA and the deans of the five California dental schools, the new law allows dental licensure applicants to take the Western Regional Examination Board (WREB) exam instead of the California clinical exam, after meeting all other California qualifications for licensure. Although the bill officially took affect on January 1, 2005, and will eventually apply to all individuals who passed the WREB exam after that date, it first required the Office of Examination Resources within the state Department of Consumer Affairs to evaluate the WREB exam to determine if it is clinically equivalent to the California exam. In mid-October CDA learned that the evaluation was favorable. Nevertheless, it is likely to be weeks or months before the Dental Board is able to actually issue licenses based on WREB exam passage, because the Board now must complete the adoption of detailed regulations that will govern the process. CDA will be closely following the Boards development of those regulations.

SB 248 (Figueroa) Dental Board Sunset Review: State law requires that all boards and commissions be reviewed periodically by the legislature to determine whether they serve a worthwhile public purpose and are adequately carrying out their statutory responsibilities. Senator Liz Figueroa (D-Fremont), as chair of the Joint Committee on Boards, Commissions, and Consumer Protection, is the author of all bills extending boards and commissions that are under review this year, including SB 248, which in its original form would have extended the life of the Dental Board until July 1, 2010. In June, after the bill had passed the Senate unanimously and was about to be heard in the Assembly Business and Professions Committee, the Department of Consumer Affairs sent a letter to the committee stating that the administration was taking an oppose unless amended position on all board and commission sunset bills, and requesting that all boards be reconstituted to become public member majorities. In the specific case of the Dental Board, the department requested that the board be reduced from 14 to 7 members, to be made up of 4 public members and 3 dentists. In addition, the department requested that the Committee on Dental Auxiliaries (COMDA) be eliminated and its functions moved to a bureau within the department. CDA is strongly opposed to a public member majority Dental Board; no other state in the nation has one, and too many issues before the board require substantial clinical and professional expertise. CDA also does not believe that there is sufficient justification for eliminating COMDA and moving the regulation of dental auxiliaries outside of the Dental Board itself. The Assembly Business and Professions Committee and the Assembly Appropriations Committee were unsympathetic toward the administrations proposals, and each passed SB 248 unanimously without adopting the administrations requested amendments while discussions continued. Ultimately, an agreement was reached to extend the sunset date for the Dental Board and COMDA until January 1, 2009, with an understanding that legislative hearings will be held next year to address the departments concerns. SB 248 was amended accordingly, passed by both houses and was signed by the Governor on October 7th. It is anticipated that this issue will receive significant discussion in 2006, including the structure of the dental board and a separate regulatory entity for dental hygiene.

SB 1111 (Figueroa) Dental Assisting: In 2004, SB 1546 (Figueroa) was enacted, after several years of negotiations designed to develop new licensure pathways for the dental assisting profession. SB 1546 created new categories of registered surgery assistant, registered restorative assistant, and registered orthodontic assistant. The bill required the Dental Board to develop regulations governing the curriculum and training requirements for the new categories, and made the changes effective January 1, 2007. This year, numerous discussions between the interested parties representing CDA, the affected dental specialties, dental assisting, and the Dental Board led to agreements on a number of technical and procedural amendments, which were incorporated into SB 1111 (Figueroa). These amendments include clarifying the role of regional occupation programs, defining the patient monitoring responsibilities of each assistant category, and clarifying the linkage between existing registered dental assisting programs and the new, phased in requirements. Most significantly, SB 1111 extends for one additional year (until January 1, 2008) the operative date for the new assisting categories and licensure requirements. This extension was necessary in order to allow sufficient time for the various public and proprietary dental assisting programs to develop and obtain any necessary approvals for their new curricula. SB 1111 was passed by both houses and was signed by the Governor on October 7th. Regulations for the educational programs for the newly developed specialty assistant programs are continuing to be discussed between CDA and the Dental Assisting Alliance. Those negotiations are expected to continue throughout the remainder of 2005.

Denti-Cal/State Budget: With California again mired in a serious budget deficit situation this year, Governor Schwarzenegger was forced to look for expenditure reductions in many areas when he introduced his annual budget proposal in January. Past Governors from both political parties have, during tough budgetary times, proposed the complete elimination of adult dental benefits, which are an optional benefit under federal Medicaid law. This year, as part of a larger Medi-Cal redesign plan, Governor Schwarzenegger instead proposed to place an annual $1,000 cap on adult dental services, with a few exceptions for emergency and federally required services. CDA testified in early committee hearings that the $1,000 cap was unrealistic for the population being served and proposed:

1. The cap be set at $2,000 over a 2-year period.

2. The cap be based on a calendar year and becomes effective only when an easy and effective system to track beneficiary history is available to providers.

3. Program changes that are placed into statute should sunset June 30, 2007.

4. All necessary oral and maxillofacial surgery that does not fall under federally mandated services provided by physicians, emergency services, or is not covered by medical benefits, be excluded from the cap.

5. Patients may purchase and pay for prescribed treatment that exceeds the cap for covered services.

6. Laboratory-processed crowns for posterior teeth be allowed at the discretion of the dentist, if the total treatment plan falls within the cap.

On May 9th, both the Assembly and Senate health budget subcommittees approved, on party-line 2-1 votes, an annual $1,800, calendar-year cap, with additional exclusions for dentures, maxillofacial and complex oral surgery, and implants, and with a 2009 sunset date. CDA testified that this proposal was preferable to the Governors original proposal. A leadership budget agreement was reached in early July, and the language to implement these changes was placed into AB 131 (Laird), which has now been signed by the Governor.

AB 1077 (Chan) -- Childrens Oral Health Assessments: Significant research over many years has demonstrated that poor dental health is one of the leading causes of missed school days for children (which results in lost average daily attendance revenues for schools), and is also one of the most preventable diseases. CDA this year sponsored AB 1077 by Assembly Member Wilma Chan (D-Oakland), which as originally written was modeled after legislation passed in Illinois that would generally require children to provide documentation of an oral health assessment by no later than May of their kindergarten, second, and sixth grade years, unless the childs parent or guardian indicates that they choose not to obtain the assessment, cannot afford the assessment, or cannot find a dentist in their area. AB 1077 was passed by the Assembly Health Committee April 5 on a 10-2 vote, and was passed by the Assembly Education Committee on April 20th on a 10-0 vote. Some school organizations objected to the bill as an unfunded mandate. The bill allows parents to opt out by completing a simple form and there is no punitive action for not completing the assessment. This bill is intended to obtain information about the severity of the problem and to build capacity to help children find the dental care they need. Because legislative staff had estimated an annual cost of $8 million, the bill was placed on the Assembly Appropriations Committee suspense file, where high-cost bills are prioritized in conjunction with the budget process. The bill remains in that committee and has now been made a two-year bill to allow time for more discussion. CDA has proposed amendments to limit the assessments to kindergarten only as a starting point, which should reduce the bills costs significantly. CDA is working with the California Society of Pediatric Dentists (CSPD) and other affected parties in education to determine the best way to move this issue forward. The Council on Government Affairs will discuss this bill at its November meeting.

SB 299 (Chesbro) Licensure By Credential: Since 2002, California has allowed dentists licensed in other states who graduated from Commission on Dental Accreditation approved dental programs, and who have met specified clinical experience requirements, to become licensed in California without having to take the state clinical examination. That legislation included provisions allowing applicants with at least two years of experience willing to work for two years in a clinic or dental school to have those two years credited in advance toward the total five-year clinical experience requirement. In order to provide further incentive for dentists coming to California to provide much-needed work in those settings, CDA is sponsoring SB 299 by Senator Wes Chesbro (D-Arcata), which would eliminate the two-year experience requirement for qualified applicants who commit to practice in a clinic or dental school. SB 299 passed the Senate and Assembly with unanimous votes, but remains on the Senate consent calendar awaiting concurrence in Assembly amendments, due to the Senates failure to vote on the consent calendar on the last day of the 2005 session. CDA will request that the bill be amended in January with an urgency clause (it will take effect immediately upon the Governors signature) and work to send it to the Governor as soon as possible in 2006.

AB 1386 (Laird) Oral Conscious Sedation: Californias Dental Practice Act requires dentists administering or ordering the administration of general anesthesia or conscious sedation (often referred to as IV-conscious sedation) to obtain permits from the Dental Board, and requires dentists using oral conscious sedation on children under age 13 to obtain a certificate from the board. When the oral conscious sedation law was enacted in 1998, the technique was primarily being used to assist in treating young children with behavioral issues. Recent years, however, have seen a steady increase in marketing of sleep dentistry to adults, by dentists using essentially the same types of oral conscious sedation techniques that require a Dental Board certificate when used on children. Last year, a blue ribbon panel of the Dental Board considered this along with other anesthesia issues, and concluded that a certificate requirement was equally warranted for dentists using oral conscious sedation to treat individuals over the age of 13. To that end, CDA and the Dental Board co-sponsored AB 1386 by Assembly Member John Laird (D-Santa Cruz), which would enact the additional certification requirement, along with a number of other largely technical changes to the states anesthesia laws. The bill was amended along the way to clarify that the certification requirement would not apply to dentists who only prescribe single doses designed for home usage. AB 1386 was passed by both houses with solid bipartisan votes and was signed by the Governor on October 5th.

AB 1143 (Emmerson) Special Permits: Current law allows the Dental Board to grant special permits to dentists who have not passed the California licensure examination, but who have been offered full-time faculty positions with a state dental school. Dental schools are facing increasing difficulty recruiting faculty members, particularly in specialties and emerging areas of practice. The special permit allows the faculty member to supplement his or her teaching salary with income earned by practicing one day per week in the schools dental clinic. The current special permit law applies only to graduates of CODA-accredited specialty programs, which has proven a significant hindrance to attracting talented faculty from the international community and for non-ADA recognized specialty areas. In order to alleviate this problem, CDA sponsored AB 1143 by Assembly Member Bill Emmerson (R-Redlands), which will expand the special permit law to allow up to five permits per dental school to be granted to specialists who graduated from non-CODA accredited (i.e., international) dental programs, as well as up to five general dentists from non-CODA accredited programs with expertise in emerging non-specialty disciplines, along with existing special permit holders who wish to move to part-time faculty status. AB 1143 was passed by both houses and was signed by the Governor on October 5th.

AB 1268 (Oropeza) Advertising: In 2002, the Legislature passed and the Governor signed AB 1026 (Oropeza), sponsored by CDA, which was intended to prevent dentists who have not completed a Commission on Dental Accreditation approved specialty program from advertising in a manner that could mislead patients into believing that the dentists are in fact bona fide specialists. Specifically, AB 1026 prohibited advertising as a specialist unless the dentist did in fact complete a CODA-accredited specialty program, and allowed a dentist to advertise an emphasis in a particular area of practice (whether a recognized specialty or not) only if the dentist clearly stated in the advertisement that he or she is a general dentist. Following the bills enactment, the American Academy of Implant Dentistry filed a legal challenge to the bills constitutionality (Potts v. Hamilton). Last year, a federal district court judge ruled in the Academys favor, finding that the new laws outright prohibitions on advertising in certain instances violated the advertising dentists free speech rights. In his initial ruling, the judge indicated that a requirement that dentists advertising a particularly practice emphasis include a disclaimer indicating that they are not in fact a specialist, might be a constitutional alternative to the existing prohibitions. The Attorney Generals office, which represents the Dental Board and the Department of Consumer Affairs in the case, elected to attempt mediation prior to formally appealing the judges decision; the first mediation meeting of all interested parties took place September 12th. While that process continues, CDA is sponsoring

AB 1268 by Assembly Member Jenny Oropeza (D-Long Beach), which will be used as a legislative vehicle at the appropriate time to make any appropriate modifications to the law if the legal issues are clarified. AB 1268 was passed by the Assembly Business and Professions Committee April 26 on the consent calendar, and is currently in the Assembly Appropriations Committee. This bill will be held in committee pending further discussions with interested parties in the Potts v. Hamilton case.

AB 966 (Saldana) Dental Amalgam: CDA strongly opposed AB 966 by Assembly Member Lori Saldana (D-San Diego) . AB 966 would phase in a requirement that certain dental offices install amalgam separators by January 1, 2007. This language would essentially give dentists no choice but to install amalgam separators in their offices, regardless whether their local water agencies have detected problems with mercury discharges. CDA already strongly encourages dentists to use well-established best management practices in their handling of dental office wastewater, and local publicly owned treatment works (water treatment facilities) can and sometimes do require the installation of amalgam separators. CDA believes this law is not necessary. These local regulatory agencies already have the statutory authority to require dentists to implement any pollution prevention strategy, including amalgam separators, and CDA has cooperated with every agency that has developed additional requirements and worked with the local component dental societies to ensure compliance. CDA has also worked effectively with local water agencies to resolve specific local issues involving mercury and amalgam. This state is too large and geographically diverse to require a one-size-fits-all approach. AB 966 was passed by the Assembly Environmental Safety and Toxic Materials Committee April 26 on a 5-2 vote, and by the Assembly Appropriations Committee May 25 on an 11-6 vote. Amendments taken on May 11 in response to concerns expressed by Environmental Safety Committee members, which exempt various specialists, nonprofit practices, and practices where a majority of the patients are Denti-Cal patients, did not change CDAs fundamental objections to the bill. After vigorous opposition lobbying by CDA, the author moved the bill to the Inactive File on the Assembly floor. It will not be eligible to be voted on again until January 2006. CDA has been requested to meet with the authors office in October to further discuss this legislation.

AB 1334 (Salinas) Registered Dental Hygienists in Alternative Practice: CDA is opposed to AB 1334 by Assembly Member Simon Salinas (D-Salinas). The licensure category of registered dental hygienist in alternative practice (RDHAP) was created in 1997, and provides an opportunity for hygienists with specified education and clinical experience to practice independently (without a dentists supervision) in certain settings. The law does, however, require RDHAPs to obtain a prescription from a dentist or physician before providing treatment to new patients. AB 1334 would remove that prescription requirement, thereby allowing RDHAPs to commence treatment without the involvement of a dentist or physician. CDA believes such a change is premature at best. Until very recently, when the two existing RDHAP programs began graduating significant numbers of students, there were too few RDHAPs practicing in the state to allow for a reasonable evaluation of the prescription requirements impact. Until data indicates otherwise, CDA believes that the prescription requirement is not unreasonable for RDHAPs, who already are required to have a referral arrangement with at least one dentist. CDA has launched an educational and outreach campaign to all dentists in the state to assist RDHAPs in developing a relationship with a dentist who can provide the necessary prescription. Because RDHAPs are not allowed to diagnose (beyond the standard hygiene assessment), CDA believes that the prescription requirement provides an important safeguard for patients, especially patients who are medically compromised, such as nursing home residents. AB 1334 was passed by the Assembly Business and Professions Committee April 26 on a 5-2 vote, and is now on the Assembly floor. The author moved the bill to the Inactive File on the Assembly floor, agreeing to allow CDA the rest of this year to work to improve communication between local RDHAPs and dentists in an effort to alleviate any existing prescription barriers. CDA continues its campaign to educate all dentists in the state about the scope of practice of the RDHAP and to encourage dentists to consider developing relationships that will benefit patients. The bill will not be eligible to be heard again until January 2006.

AB 775 (Yee) Interpreters Prohibition On Use Of Children: CDA opposed

AB 775 by Assembly Member Leland Yee (D-San Francisco). AB 775 would prohibit any entity that receives state funds from using, or permitting the use of, any child under age 15 as an interpreter in a hospital, clinic, or physicians office for purposes of diagnosis or treatment. The bill would require the entity to have procedures in place for making competent interpretation services available to the patient. Violations could cause the provider to lose its eligibility for state funding after failure to comply within 90 days. While CDA appreciates the authors interest in preventing children from being placed in stressful and emotional situations when translating difficult health care information for a parent, most dental health information is preventive in nature. Requiring dentists to make professional interpretation services available in all cases will only serve as a further disincentive for them to participate in already low reimbursement programs such as Denti-Cal and Healthy Families, and would therefore only result in a reduction in access to dental care services. AB 775 was passed by the Assembly in June on a 41-35 vote, but failed passage in the Senate Judiciary Committee June 28 on a 2-3 vote. The author was granted reconsideration, but the bill will not be heard again this year.