Major Legislative Issues - 2007

Updated – 12/17/07

Following are brief summaries of bills and issues supported and opposed by CDA in 2007.

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.

Licensure of Dental Hygienists – Separate Committee:  Under current law, the Dental Board of California is responsible for licensure and regulation of dentists, dental hygienists, and registered dental assistants.  The Committee on Dental Auxiliaries (COMDA) is a separately appointed committee of the Dental Board, which administers the licensure process for dental hygienists and dental assistants, but otherwise acts in an advisory capacity to the board.  Last year, SB 1472 (Figueroa), which would have created a separate California Dental Hygiene Bureau within the state Department of Consumer Affairs, was opposed by CDA and ultimately vetoed by the Governor.  With Senator Figueroa having left the legislature at the end of 2006 due to term limits, this year Senate President Pro Tem Don Perata (D-Oakland) introduced SB 534, which in its early form would have created a separate regulatory board for dental hygienists, equivalent in general structure and authority to other regulatory boards including the Dental Board.    Earlier this year CDA convened a work group to look at the regulation of dental hygiene and as a result, provided an initial list of priorities and concerns to Senator Perata, and discussions continued throughout the year.  After significant mid-year amendments, the bill in its final form would have instead created a Dental Hygiene Committee of California that would remain under the jurisdiction of the Dental Board, while eliminating COMDA and placing responsibility for regulation of dental assistants directly with the board, which would be required to create a dental assisting committee chaired by the registered dental assistant member of the board.  The author had accepted every significant amendment CDA had requested, and CDA ultimately moved to a Support position on the bill. 

SB 534 was passed by both the Senate and Assembly, but was vetoed by the governor on October 14.  In his veto message the governor expressed concern that the bill would “lead to increased licensure fees for dental hygienists and dental assistants without providing additional consumer protection.”  An added consequence of the veto was caused by the bill’s inclusion of a necessary extension of the current July 1, 2008 sunset date for the Dental Board.  Without the enactment of legislation in 2007 to extend that date, licensure and regulation of dentists, dental hygienists, and dental assistants will revert to a bureau of the Department of Consumer Affairs as of July 1, 2008.  Since the veto of SB 534, CDA has been engaged in ongoing discussions with all interested parties in an effort to reach agreement at least on legislation to extend the life of the Dental Board. 

Dental Plan Coordination of Benefits Policies:  “Coordination of benefits” is the means by which two insurance plans determine their relative responsibilities when a patient has dual coverage, typically when the patient’s spouse has his or her own dental plan that covers spouses and/or dependents.  In recent years, CDA’s members and their patients have seen increasing instances in which dental plans that are the secondary payers are using “non-duplication” clauses and other similar policies to deny any additional reimbursement beyond what the primary plan has already paid.  CDA believes that these policies unfairly short-change patients and employers who have paid premiums to the secondary payer with the expectation that benefits will in fact be provided.  This year CDA sponsored AB 895 by Assembly Member Greg Aghazarian (R-Stockton), which will require dental plans, when they are secondary payers, to provide supplemental reimbursement for the patient’s out-of-pocket costs under the primary plan for benefits covered by the secondary plan (unless that amount exceeds what the supplemental plan would have paid as a primary plan), and will require all dental plans to clearly disclose their coordination of benefits policies in the evidence of coverage documents they provide to their enrollees.  CDA believes that AB 895 will ensure that dental patients with dual coverage receive the benefits from both plans to which they are entitled.  AB 895 passed through both houses of the legislature with unanimous votes and was signed by the governor on July 30, 2007. 

Children’s Dental Disease Prevention Program (CDDPP) Enhancement:  The Children’s Dental Disease Prevention Program (CDDPP) is a school-based dental disease prevention program that began in 1979 and was originally known as the SB 111 program.  The program currently receives annual state funding of $3.3 million and serves more than 300,000 low-income California preschool and elementary school children annually, providing classroom oral health education, fluoride treatments, plaque control, and dental sealants.  The programs are administered locally by school districts or county health departments, and contractors receive a maximum $10 per child reimbursement from the state.  Although the program has been a success, it is estimated that nearly 1 million children are eligible but not able to receive services because of funding limitations.  CDA  therefore sponsored AB 834 by Assembly Member Mary Hayashi (D-Hayward), which among other things would have changed the $10 per child reimbursement cap to a per-child minimum, encouraged the billing of government programs thereby accessing federal  matching funds, and created a state advisory committee to provide ongoing program guidance.  These changes would allow more children to be served and significantly more dental sealants to be provided to those children.  At the same time, CDA has been advocating increased state funding for the program, but in a difficult budget year no new appropriations were included in the final 2007-08 budget.  AB 834 was passed by the Assembly and Senate with unanimous votes, but was vetoed by the governor on October 10th.  In his veto message, the governor expressed concern about the bill’s potential fiscal impact during a difficult budget year.  However, he also directed the Department of Public Health to look for ways to improve the CDDP program administratively, and CDA has begun discussions with the department towards that end.    

Dental Practice Ownership Transition:  California’s Dental Practice Act specifies that only a licensed dentist can own and operate a dental practice, including hiring other dentists.  This law is rightly intended to prevent the corporate practice of dentistry, but it has significant, arguably unintended consequences for families and patients when a dentist owner dies unexpectedly and his or her spouse or estate wishes to keep the practice operating while they attempt to sell it permanently.  Because of the current legal restrictions, a non-dentist spouse or estate representative cannot employ dentists temporarily in order to maintain treatment for existing patients, who are thereby forced to seek new dentists for their treatment.  To remedy this unique and temporary situation in a way that encourages continuity of care for patients, CDA this year sponsored SB 387 by Senator Elaine Alquist (D-Santa Clara).  This bill will allow an estate, trustee, or other legal representative to employ or contract with dentists and otherwise operate the practice of a deceased or incapacitated dentist for up to 12 months, while assuring that patients are appropriately notified and assuring that the temporary operator of the practice does not interfere with a contracting dentist’s professional judgment.  As the bill has moved through the legislature, amendments were adopted which will clarify the legal authority for dentists to place their practices into trusteeships as a way to prepare in advance for such an eventuality.  SB 387 was passed by both houses with unanimous votes and was signed by the governor on October 10th. 

Denti-Cal Orthodontic Billing:  California’s Denti-Cal program provides coverage for medically necessary orthodontic services.  Unfortunately, the program currently requires to submit claims based only on monthly patient visits, which is inconsistent with the standard of care.  Orthodontic treatments typically are spread out over many months, sometimes calling for no visits in a given month and other times requiring multiple visits within the same month.  The requirement for monthly claim submittals forces orthodontists to schedule Denti-Cal patients for monthly visits that do not fit within the ideal sequence of treatment, which creates a significant disincentive for orthodontists to participate as Denti-Cal providers.  CDA therefore sponsored AB 383 by Assembly Member Van Tran (R-Costa Mesa), which will allow orthodontists to be reimbursed on a quarterly basis.  This will give participating orthodontists the ability to “bundle” a series of treatment visits into a single quarterly claim submittal, which will enable them to schedule their patients’ treatment visits on a schedule fully consistent with the standard of care.  AB 383 passed both houses with unanimous votes, and was signed by the governor on October 11th. 

General Anesthesia Permits for MDs:  Current law requires dentists who wish to administer or order the administration of general anesthesia to obtain a permit from the Dental Board.  The law does, however, also allow MD anesthesiologists (MDAs) to obtain general anesthesia permits from the board, which allows them to provide anesthesia services for dentists who do not themselves have permits.  To date, approximately 80 MDAs have current general anesthesia permits, and are able to provide much-needed services for patients who need dental treatment under anesthesia.  This law, first enacted in 1997, had been extended via legislation three times, but would have “sunset” again on January 1, 2008, unless new legislation was enacted.  CDA therefore sponsored SB 620 by Senator Lou Correa (D-Santa Ana), which will make the MD anesthesiologist law permanent by deleting the sunset date entirely.  CDA believes that this law has proven to work well over the past 10 years and should become permanent.  In addition to sponsoring the legislation, CDA is aware that many of the MDAs have not received their required, periodic evaluation, which is required by law.  CDA, CalAOMS, and the California Society of Anesthesiologists are working closely with the dental board to ensure that evaluators are identified and trained and that the MDAs complete their evaluations in a timely fashion.  SB 620 was passed by both houses with unanimous votes and was signed by the governor on September 11th. 

Federally Qualified Health Centers – Billing for Hygiene Services:  Current law requires federally qualified health centers (FQHCs) and rural health centers to bill Medi-Cal for services provided on a per-visit basis, but they can only bill for services provided by a specific list of designated providers.  That list currently does not include registered dental hygienists, which means that the facility can only bill for services when a dentist is directly involved in the visit.  CDA believes that this policy limits access to services and is needlessly restrictive and inconsistent with dental hygienists’ ability to provide services in private offices under a dentist’s general supervision.  This year CDA co-sponsored, with the California Primary Care Association and the California Dental Hygienists’ Association, SB 238 by Senator Sam Aanestad (R-Grass Valley), which will allow an FQHC or rural health center to count treatment by a dental hygienist as a “visit” for purposes of determining the facility’s reimbursement level.  SB 238 was passed easily by both houses and was signed by the governor on October 13th. 

 

Dental Assisting Licensure – Specialty Categories:  In 2004, SB 1546 (Figueroa) was enacted, which after extensive discussions between CDA, the Dental Board, and the dental assisting community, created three new “specialty” dental assisting categories (registered restorative assistant, registered orthodontic assistant, and registered surgery assistant).  Subsequent legislation in 2006, SB 1541 (Figueroa), clarified the authority for dentists to train specialty assistants through a work experience pathway.  Current law would make the new specialty categories become effective January 1, 2008; however, due to the many regulatory and educational challenges involved in developing training programs and curricula for these new positions, this year all interested parties agreed that more time was needed before the new positions could be implemented.  SB 1048, a Senate Business, Professions, and Economic Development Committee “omnibus” health professions bill, was amended in June to, among other things, extend the effective date of the new specialty assistant categories until January 1, 2010.   SB 1048 was passed by both houses and was signed by the governor in October. 

Health Care Reform:  This year, statewide health care reform has reached the “front burner” for consideration by the governor and the Legislature.  In January, Governor Schwarzenegger released a sweeping proposal (never introduced as legislation) that encompassed a mandate that employers purchase health insurance for their employees or pay a 4 percent payroll tax to fund a state purchasing pool, a requirement that all individuals obtain at least a minimal level of coverage, Medi-Cal provider rate increases offset by a hospital and physician “fee,” and many other elements.  Assembly Speaker Fabian Nunez and Senate President Pro Tem Don Perata subsequently introduced a jointly authored bill, AB 8, which had many similarities to the governor’s proposal but did not require all individuals to purchase health coverage and relied on a 7.5 percent payroll tax to fund expanded coverage for employees.  Both the Assembly and Senate Republican caucuses introduced packages of reform bills (none of which have been successful in the legislature) which emphasized tax incentives to obtain or provide health coverage, rather than mandates on employers or individuals.  In addition, Senator Sheila Kuehl reintroduced legislation to create a government-run, “single-payer” health care system, which is the only proposal thus far that would specifically include dental care as a covered benefit.  Both the governor’s plan and AB 8 (Nunez/Perata) would make dental benefits available as an option through the purchasing pool.  Although both proposals were modified several times during the year, significant differences remained, and the governor vetoed AB 8 in October, before calling for a special legislative session on health care reform that has yet to achieve results.  In anticipation of this issue, the 2006 CDA House of Delegates adopted a policy statement on expanding access to oral health care coverage, which emphasizes the importance of maintaining the viability of the dentist-patient relationship and the ability of the dentist to determine appropriate care while receiving reasonable reimbursement for the costs of providing that care.  CDA continues to be an active participant in all discussions as this issue unfolds over the remainder of the year.