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Even prior to the COVID-19 pandemic, dental practices in California were struggling with staff shortages, specifically a lack of dental assistants. First-year enrollment in dental assistant programs has declined 50% over the last 10 years. In recent months, the need to recruit dental staff has become even more prevalent as practices recover from the pandemic. Dental practices are stabilizing and have been able to rehire most team members, but staffing remains well below demand. Recent survey data shows that nearly 90% of practices have greater challenges in recruiting and hiring dental assistants than before the pandemic, and 44% of practices report that those challenges are limiting their ability to see more patients.
CDA is pursuing both immediate and long-term solutions through recruitment and training programs, state budget funding and legislation to improve dental career pipeline opportunities:
Recognizing the state’s significant budget surplus, this year CDA requested one-time funding for two strategic investments in dental workforce and infrastructure to increase access to care for underserved, rural and vulnerable populations. We are very pleased that Gov. Newsom and the Legislature included both requests in the final 2022-23 budget:
More than half of children and a third of adults — over 14 million Californians — rely on the state’s Medi-Cal program for their medical and dental coverage. Historically, Medi-Cal patients have faced major barriers to care including long delays for appointments, difficulty finding specialists and traveling long distances to receive care. A primary reason has been a lack of providers who are able to participate in the program due to administrative and enrollment barriers as well as reimbursement rates that were among the lowest in the nation.
Making the Medi-Cal program functional has been a critical priority for CDA. Over the last five years, the Medi-Cal Dental Program has made tremendous progress that the state must continue to build upon. This is a result of (1) improved reimbursement rates following the passage of Proposition 56 (2016), a tobacco-tax increase co-sponsored by CDA; (2) enhanced federal funding through the Medicaid waiver process that is continuing through the CalAIM program; (3) restoration of adult dental benefits the state eliminated during the Great Recession; and (4) improvements to administrative and enrollment barriers for providers. These changes have increased dental-provider enrollment by 25% since 2017.
This year’s budget continues this progress, with Newsom and the legislature committing significant funding toward continued improvements in the Medi-Cal Dental Program. CDA successfully engaged in a number of Medi-Cal-related budget items this year including support for:
More details on how the 2022-23 state budget will impact dentistry can be found here.
California’s health care community, including CDA and The Dentists Insurance Company (TDIC), has reached an agreement that will extend the long-term predictability and sustainability of MICRA, the state’s medical professional liability law. This agreement settles a decades-long divide on the issue and has resulted in the withdrawal of a November 2022 ballot measure that would have dismantled the MICRA law.
The agreement keeps in place MICRA’s essential cost-control guardrails while protecting the rights of injured patients. The MICRA coalition and the ballot measure sponsors jointly supported AB 35 (Reyes) to codify the agreement, and the sponsors have removed the measure from the ballot.
AB 35 includes several provisions that will update MICRA while continuing its medical liability protections. The most central provision changes the cap on noneconomic damages from the current $250,000 to:
More details can be found here.
The use of telehealth has significantly increased since the onset of the COVID-19 pandemic. While telehealth has proven to be an effective model of delivering care, third-party corporate telehealth providers operate in a completely virtual environment and generally have no relationship or interaction with a patient’s in-network provider. Last year, Newsom signed AB 457 (Santiago), which requires health plans and insurers to comply with specified notice and consent requirements if the plan or insurer offers a service via a third-party corporate telehealth provider. However, dental benefit plans were exempt from the requirements of AB 457 despite also steering patients to use third-party corporate telehealth providers. Telehealth is a useful tool in dentistry to triage patients experiencing pain or discomfort, but almost no dental care can be provided remotely. These triage appointments can unknowingly impact a patient’s visit-frequency limitations and annual maximums before the patient even sees a dentist in person for necessary treatment. This year, CDA is sponsoring AB 1982 by Assemblymember Miguel Santiago (D-Los Angeles), which will ensure patients have the ability to make an informed decision about how to access their dental care, as they do for their medical care, by removing the dental exclusion from statute and direct dental benefit plans to provide a disclosure of the impact of third-party telehealth visits on a patient’s benefit limitations. This bill will ensure patients receive quality telehealth services, protect the patient-provider relationship and provide better integration of care. AB 1982 has been signed by Gov. Newsom and will take effect January 1, 2023.
In 2018, AB 2789 (Wood) was signed into law and mandated electronic prescribing for dentists and other prescribers. At the time, CDA advocated for a three-year implementation window to give dentists time to obtain adequate e-prescribing systems and train staff. The mandate went into effect on January 1, 2022. In response to member concerns about the cost of e-prescribing systems, particularly for low volumes of prescriptions, AB 852 (Wood) allows exemptions from the e-prescribing mandate for health care practitioners, including dentists, who are required to issue a prescription electronically. Practitioners are exempted from submitting e-prescriptions if they register with the Board of Pharmacy and certify that they issue 100 or fewer prescriptions per calendar year. While the cost to register with the Board of Pharmacy has yet to be determined, CDA has been assured that the annual registration fee will be much lower than a subscription to e-prescription software.
Additionally, the bill bars a pharmacy or pharmacist from refusing to dispense an e-prescription just because it was not submitted via their preferred or propriety prescribing software, so long as the e-prescription meets certain minimum standards, to increase competition and allow new competitors to make their way into the e-prescribing software market. AB 852 has been signed by Gov. Newsom and the Board of Pharmacy is working on implementation to allow dentists and other prescribers to register for the exemption.
Over the past several years, CDA has worked to improve the transparency and value of dental benefit plans, hold dental plans accountable for how they spend premium dollars and level the playing field for dentists and consumers. Furthermore, the COVID-19 pandemic highlighted the ability of medical and dental plans to make record profits during a public health emergency by collecting the same amount in premiums while paying fewer claims, as patients were receiving care less often. Since the onset of the pandemic, costs of personal protective equipment have skyrocketed and been incredibly unpredictable, issues exacerbated by product scarcity, supply chain disruptions and price gouging. Many providers are still paying in the range of $10 to $25 per patient for medically necessary PPE, adding up to thousands of dollars of extra costs every month. Dental plans did not share in the burden of these costs in any substantial way, worsening the longer-term trend in which payments from plans remain stagnant while the cost of providing care continues to rise. CDA has advocated for a number of bills signed into law in recent years that strengthen transparency and accountability of dental plans.
Providing dental care that involves the movement of teeth without a proper evaluation, including X-rays, can lead to serious patient harm, such as loose or cracked teeth, bleeding tongue and gums, gum recession or a misaligned bite. With the emergence of direct-to-consumer business models offering various dental services that are ordered without an in-person clinical examination, it is imperative that dental treatment continues to meet a uniform standard of care regardless of whether a dentist provides treatment through telehealth or in person. CDA continues to advocate for consumer protections that ensure that DTC orthodontic business models have the same level of dentist oversight and patient safety as the virtual dental home model and in-person dental care. CDA will continue to work with the appropriate enforcement entities, including the dental board, to push for increased patient safety while pursuing improved statutory and regulatory enforcement.
Updated October 2022