The COVID-19 pandemic has highlighted the ability of medical and dental plans to make record profits during a public health emergency by collecting premiums while paying fewer claims as patients receive less care. This year CDA supported SB 242 by Senator Josh Newman (D-Fullerton), which requires insurance plans to reimburse health care providers for increased costs of critical personal protective equipment (PPE) during future public health emergencies. Like many other professions and industries, the practice of dentistry was hit hard by the COVID-19 pandemic. Since the onset of the pandemic, costs of PPE 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-$25 per patient for medically necessary PPE, adding up to thousands of dollars of extra costs every month.
With the increased economic burden of safely operating during a pandemic, there is a risk of patients losing access to care and a constriction of the dental network in our state. While we continue to work through the ongoing complications and challenges of the COVID-19 crisis, we also need to ensure a regulatory structure that can respond to future public health emergencies. By requiring insurance plans to provide financial assistance for PPE during future public health emergencies, SB 242 will help ensure that provider networks remain intact and prevent future disruptions in access to care. SB 242 passed out of the legislature and was signed by Gov. Newsom.
Similarly, CDA co-sponsored AB 454 by Assemblymember Freddie Rodriguez (D-Pomona), which, in the event of a future catastrophic public health emergency, would give authority to the Department of Managed Health Care and the California Department of Insurance to require medical and dental plans to support providers through various means such as grants, increased rates or payments for increased costs of mandatory infection control measures. AB 454 was held in the Assembly Appropriations Committee and can be taken up again next year.
Using the state’s record revenues and federal stimulus funding, the 2021-2022 state budget makes significant commitments to improving oral health across the state. CDA advocated strongly for the following investments by the state which:
CDA sponsored AB 526 by Assemblymember Jim Wood, DDS, (D-Santa Rosa), which amends the Dental Practice Act to allow dentists to administer COVID-19 and flu vaccines. This bill codified the existing Department of Consumer Affairs waiver that allows dentists to administer COVID-19 vaccines during the current public health emergency. Specifically, AB 526 allows a dentist to independently prescribe and administer influenza and COVID-19 vaccines authorized by the FDA in compliance with federal vaccination schedule guidelines.
Additionally, AB 526 aligns the California Department of Public Health regulations with federal law so dentists can obtain the appropriate state licensure alongside their Clinical Laboratory Improvement Amendments certificate, which allows them to conduct COVID-19 rapid tests to screen their patients and dental team members when such tests become appropriate for use in the dental office.
AB 526 passed unanimously out of the legislature and was signed by Gov. Newsom. Because AB 526 contained an urgency clause, it went into effect as soon as it was signed, allowing dentists to administer both flu and COVID-19 vaccines as well as apply for lab testing licensure in order to conduct COVID-19 rapid tests in-office for patients and dental team members, as early as Oct. 9, 2021. In order to help dentists begin offering vaccines and rapid tests in office, CDA has developed vaccine confidence and lab testing toolkits.
Youth vaping in California and throughout the United States has become an epidemic. According to the CDC, vaping amongst high school students has increased rapidly, even as smoking combustible tobacco products has decreased. In 2020, about 1 of every 5 high school students reported that they used electronic cigarettes in the past 30 days. Proposition 56, co-sponsored by CDA and approved by the voters in 2016, established a tax of $2.87 on a pack of cigarettes but left a loophole where e-cigarette products are taxed at a much lower rate than traditional combustible tobacco. This year CDA supported SB 395 by Senator Anna Caballero (D-Salinas), which closes that loophole and increases access to care at the same time. Revenue generated from the tax will be divided among several accounts, with 48% of the total revenue dedicated to the CalHealthCares Student Loan Repayment Program for physicians and dentists. This is the first ongoing, dedicated funding for the program, which was initially funded by one-time Prop. 56 funds. The rest of SB 395’s annual revenue will be used for tobacco control and education, First 5 children and youth programs, residency programs in the Central Valley, grants to improve access to health profession programs for underrepresented students and rural hospital relief. SB 395 passed out of the legislature and was signed by Gov. Newsom. The increased tax on vaping products will go into effect on July 1, 2022.
The Medical Injury Compensation Reform Act allows injured patients to receive unlimited economic damages for all past and future medical costs, lost wages and lifetime earning potential. MICRA also allows up to $250,000 in noneconomic damages and includes a limit on attorneys’ fees, stabilizes liability costs and reduces incentives for frivolous lawsuits against health care providers. A group of trial lawyers have qualified a ballot measure for the November 2022 election that would essentially eliminate MICRA’s protections. This measure would undeniably raise health care costs and reduce access to care for those who need it most, including people who use Medi-Cal, county health programs, safety-net providers and school-based health centers. CDA is part of Californians to Protect Patients and Contain Health Care Costs, a broad coalition including physicians, nurses, hospitals, safety-net clinics and other health care providers committed to fighting this initiative.
CDA and the California Dental Hygienists Association are co-sponsoring a collaborative effort to help improve access to care for Medi-Cal dental beneficiaries without a dental home. AB 733 by Assemblymember David Chiu (D-San Francisco) seeks to expand access to oral health care for Medi-Cal-enrolled children and pregnant people by allowing RDHAPs to partner with physicians in medical settings to provide fluoride treatments and oral health education and to coordinate care with dental providers and the dental care system. CDA and CDHA are working with stakeholders including the California Society of Pediatric Dentists, CMA, Children Now and the American Academy of Pediatrics-California on this collaborative effort to expand access to care and improve medical-dental integration. AB 733 is a two-year bill as CDA continues to work with stakeholders.
Sugar-sweetened beverages are the single largest source of added sugar in the American diet. They are also a significant driver of various health conditions including tooth decay, which affects more than two-thirds of California children (making dental caries the most common chronic childhood disease). CDA and a coalition of more than a dozen leading health care organizations are pursuing legislation, AB 1163 by Assemblymember Adrin Nazarian (D-North Hollywood), to return power to local cities and counties, allowing them to pass local sugary drink excise taxes if they are appropriate for their communities. When the legislature passed a statewide preemption on these local taxes in 2018, the state eliminated a popular and helpful tool that municipalities could use to raise additional revenue and improve public health — dual policy objectives especially important in the wake of the COVID-19 pandemic. AB 1163 did not receive a hearing this year and may be reconsidered in 2022.
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 new direct-to-consumer (DTC) 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.
Over the past several years, CDA has worked to improve transparency of dental benefit plans for dentists and consumers. AB 1962 (2014) required commercial dental plans to annually disclose to the state how much premium revenue they spend on patient care versus administrative costs, known as a dental loss ratio (DLR). The reported data show a wide range of premium revenue spent on patient care, with a quarter of all California dental plans spending less than 50% of premiums on care and some plans even falling below 10%. SB 1008 (2018) built upon this by requiring all dental plans to use a uniform matrix to disclose their benefits directly to consumers, similar to the one used by medical plans. This provides plan beneficiaries with a uniform summary of plan details, including covered services, reimbursement levels, estimated enrollee cost share, limitations and exceptions. In 2019, CDA successfully sponsored AB 954 (Wood, D-Santa Rosa), which requires dental benefit plans to be more transparent about the common practice of “leasing” access to a network of contracted dentists from another dental benefit plan to provide clarity for patients and providers, reduce confusion and help preserve trust in the dentist-patient relationship. These transparency measures help level the playing field for consumers and providers, are consistent with standards that apply to medical plans and help hold dental plans accountable for how they spend premium dollars.
Updated October 2021
Public Affairs Specialist