There is an ongoing trend within health care toward integration and consolidation of health care delivery systems. This trend is reflected in provisions of the federal Affordable Care Act, such as the envisioned coordination of care provided under a single entity, the "Accountable Care Organization." The objective of such integration and consolidation is to provide better management of care, create greater efficiencies in the provision of care and improve patient outcomes.

CDA Practice Support occasionally hears a complaint from dental offices that a plan granted a preauthorization for treatment and then denied payment when the claim was submitted. Digging a little deeper into these complaints, there may be some confusion between what constitutes a “preauthorization” and what is a “predetermination” or pre-estimate of benefits.

Beginning in the New Year, and with the forthcoming issue of the CDA Update, the dental benefits column will host a semiregular series discussing basic dental benefit issues. The topics covered address questions that CDA Practice Support receives from dental offices and from local dental components. This first installment addresses proper billing for treatment provided by an associate and waiving of co-payments.

The 2018-19 state budget signed by Gov. Jerry Brown dedicates $210 million from the Proposition 56 Tobacco Tax revenue to Denti-Cal providers, a $70 million increase from last year’s amount. This effort is the result of years of activity to improve the Medi-Cal dental program and increase access to oral health care for the state’s 13.5 million Medi-Cal enrollees.

Every employee’s employment life cycle ends eventually, whether due to resignation, retirement, termination or other reason. In the dental office, any employee who separates should do so in a structured and professional manner with minimum disruption to the patients, staff and practice. Still, depending on what triggers an employee’s departure, separation can be an awkward situation for employers to navigate. Such discomfort can be lessened if clear policies and practices are in place.

In a final rule issued by the Food and Drug Administration, 24 active ingredients used in nonprescription antiseptic products are “not generally recognized as safe and effective” (GRAS/GRAE) for use by health care professionals in health care settings or situations “due to insufficient data.” The ban applies to use of these ingredients in over-the-counter antiseptics and takes effect Dec. 20, 2018.

Benco Dental Supply Company, Henry Schein Inc. and Patterson Companies Inc. were named in a complaint filed recently by the Federal Trade Commission. The FTC alleges that the three dental suppliers — the nation’s largest — violated federal antitrust laws by conspiring to refuse to provide discounts to buying groups representing solo and small-group dental practices.

The Department of Justice on April 2 announced that California’s Controlled Substance Utilization Review and Evaluation System, also known as CURES 2.0, is ready for statewide use and that mandatory CURES consultation becomes effective Oct. 2, 2018. Beginning on this date, prescribers must check a patient’s prescription history in CURES 2.0 before prescribing a Schedule II-IV substance, with some exceptions.

Beginning Oct. 2, all licensees authorized to prescribe, order, administer, furnish or dispense controlled substances in California must, with some exceptions, check a patient’s prescription history in CURES 2.0 before prescribing a Schedule II-IV substance, as CDA first reported in April. One notable exemption to mandatory CURES consultation that applies to dental care and that CDA helped secure is summarized here.

More than 7 million adults enrolled in Denti-Cal, California’s Medicaid dental program, will have a fully restored package of dental benefits in 2018. The adult benefit package was drastically cut in 2009 due to the state budget crisis and was partially restored in May 2014. The restoration of the adult dental benefit services is a result of legislative action taken during the 2017-18 budget process.

When performing procedures on exposed dental pulp, water or other methods used for irrigation must be “sterile or contain recognized disinfecting or antibacterial properties,” according to a new requirement that all licensed dentists in California must follow beginning Jan. 1, 2019.

Many bills were introduced over the past year to combat the opioid epidemic in California, as CDA previously reported. Here is an overview of CDA-supported legislation in the areas of e-prescribing, informed consent, interstate data sharing and prescription-pad requirements, that Gov. Jerry Brown signed into law in September and how these bills will affect the practice of dentistry.

No later than Aug. 30, 2018, dental practices that employ 10 or more employees must post at the entrance of the office the new Proposition 65 warning notice, unless the practice chooses instead to provide a warning with an informed consent form. The form must be signed by the patient prior to exposure to the chemicals regulated by Proposition 65.

Beginning Jan. 1, 2018, adults enrolled in the Denti-Cal program are eligible for an expanded set of dental benefits. The Department of Health Care Services on Nov. 9 issued a special provider bulletin to clarify the dental services that providers may render, bill and be reimbursed for by Denti-Cal in 2018, including scaling and root planing, partial dentures and posterior root canals.

On May 24, 2018, the Registered Dental Assistant Written and Registered Dental Assistant Law and Ethics examinations are expected to launch as a single combined exam. The Dental Board of California and the Dental Assisting Council in a December 2016 meeting agreed to take this action to “ensure that the combined examination is legally defensible and meets the requirements of Business and Professions Code Section 139.”

The ordered closure in mid-December of a children’s dental clinic in Southern California reminds dental practices of the importance of cleaning and maintaining dental unit water lines for the safety of patients. CDA urges dentists to ensure they are following the Dental Board of California’s current requirements along with CDC recommendations.