CDA Major Issues & Priorities

1. SB 1369: Predatory Dental Insurance Fees (CDA-Sponsored)

CDA is sponsoring legislation to curtail the usage of virtual credit cards (VCCs) as a method of payment used by dental insurance companies. Dental plans are more frequently using third party companies to issue payments to dental offices through VCCs, which take a processing fee of 2-5%, plus the merchant transaction fee through their credit card terminal. These predatory fees can take up to 10% off the top of the payment owed by the plan.

VCC payments in many cases become the default payment method. While dental practices can opt out of VCC services, the opt-out process is often difficult and not always permanent. VCC companies are known to reinstitute the payment method with its excessive fees after the provider opts out, even as soon as the very next payment. Furthermore, requesting an alternative payment method can delay receipt of that payment, waste administrative staff time and create challenges for office accounting.

Ultimately, this trend takes health care dollars away from patient care. SB 1369 by Sen. Monique Limon (D-Santa Barbara) will address this issue by:

• • Requiring that the default payment method must be one that does not include a fee. If a provider would like to use VCCs as their primary payment method, they may do so, but only by written authorization – and they may opt out of VCCs again at any time.
  • Requiring plans to provide notice of any fees associated with a particular payment method and advise dentists of alternative methods of payment along with clear instructions as to how to select an alternative method of payment.
  • Requiring dental plans to provide notification of any profit-sharing or fee arrangement with the VCC company.

As dental patients continue to seek care deferred during the COVID-19 pandemic, timely access to care is imperative as ever. The fees associated with virtual credit cards can cause a significant increase in dental office overhead costs, leading to reduced office hours, limited patient scheduling and delayed care. It is essential to reduce predatory practices of dental plans and VCC companies to maximize the health care dollars going to patient care. SB 1369 passed both houses of the legislature without any “no” votes and is now on Gov. Gavin Newsom’s desk.

2. Yes on Proposition 35 – November 2024 Ballot

CDA and the Coalition to Protect Access to Care are sponsoring Prop. 35, a measure on the November 2024 ballot that will protect and increase funding for health care, including Medi-Cal Dental services, dental student loan repayments, health care workforce development and many other programs.

Medi-Cal currently provides medical and dental coverage to 15 million low-income Californians (1/3 of all residents and half of all children), making it the largest provider of medical and dental insurance in the state. The program continues to grow and needs long-term permanent funding solutions, after decades of underfunding.

The ballot measure is an important opportunity to build on Medi-Cal’s recent progress and ensure health care dollars stay in the health care system. The restoration of Medi-Cal dental benefits that had been eliminated during the Great Recession, substantially improved reimbursement rates (40% increases or more across most covered dental services) and other major programmatic changes have led to meaningful and sustained results in the Medi-Cal Dental program. In the past seven years, the state has seen nearly a 30% increase in Medi-Cal Dental providers, a rate that is consistently increasing each year, as well as a doubling of patient utilization of Medi-Cal Dental services since the Great Recession.

Prop. 35 would provide an ongoing funding source by permanently extending the state’s existing “managed care organization” (MCO) tax on health insurance companies. The revenue would be dedicated to Medi-Cal and specific health programs (as opposed to the state’s general fund like previous MCO taxes) and Medi-Cal dental services would be among the programs receiving funds starting in 2027. Prop. 35 would also secure new funding for CalHealthCares, the state’s student loan repayment program for dentists and physicians. Furthermore, the measure will prevent the state from redirecting these revenues for non-health care purposes.

3. Dental Staffing Shortages/Dental Board Sunset Review

Approximately every four years the California Dental Board, like other regulatory boards, undergoes a standard evaluation by the state legislature, called sunset review, of roles and responsibilities of the board and the laws it enforces. CDA successfully advocated for inclusion of the following issues in this year’s sunset review legislation, SB 1453 by Sen. Angelique Ashby (D-Sacramento):

Dental Assistant Licensure Pathways: CDA has been seeking new pathways to become a registered dental assistant (RDA) to help address the critical shortage of dental staff. SB 1453 will:

• • Streamline and shorten the existing 15 months of on-the-job training to 800 supervised preceptorship hours, inclusive of educational and clinical experience. 800 hours is the current standard in RDA educational programs, so this will create parity between the two options.
  • Allow individuals who move to California and hold a certified dental assistant certificate from the Dental Assisting National Board (DANB) to apply for RDA licensure if they meet certain criteria.

Pediatric Sedation Permits: A law that took effect in 2022 (SB 501, Glazer) unintentionally made pediatric dentists ineligible to obtain adult minimal sedation permits required to treat patients aged 13 and older. In coordination with the California Society of Pediatric Dentists, CDA pushed for a technical fix to allow pediatric dentists to be eligible for both pediatric and adult minimal sedation permits.

Continuing Education: Specified mental health courses would now qualify as core CE for dentists, to help address well-being and burn out.

Licensure: Simplifies the path for out-of-state public health dentists practicing non-clinically to receive a California license through licensure by credential.

Scope of Practice: The duty statements for all dental assisting licensure categories will be modernized to account for improvements in technology. Additionally, the following duties have been expanded:

• • Unlicensed dental assistants will be able to perform coronal polishing under direct supervision after successfully completing a board-approved course; and
  • RDAs will be able to attach buttons and add/remove orthodontic bands under direct supervision.

Orthodontic Assistant Permit Changes: In partnership with the California Orthodontic Association, CDA advocated for the following changes and expansions to the orthodontic assistant permit (OAP):

• • OAP applications will no longer have work experience requirements to begin an OAP course or take the OAP exam (previously 6 and 12 months, respectively);
  • OAP permitholders will be able to prepare teeth for provisional and bonded attachments, buttons, connections, brackets, and appliances under direct supervision; and
  • OAP permitholders will also able to remove brackets and attachments under direct supervision.

SD 1453 is now on Governor Newsom’s desk awaiting a signature.

4. State Budget: Specialty Dental Clinic Grant Program

CDA successfully worked with lawmakers to maintain funding in the 2024-25 state budget for the Specialty Dental Clinic Grant program, which will fund the construction and expansion of dental facilities for patients with special health care needs and disabilities. In 2022, CDA and a broad coalition of disability, consumer and provider groups advocated for $50 million in-one time funding to establish the program, which would fund the construction of at least 10 new dental clinics. The intent of the program is to increase capacity and access to care for those who cannot receive care in traditional dental settings. Current capacity is limited and often centralized in urban areas, so patients and their families are often forced to wait, sometimes up to two years, and travel long distances to receive basic oral health care.

The grant application process for the program, overseen by the California Health Facilities Financing Authority (CHFFA), closed on April 1, 2024, with CHFFA receiving 101 applications totaling $270 million in proposed projects, far beyond the $50 million allocated. CDA greatly appreciates that lawmakers preserved this urgently needed funding while facing a substantial budget deficit. This program will help transform dental care for patients with special needs, and the funding process can now continue for the many shovel-ready projects that are pending.

5. AB 2701: Medi-Cal Coverage for Adult Dental Cleanings (CDA-Sponsored)

Current Medi-Cal Dental benefits cover two cleanings and exams per year for those up to age 21. However, once an individual is age 21+, Medi-Cal only covers one cleaning and exam per year. The standard of care for most people is two dental cleanings and exams per year to prevent long-term dental disease, while some high-risk adults may need up to four cleanings annually. Unfortunately, prevalence of dental disease and tooth loss is disproportionately high among individuals who have lower incomes. Individuals eligible for Medi-Cal are likely to be most in need of additional preventive visits and the most harmed by only receiving one cleaning per year.

CDA AB 2701 by Asm. Carlos Villapudua (D-Stockton) this year, which would expand California’s Medi-Cal Dental benefits to include a second cleaning and exam for adults aged 21+ when medically necessary. Over half of all states cover two adult cleaning and prevention visits a year, while California does not currently offer this basic preventive benefit. AB 2701 passed in the Assembly without any “no” votes, however, it was held in the Senate Appropriations Committee due to state budget limitations. The bill highlighted an important gap that remains in Medi-Cal Dental coverage and CDA will continue pursuing dental benefit improvements as state budget conditions allow.

6. SB 1290/AB 2914: Adult Dental Care – Essential Health Benefits (Support if Amended)

The Biden Administration released a final rule in early April that gives states the option of adding adult dental care as an essential health benefit (EHB). Addition of adult dental services as an EHB would be a monumental step in recognizing dental care as critical for overall health and would set a minimum standard benefit for dental plans, in addition to bringing dental care to adults in California who still lack coverage.

EHBs are ten categories of services that health plans are required to cover per the Affordable Care Act, including pediatric dental care. Each state selects a health care plan as the “benchmark” that identifies the minimum coverage that health plans must offer in the state, which may go beyond the federal EHBs. The new federal rule means that California has the option to require health plans offered in the individual and small group markets to provide adult dental services.

California cannot change or select a new EHB benchmark plan without legislation. SB 1290 (Roth) and AB 2914 (Bonta) were introduced this year to set a new EHB benchmark for California. The state intends to update the EHB benchmark plan in the near future, however the legislature is waiting on an analysis of the cost to add potentially several services to the benchmark, including hearing aids, fertility treatments and adult dental care. CDA will continue advocating for adult dental care to be included.