09/18/2015

CDA blocks legislation by insurance plans


In the Legislature's final week of its 2015 session, CDA successfully blocked problematic legislation backed by insurance plans that would have placed an unfair burden on dentists and delayed access to care for patients. AB 533 had a well-intentioned goal of addressing "balance billing" of patients who may receive unexpected billing amounts after receiving care at a facility that is a part of their insurance plan's network but from an out-of-network provider who contracts with the facility.

However, amendments made to the bill in the last week of the legislative session would have limited payments to Medicare rates for out-of-network providers in these cases and required providers to go through a yet-to-be determined dispute resolution process to collect additional payment, unless the patient goes through a three-day waiting period.

The bill would have applied to dentists practicing in hospitals, surgery centers or offices that provide care under general anesthesia, who are often treating vulnerable patients with critical oral health needs. 

While CDA did not have a position on the bill up until that point, the amendments forced CDA to actively oppose it. After an intensive lobbying effort in the Capitol by multiple provider groups and through grassroots contact by CDA members with legislators in the final days of the session, the bill failed to pass in a vote of the full state Assembly, falling three votes short of the majority needed.

"CDA shares the goal of wanting to avoid unexpected bills for patients and is committed to finding a solution, but more time is needed to work on this and it shouldn't be slapped together in the final week of the legislative session," said CDA President Walt Weber, DDS. "We are very pleased that legislators heard us loud and clear."

The provision on Medicare rates raised many questions because the Medicare program does not have reimbursement rates for many of the services provided to patients in these facilities, including preventive care like intraoral films, prophylaxis and dental sealants, restorative treatments such as fillings and root canals, as well as certain periodontal services.

CDA will continue working with stakeholders to develop workable legislation that can be taken up next year. 

Tobacco Fight Continues

Proposals sponsored by CDA and the Save Lives California coalition to raise the state's tobacco tax and reduce tobacco use did not advance at the end of the regular legislative session, but remain pending in the special legislative session on health care, which is ongoing.

The coalition continues to prepare for a ballot measure campaign for the November 2016 election if the Legislature does not act. The ballot measure would increase the state's tobacco tax by $2 per pack, which will help reduce smoking long term and offset billions in health care costs resulting from tobacco use. A recent field poll found that 67 percent of voters are in support of this proposal. 



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