Legislative victory: Dental Plan Transparency Act passes

Gov. Brown also signs bill that adds training requirements for pediatric dental sedation

CDA’s sponsored legislation calling for more value and transparency from dental plans passed the California Legislature with bipartisan support and was signed by Gov. Jerry Brown on Sept. 29. CDA and the author of SB 1008, Sen. Nancy Skinner (D-Berkeley), worked closely with stakeholders to ensure the best outcome for CDA members and consumers in California — increased transparency, accountability and value from dental benefit plans.

“Signing this bill into law is an unqualified victory for dental plan patients in California. Patients deserve to have clear, understandable information about their dental plans,” said CDA President Natasha Lee, DDS. “As providers, we all too often see patients in our offices struggle to understand what procedures are and are not covered. We aim to stop that and ensure patients get the care they need with SB 1008.”

Dr. Lee continued: “I want to thank Gov. Brown for signing SB 1008 and state Sen. Skinner for working with her colleagues to pass this important reform.”

SB 1008 builds off CDA-sponsored legislation that passed in 2014, AB 1962 (Skinner), which created a mandate for dental plans to annually disclose to state regulators and the public their “loss ratio,” or how much of premium dollars are spent on patient care. Three years of reporting shows a wide variation in dental loss ratios (DLR) by product type and market, with some plans falling as low as 4 percent. This variation raises significant questions about the consistency and value of many dental plans. The plan-reported data validates the concern that too much of dental plan premiums are spent on administrative overhead costs and not enough are spent on patient care.

The lack of standardization among dental plans and a regulatory “Wild West” lead to questionable plan value and consumer frustration when needed services are not covered. To help combat this, SB 1008 will require all dental plans to use a uniform matrix to disclose their benefits, similar to the matrix used by medical plans. The matrix will provide plan beneficiaries with a uniform summary of benefits and coverage template to include plan details, including: deductible; annual benefit limit; coverage of the following categories: preventive and diagnostic services, basic and major services, and orthodontia; reimbursement levels and estimated enrollee cost share; waiting periods; and examples to illustrate coverage of commonly used benefits. The uniform matrix will be designed through a stakeholder process to be available starting in 2021 or 12 months after regulations are adopted.

Sen. Skinner said, “No one should have to drill into 80 pages of legalese to understand their dental plan. SB 1008 requires dental insurers to provide details on what their plans cover in a simple, easy to understand format, so consumers understand what services are covered and what services they may have to pay for out of pocket.” 

SB 1008 will help level the playing field for consumers and providers by holding plans accountable to comparable disclosure standards as medical plans. While amendments were taken along the way, CDA is pleased that the new law continues the association’s efforts to increase dental plan transparency and accountability.

SB 501 passes, adds training, monitoring requirements for pediatric dental sedation

Gov. Brown also signed into law SB 501, authored by Sen. Steve Glazer (D-Orinda), which updates the regulatory structure for pediatric dental sedation and ensures that children have access to safe, effective pediatric sedation services when needed.

SB 501 reflects three years of work, starting with a 2016 report from the Dental Board of California that studied recent pediatric deaths and made recommendations to improve safety. SB 501 updates definitions for levels of sedation to reflect those recognized by the American Dental Association, acknowledging that level of sedation is independent from route of administration.

Developed through substantial stakeholder involvement, SB 501 provides for additional training and monitoring requirements targeted to ensure that during the provision of pediatric dental sedation, the right people are in the room with the training and ability to respond quickly and expertly to emergencies should they arise.

Gov. Brown vetoes SDF legislation

Lastly, another CDA-sponsored bill, SB 1148 authored by Sen. Richard Pan, MD, (D-Sacramento) was vetoed. This bill would have made silver diamine fluoride a covered benefit in the Medi-Cal dental program for young children, the developmentally delayed, and adults residing in living facilities. Gov. Brown issued a message on this bill saying that because it would have required new ongoing state funding, he believes it should be considered as part of the budget.

CDA will update members about the provisions of SB 1008, including the new uniform matrix to be used by dental plans, once they are developed.

Related Items

A CDA-sponsored bill requiring standardized disclosures from dental plans is headed to the governor’s desk as a new journal paper highlights the need to establish greater transparency from dental plans to protect consumers. The paper, based on a CDA-commissioned report, makes the case for a minimum dental loss ratio. Currently, no minimum standard exists for dental plans to spend a certain percentage of patient premiums directly on patient care.

CDA last week became aware of a bill that seeks to regulate and cap provider rates to a percentage of Medicare. Assembly Bill 3087 raises significant concerns about fracturing the market and undermining the ability of providers to balance their patient mix. CDA joins a number of other major provider groups representing a wide range of California health care professionals in voicing deep concerns about AB 3087 and issued a statement from CDA President Natasha Lee, DDS.

Of the three bills introduced in the Legislature early this year to improve safety in pediatric dental anesthesia, only Senate Bill 501 (Glazer, D-Orinda), which CDA supports, will advance in the current legislative session. The Assembly Business and Professions Committee on July 11 passed SB 501 on a bipartisan, unanimous vote.