BILL NUMBER: AB 2229	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  MARCH 13, 2008

INTRODUCED BY   Assembly Member Huffman
   (Principal coauthor: Assembly Member Berg)
   (  Coauthor:   Assembly Member 
 Horton   Coauthors:   Assembly Members
  Horton   and Krekorian  )

                        FEBRUARY 20, 2008

   An act to amend Section 14132.88 of the Welfare and Institutions
Code, relating to Medi-Cal.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 2229, as amended, Huffman. Medi-Cal: dental examinations.
   Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services under
which qualified low-income individuals receive health care benefits,
including, to the extent funds are made available in the annual
budget, dental prophylaxis cleanings and initial dental examinations
for beneficiaries 21 years of age or older.
   This bill would provide for one dental examination per year for
Medi-Cal beneficiaries living in long-term care facilities as a
covered Medi-Cal benefit, to the extent funds are made available in
the annual Budget Act.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 14132.88 of the Welfare and Institutions Code
is amended to read:
   14132.88.  (a) Notwithstanding subdivision (h) of Section 14132
and to the extent funds are made available in the annual Budget Act
for this purpose, the following are covered benefits for
beneficiaries 21 years of age or older under this chapter:
   (1) One dental prophylaxis cleaning per year.
   (2) One initial dental examination by a dentist.
   (3) One dental examination per year for beneficiaries living in
long-term care facilities.
   (b) The following are covered benefits for beneficiaries under 21
years of age under this chapter:
   (1) Two dental prophylaxis cleanings per year.
   (2) Two periodic dental examinations per year.
   (c) For persons 21 years of age or older, laboratory-processed
crowns on posterior teeth are not a covered benefit except when a
posterior tooth is necessary as an abutment for any fixed or
removable prosthesis.
   (d) Any prefabricated crown made from ADA-approved materials may
be used on posterior teeth and may be reimbursed as a stainless steel
crown.
   (e) The department shall reduce the rate of subgingival curettage
and root planing by 41 percent for all beneficiaries except those
residing in a skilled nursing facility or an intermediate care
facility for the developmentally disabled. Notwithstanding Section
14105 and Chapter 3.5 (commencing with Section 11340) of Part 1 of
Division 3 of Title 2 of the Government Code, the department may
implement this subdivision by means of a provider bulletin or similar
instruction, without taking regulatory action.
   (f) (1) Except as provided in paragraph (2), the department shall
require pretreatment radiograph documentation on posttreatment claims
to establish the medical necessity for dental restorations. The
pretreatment documentation required under this subdivision is
intended to reduce fraudulent claims for unnecessary dental fillings.
In order to avoid any undue barriers to accessing dental care, the
department shall stipulate that the pretreatment radiograph
documentation for posttreatment claims will be required only when
there are four or more dental fillings being completed in any
12-month period.
   (2) For any beneficiary who is under four years of age, or who,
regardless of age, has a developmental disability, as defined in
subdivision (a) of Section 4512, radiographs or photographs that
indicate decay on any tooth surface shall be considered sufficient
documentation to establish the medical necessity for treatment
provided.
   (3) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall implement this subdivision by means of a provider
bulletin or similar instruction, without taking regulatory action.

   (g) Nothing in this section is intended to place a requirement on
long-term care facilities.