BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 694
AUTHOR: Padilla
AMENDED: January 4, 2012
HEARING DATE: January 11, 2012
CONSULTANT: Moreno
SUBJECT : Dental care.
SUMMARY : Repeals existing law that requires the Department
of Public Health (DPH) to maintain a dental program, and
instead creates a Statewide Office of Oral Health (Office)
within DPH and requires that a licensed dentist serve as
the dental director. Requires the Office to design and
implement a scientifically rigorous study to assess the
safety, quality, cost effectiveness, and patient
satisfaction of irreversible dental procedures performed by
traditional and non-traditional providers, as specified.
Existing law: Requires DPH to maintain a dental program
that includes, but is not limited to, development of
comprehensive dental health plans within the framework of a
specified state plan. Requires a dentist licensed in the
state of California to administer the dental program.
This bill:
1.Repeals existing law that requires DPH to maintain a
dental program, and instead:
a. Establishes the Office within DPH and requires that
a licensed dentist serve as the dental director.
b. Requires the dental director and his/her staff to
advance and protect the oral health of all
Californians, develop a comprehensive and sustainable
state oral health action plan, encourage private and
public collaboration to meet the oral health needs of
Californians, secure funds to support infrastructure
and programs, promote evidence-based approaches to
increase oral health literacy, and establish a system
for surveillance and oral health reporting.
c. Permits the state to accept public and private
funds for the purpose of implementing the Office.
d. Requires the Office to be established only after a
determination has been made by the Department of
Finance (DOF) that federal or private funds in an
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amount sufficient to fully support the activities of
the Office, including staffing of the Office, have
been deposited with the state.
e. Requires the Office, if established, to assume
responsibility for identifying and securing funding
sources to maintain its functions.
f. Becomes inoperative, on January 1, 2016, if the
Office does not secure sustainable funding sources to
maintain its activities.
2.Requires the Office to design and implement a
scientifically rigorous study to assess the safety,
quality, cost effectiveness, and patient satisfaction of
irreversible dental procedures performed by traditional
and non-traditional providers, for the purpose of
informing future decisions about scope of practice
changes in the dental workforce that include irreversible
or surgical procedures.
3.Requires the research parameters of the study to include
public health settings, multiple models of dentist
supervision, multiple pathways of education and training
and multiple dental providers, including dentists and
non-dentists.
4.Requires the dental director to convene an advisory group
on the study design and recommendations, to provide input
regarding the study design and implementation, receive
all study data and reports, and develop a report and
recommendations to the Legislature based on the study
findings.
5.Prohibits any General Fund moneys from being used to
implement the study, and requires funding to be secured
from other public or private sources.
6.Makes the study provisions inoperative, on January 1,
2014, in the event that the study is not sufficiently
funded and commenced by that date.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1.Author's statement. According to the author, this bill is
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intended to help begin to address the dental health
access dilemma in California, especially its impact on
children. Oral health is often taken for granted, but is
in fact a critical component of overall health. According
to the National Maternal and Child Oral Health Resource
Center, poor dental health can disrupt normal childhood
development; seriously damage overall health; and impair
children's ability to learn, concentrate, and perform
well in school. In addition, a New York University study
found that poor dental health is increasingly being
linked to long-term, costly chronic conditions, such as
heart disease, stroke, and Alzheimer's disease. In rare,
but tragic cases, untreated tooth decay can lead to
death. This bill requires a scientifically rigorous
study to assess the safety, quality, cost effectiveness,
and patient satisfaction of irreversible dental
procedures performed by traditional and non-traditional
providers, for the purpose of informing future decisions
about scope of practice changes in the dental workforce
that include irreversible/surgical procedures. The bill
would also establish a state dental director to help
guide policymakers, state departments, local health
jurisdictions, advocacy organizations, professional
associations, funders, educational institutions and
community based programs. With the implementation of
federal Patient Protection and Affordable Care Act (ACA)
looming, the position of the state dental director
becomes even more critical - to direct the state's oral
health plan.
2.Background. Nearly a quarter of California's children
ages 0 to 11 have never been to the dentist despite the
recommendation by the American Academy of Pediatric
Dentistry that children visit the dentist at the time of
first-tooth eruption and no later than one year of age
and that they have a dental check-up every six months
after that. According to Children NOW, common problems
such as tooth decay become debilitating for children when
left untreated because it is progressive and can
undermine long-term health, educational achievements,
self-image, and overall success. For every dollar spent
on preventive oral health care, as much as $50 is saved
on restorative and emergency oral health procedures.
Preventable oral health problems in children are also a
considerable cost to the education system. In California,
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students miss an estimated 874,000 school days annually
due to dental problems. These absences cost local school
districts approximately $28.8 million. California's poor
and low-income children, in particular, lack needed
access to quality oral health care. For example, only 59
percent of children covered by Healthy Families
(California's Children's Health Insurance Program) visit
a dentist each year. African American and Latino
children access dental services less frequently than
white children, and in 13 of California's 58 counties, no
dentists accept Medi-Cal affecting access for low-income
children.
3.The ACA. On March 23, 2010, President Obama signed the
ACA, Public Law (P. L.) 111-148, as amended by the Health
Care and Education Reconciliation Act of 2010, P. L.
111-152. It is estimated that 4.7 million California
children and adults who were uninsured during some part
of 2009 will be eligible for health coverage under the
ACA. Among its many provisions, the ACA:
a. Requires that insurance plans offered under the
Exchange include oral care for children,
b. Expands school-based sealant programs,
c. Authorizes $30 million for fiscal year 2010 to
train oral health workforce,
d. Establishes five-year, $4 million demonstration
projects to test alternative dental health care
providers,
e. Establishes a public health workforce track,
including funding for scholarships and loan
repayment programs for dental students and grants to
dental schools,
f. Establishes three-year, $500,000 grants to
establish new primary care residency programs,
including dental programs, and
g. Provides funding for new and expanded graduate
medical education, including dental education.
4.Dental workforce capacity. At a March 2011 oversight
hearing of the Senate Committee on Business, Professions
and Economic Development related to the Dental Board of
California, concerns were raised about whether California
will be able to meet the increased demand for dental
services with the enactment of the ACA. Background
information provided to the members included a June 2009
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Health Policy Fact Sheet by the University of California,
Los Angeles Center for Health Policy Research, which
indicated that California has about 14 percent of the
total number of dentists nationwide (the largest
percentage among all states). The dentist-to-population
ratio in California is estimated to be 3.5 dentists per
5,000 or a dentist for every 1,440 persons. This ratio
is higher than the national estimate of three dentists
per 5,000 or a dentist for every 1,660 persons. However,
the Health Policy Fact Sheet revealed that although there
is a large number of practicing dentists in California,
many areas in the state continue to have a shortage of
dentists, and these areas are mostly located in rural
areas, including Yuba, Alpine, Colusa, Mariposa, Mono and
San Benito counties. Additionally, according to the
United States Health and Human Services Agency, there are
333 dental health professional shortage areas statewide.
These areas generally have a dentist-to-population ratio
of one per 5,000 or lower, a high population need with a
ratio of at least 1.25 dentists per 5,000 (or 1 per
4,000), and a public or non-profit health center that
provides dental services to shortage areas or
populations. Additionally, the Health Policy Fact Sheet
indicated that the percentage of dentists who may be
nearing retirement age is greater than the percentage of
newly licensed dentists. In some counties, far fewer are
newly licensed and many more are nearing retirement age.
The background paper for the hearing indicated that these
shortages could potentially impact the implementation of
the ACA.
5.DPH Oral Health Unit. According to information provided
by DPH, loss of funding during the past 10 years has
forced DPH to significantly cut back the functions of the
Oral Health Unit (OHU, formerly the Office of Oral
Health). Until 1995, there was a dentist leading the
OHU. In 2000, OHU entered into a contract with the
University of California, San Francisco to employ a
dentist for the Community Water Fluoridation program to
provide training and technical assistance to communities.
The dentist provided content expertise on other areas of
oral health as well. Due to funding reductions from the
Preventive Health & Health Services Block Grant (PHHSBG),
which funded the Community Water Fluoridation Program,
the position for the dentist was terminated in September
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2011. OHU has been researching possible funding
opportunities to restore partially or fully the
California Children's Dental Disease Prevention Program,
which had been a cost-effective children's dental program
prior to the loss of funding in 2009. OHU has maintained
a Community Water Fluoridation Program which has been
funded through the PHHSBG.
6.Double referral. This bill is double referred. Should
it pass out of Senate Business, Professions and Economic
Development Committee, it will be referred to this
committee.
7.Support. Worksite Wellness LA, California Coverage and
Health Initiatives, and the Venice Family Clinic state
that tooth decay is the most common chronic disease and
unmet health care need of children in California. In
fact, 71 percent of California's children experience
tooth decay by the time they reach the third grade. The
California Dental Association writes that with full
implementation of ACA, 1.2 million additional children in
California are expected to gain dental coverage, yet oral
health programs in California have been decimated in
recent years. According to The Children's Partnership,
addressing the dental access problem requires a
comprehensive approach. An essential element of that
approach is to test different workforce models that
include providers whose scope of practice is narrower
than that of dentists but who can effectively deliver
urgently needed, high-quality preventive and routine
restorative dental care in places where children who
would otherwise go without dental care are located.
Western Dental Services states that the goals of this
bill will help to provide more focus and leadership in
the delivery of dental care in California.
8.Concerns. The California Dental Hygienists Association
writes that while they support the efforts of the bill in
concept, they state the following concerns:
a. The director position is restricted to a
dentist, and a candidate with a Masters in dental
hygiene and public health would be just as qualified
for the position.
b. There is no requirement that the dental
director include concerns or advice of the workforce
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study advisory group when composing the required
report and recommendations.
c. The legislation is limited to underserved
children, and it would be a misstep to create an
office with such a limited focus
d. Specified sections related to an integrated
system of dental care should refer more specifically
to "licensed dental professionals."
9.Policy concern. This bill repeals existing law that
establishes an oral health program within DPH
indefinitely and replaces it with language establishing a
similar program, but makes it inoperative in 2016 if
funding is not secured. While the role of the existing
OHU has been significantly pared back over the past
several years, the office still has some function. Under
this bill, if funding is not secured, the state's statute
will not include either requirement for the existing OHU
or for the Office proposed under this bill.
10.Amendments. The author intends to amend the bill as
follows:
a. On page 2, line 13: delete "absences" and
insert "problems"
b. On page 3, line 36: delete "responsible" and
insert "responsibility"
c. On page 3, lines 38 through 40: strike "If the
department of Finance makes a determination that the
amount of federal or private funds deposited with
the state is not sufficient to support the
activities of the office, it is the intent of the
Legislature that this section become inoperative"
and insert "There shall be no General Fund moneys
used to fund this section. Moneys to fund the office
of oral health shall be secured from other public or
private sources. If the department of Finance makes
a determination that the amount of federal or
private funds deposited with the state is not
sufficient to support the activities of the office,
it is the intent of the Legislature that this
section become inoperative."
d. On page 3, after line 40: insert "(f)(3) This
section shall become inoperative on January 1,
2016."
e. On page 4, line 8: delete "The office shall
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design and implement" and insert "The Legislature
authorizes a"
f. On page 4, line 24: insert "(1)" after (e)
g. On page 4, line 26: insert: "(e) (2) All
procedures administered by the providers in the
study shall be paid for by private or federal
dollars. No General Fund moneys shall be used to
fund procedures performed as part of the study."
h. On page 24, line 27: insert "(1)" after "(f)"
i. On page 4, after line 29: insert "(f)(2) This
section shall become inoperative on January 1,
2016."
SUPPORT AND OPPOSITION :
Support:The Children's Partnership (sponsor)
California Coverage and Health Initiatives
California Dental Association
Children Now
Los Angeles Area Chamber of Commerce
Mendocino Community Health Clinic, Inc.
Venice Family Clinic
Western Dental Services, Inc.
Worksite Wellness LA
Oppose: None received.
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