BILL ANALYSIS Ó
Senate Appropriations Committee Fiscal Summary
Senator Kevin de León, Chair
AB 1174 (Bocanegra) - Dental professionals.
Amended: July 2, 2014 Policy Vote: B&P 8-0, Health 8-0
Urgency: No Mandate: No
Hearing Date: August 4, 2014
Consultant: Brendan McCarthy
This bill meets the criteria for referral to the Suspense File.
Bill Summary: AB 1174 would authorize certain allied dental
professionals to perform additional activities using telehealth.
The bill would prohibit Medi-Cal from requiring a face-to-face
visit between a patient and provider before allowing for
teledentistry services.
Fiscal Impact:
One-time costs of about $50,000 for the development of
regulations and information technology upgrades and ongoing
costs of $200,000 per year for licensing and enforcement by
the Dental Board of California (State Dentistry Fund).
One-time costs of about $50,000 for the development of
regulations and information technology upgrades and ongoing
costs of $80,000 per year for licensing by the Dental
Hygiene Committee of California (State Dental Hygiene Fund).
Minor costs to continue the operation of Health Workforce
Pilot Project #172 (private funds).
Unknown impact on Medi-Cal costs for dental procedures
(General Fund and federal funds). Under current practice,
the Medi-Cal program does not provide reimbursement for
dental services provided through telehealth. By specifically
authorizing such reimbursement and making changes to scope
of practice laws that will increase the potential use of
telehealth, the bill will likely increase utilization to
some degree. The size of that impact is unknown.
The Department has indicated that the cost of setting up the
required information technology systems to facilitate dental
telehealth will limit implementation. This may be
AB 1174 (Bocanegra)
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particularly significant for the Denti-Cal program, in which
reimbursement rates are generally low. On the other hand,
utilization rates in the Denti-Cal program are very low (in
2011, only 27% of eligible children received dental care).
Therefore, there is significant scope for increasing
utilization of services in the Denti-Cal program.
Finally, it may be the case that more early intervention
will reduce long-run costs to provide dental care in the
Medi-Cal program.
Background: Under current law, the Dental Hygiene Committee
regulates registered dental hygienists and registered dental
hygienists in alternative practice while the Dental Board
regulates registered dental assistant in extended functions.
Current law specifies which activities such providers are
authorized to perform independently and which activities must be
performed under the supervision of a dentist.
Proposed Law: AB 1174 would authorize certain allied dental
professionals, using telehealth, to perform additional
activities. The bill would prohibit Medi-Cal from requiring a
face-to-face visit between a patient and provider before
allowing for teledentistry services.
Specific provisions of the bill would:
Authorize a dentist to allow a registered dental hygienist,
registered dental hygienist in alternative practice, or a
registered dental assistant in extended functions to perform
x-rays, using telehealth, prior to an examination by the
dentist;
Authorize a registered dental hygienist, registered dental
hygienist in alternative practice, or a registered dental
assistant in extended functions to determine which x-rays to
perform on a patient before an initial examination by a
dentist and to place protective restorations in a dental
office or using telehealth after a diagnosis by a dentist;
Require the development of regulations by the Dental Board
and the Dental Hygiene Committee;
Require the Office of Statewide Health Planning and
Development to extend the existing Health Workforce Pilot
Project #172 until January 1, 2016;
Specify that face-to-face contact between a patient and a
provider is not required in the Medi-Cal program for
AB 1174 (Bocanegra)
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teledentistry services.
Related legislation: AB 1310 (Bonta) would prohibit the
Department of Health Care Services from requiring a health care
provider who is licensed to practice in California to be located
in California to provide telehealth services to Medi-Cal
beneficiaries. That bill will be heard in this committee.
Staff Comments: Under current policy, the Department of Health
Care Services does not reimburse dental providers for services
provided through telehealth. However, current law does not
prohibit this and the Department is currently evaluating whether
to begin providing reimbursement for dental services provided
through telehealth.
Under the oversight of the Office of Statewide Health Planning
and Development, a Health Workforce Pilot Project (#172) has
been undertaken to evaluate the changes in scope of practice and
the use of telehealth that would be implemented in this bill.
According to a review of the Pilot Project by researchers at the
University of the Pacific, allied dental professionals are able
to perform the duties tested in the Pilot Project safely and
effectively with a high level of patient satisfaction.