BILL ANALYSIS Ó
AB 502
Page 1
ASSEMBLY THIRD READING
AB
502 (Chau)
As Amended April 30, 2015
Majority vote
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|Committee |Votes |Ayes |Noes |
| | | | |
| | | | |
|----------------+------+----------------------+--------------------|
|Business & |10-4 |Bonilla, Jones, |Baker, Chang, |
|Professions | |Bloom, Campos, Dodd, |Gatto, Wilk |
| | |Eggman, Holden, | |
| | |Mullin, Ting, Wood | |
| | | | |
|----------------+------+----------------------+--------------------|
|Health |11-7 |Bonta, Bonilla, |Maienschein, |
| | |Burke, Chiu, Gomez, |Chávez, Gonzalez, |
| | |Nazarian, |Lackey, Patterson, |
| | | |Steinorth, Waldron |
| | | | |
| | |Ridley-Thomas, | |
| | |Rodriguez, Santiago, | |
| | |Thurmond, Wood | |
| | | | |
|----------------+------+----------------------+--------------------|
|Appropriations |13-3 |Gomez, Bloom, Bonta, |Bigelow, Chang, |
| | |Calderon, Daly, |Gallagher |
| | |Eggman, Eduardo | |
| | |Garcia, Holden, | |
| | |Jones, Quirk, Rendon, | |
AB 502
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| | |Wagner, Weber | |
| | | | |
| | | | |
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SUMMARY: Authorizes registered dental hygienists in alternative
practice (RDHAPs), who established practices within certified
dental shortage areas, to continue their practice when the
shortage area designation is removed; requires insurance companies
to reimburse RDHAPs for dental hygiene care legally provided and
covered by insurance; and clarifies that RDHAPs are authorized to
establish corporations. Specifically, this bill:
1)Authorizes an alternative dental hygiene practice established
within a certified shortage area to continue to operate if the
certification is removed if the RDHAP continues to serve those
patients that lack or have limited access to dental care, and at
least 40% of the total patient population is comprised of
underserved populations.
2)Exempts professional corporations, rendering professional
services by persons duly licensed by the Dental Hygiene
Committee of California (DHCC), from the requirement to obtain a
certificate of registration in order to render those
professional services, and specifies that RDHAPs may be
shareholders, officers, or directors of an RDHAP corporation,
and that licensed dentists and dental assistants may be
professional employees of an RDHAP corporation.
3)Requires health care service plan contracts covering dental
services, specialized health care service plan contracts
covering dental services, health insurance policies covering
dental services, and specialized health insurance policies
covering dental services issued, amended, or renewed on or after
January 1, 2016, to reimburse RDHAPs for performing dental
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hygiene services that may lawfully be performed by registered
dental hygienists (RDH) and that are reimbursable under the
contracts or policies, and would require the plan or insurer to
use the same fee schedule for reimbursing both registered dental
hygienists and RDHAP.
4)Makes other clarifying and conforming changes.
FISCAL EFFECT: According to the Assembly Appropriations
Committee, any costs to the California Department of Insurance and
the Department of Managed Health Care to assess compliance with
this bill's requirements are expected to be minor and absorbable.
COMMENTS:
Purpose. This bill is sponsored by the California Dental
Hygienists' Association. According to the author, "A number of
situations reduce access to RDHAPs. First, California law allows
[RDHs]to open practice in geographic areas where people have no
access to regular preventive oral care due to an absence or
shortage of dentists. However, under current law, RDHAPs who
practice in dental health shortage areas can no longer practice in
those areas once they are no longer designated a dental shortage
area. Second, many dental insurance companies recognize dentists
in a dental practice as the billable provider of dental hygiene
services and even though RDHAPs provide the same billable services
that an RDH provide, billed by the dentist, the insurance
companies are denying RDHAP's reimbursement for services. This
forces patients who cannot easily access care in a traditional
dental office to pay out of pocket for the services of a RDHAP or
not receive the care due to finances. Additionally, any patient
who goes directly to an RDHAP for preventative services must
obtain a dentist's or doctor's prescription to continue those
services once they pass 18 months of service with the RDHAP. This
is problematic in areas where dentists are in short supply
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creating a barrier for patients to obtain much needed services.
Finally, the [BPC] authorizes RDHAPs to incorporate. Corporation
law would protect the RDHAP's business, however, there is not
language in the Corporations Code authorizing RDHAPs to establish
corporations, leaving them without critical protections. [This
bill] would address these issues and ensure that the public has
access to quality dental hygiene services."
Background. In 1986, the Office of Statewide Health Planning and
Development (OSHPD) created the RDHAP. In 1993, the professional
designation was made permanent in statute. An RDHAP must have
been engaged in the practice of dental hygiene as a registered
dental hygienist in any setting, including educational settings
and public health settings, for a minimum of 2,000 hours during
the immediately preceding 36 months, complete 150 additional hours
of education courses, and pass a written exam. An RDHAP has a
unique distinction in that they can work for a dentist or as an
employee of another RDHAP as an independent contractor, as a sole
proprietor of an alternative hygiene practice, or other locations
such as residences of the homebound, schools, residential
facilities, and in underserved dental shortage areas, as
determined by OSHPD. They may also operate a mobile dental clinic
or operate an independent office or offices.
As a result, RDHAPs may practice in settings outside of the
traditional dental office, and allow patients to receive the same
type of professional preventive care they would receive in a
dental office in schools, skilled and residential care facilities,
hospitals, private homes, and in some instances in an RDHAP's own
office. A 2009 survey of California RDHAPs found that more than
two-thirds of their patients had no other source of oral health
care. RDHAPs also struggle to find referrals to dentists for
patients in need of more advanced care and charge lower fees than
dentists.
The DHCC licenses and regulates approximately 509 RDHAPs.
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Prescription Requirements. Business and Professions Code Section
1931 allows a RDHAP to provide dental hygiene services to a
patient without referral by a dentist for up to 18 months.
However, after 18 months a patient needs to have a prescription
from a dentist or a physician and surgeon in order to continue
dental hygiene services with the RDHAP. The prescription is valid
for up to two years. According to the author, this is problematic
in areas where dentists are in short supply creating a barrier for
patients to obtain much needed basic preventive care services.
According to the author, RDHAPs have proven to be safe providers
who refer patients to dentists when major dental issues arise
outside of their scope of practice to treat. There is no
precedent for requiring a practice agreement for licensure, nor
for services delivered within a professional's own scope of
practice. This is unique in that most restrictions requiring a
prescription of one provider to another are for specialty care,
not for primary preventive health care services. In practice,
this is simply an administrative hurdle, time consuming for
providers, and has not been shown to contribute to positive
patient outcomes. The author indicates that patients should have
their choice of dental hygiene care provider, and the public
should not need a prescription to receive basic preventive care.
According to the sponsors, an RDHAP is the only oral health care
provider a patient has access to, and if a prescription is not
obtained, the patient cannot even continue to receive preventative
dental hygiene care, even though the need for and benefits of that
care still exist.
Dental Health Professional Shortage Areas (DHPSAs). According to
OSHPD, DHPSAs are based on the evaluation of criteria established
through federal regulation to identify geographic areas or
population groups with a shortage of dental providers. The
federal DHPSA designation identifies areas as having a shortage of
dental providers on the basis of availability of dentists and
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other dental auxiliaries. To qualify for designation as a DHPSA,
an area must be: 1) a rational service area; have a population to
general practice dentist ratio of 5,000:1 or 4,000:1 plus
population features demonstrating "unusually high need"; and 2) a
lack of access to dental care in surrounding areas because of
excessive distance, overutilization, or access barriers.
According to OSHPD, there are 53 DHPSAs. Approximately 5% of
Californians live in a DHPSA.
The DHCC noted in their 2014 Sunset Review Report that problems
have arisen when the shortage area in which an RDHAP sets up a
practice is redesignated as a non-shortage area. Existing law
requires the RDHAP to close down the practice when this occurs.
The DHCC views this as "counterproductive...as the closure of the
practice would leave patients with no access to dental hygiene
services." According to the sponsors, when a DHPSA in San Luis
Obispo was faced with losing its designation status, RDHAPs in
that area fought to keep the designation area so that patients
could continue to be served. This bill seeks to prevent patients
from losing access to established dental care should an area lose
its DHPSA.
Reimbursement for Services. Currently, many dental insurance
companies recognize dentists in a dental practice as the billable
provider of dental hygiene services and even though RDHAPs provide
the same billable services that an RDH provide, billed by the
dentist, the insurance companies are denying RDHAP's reimbursement
for services. In its 2014 Sunset Review Report, the DHCC
identified as a barrier to RDHAP practice the inability for RDHAPs
to collect payment for services rendered. The DHCC noted that
RDHAPs have difficulty collecting payment for services from
insurance companies based outside of California. This is because
not all states have the RDHAP provider status making them
ineligible for reimbursement. As a result, some patients who
cannot easily access care in a traditional dental office are
forced to pay out of pocket for the services of a RDHAP or not
receive care due to financial constraints.
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Professional Corporations. A professional corporation is an
organization made up of individuals of the same trade or
profession. The Moscone-Knox Professional Corporations Act of
1968 authorized the formation of professional corporations to
obtain certain benefits of the corporate form of doing business,
such as limited legal liability. At that time, only medical, law
and dental professional corporations were envisioned; there are
now 15 authorized healing arts professional corporations. Current
law specifies which healing arts licensees may be shareholders,
officers, directors or professional employees of professional
corporations controlled by a differing profession if the sum of
all shares owned by those licensed persons does not exceed 49% of
the total shares of the professional corporation.
Business and Professions Code Section 1962 authorizes an
association, partnership, corporation, or group of three or more
registered RDHAPs to practice under an assumed or fictitious name
if the association, partnership, corporation, or group holds a
permit issued by the DHCC authorizing the holder to use that name
connection with the holder's practice, as specified. According to
the sponsors, this section was intended to allow RDHAPs to
incorporate to gain the protections afforded by corporation law,
most importantly, protection against personal liability. However,
conforming changes were not made to the Corporations Code. This
bill would specify that RDHAPs may be shareholders, officers, or
directors of an RDHAP corporation, and specify that licensed
dentists and dental assistants may be professional employees of an
RDHAP corporation.
Policy Issues:
DHPSAs. The sponsors assert that it is necessary to allow RDHAPs
who have established practices in DHPSAs to be able to continue
that practice, even if that designation is later removed.
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However, while there is anecdotal evidence that this is a concern,
it does not appear that any DHPSA has in fact been un-designated
as a shortage area.
Analysis Prepared by:
Eunie Linden / B. & P. / (916) 319-3301 FN:
0000413