BILL ANALYSIS Ó
AB 648
Page 1
Date of Hearing: April 7, 2015
ASSEMBLY COMMITTEE ON HEALTH
Rob Bonta, Chair
AB 648
(Low) - As Introduced February 24, 2015
SUBJECT: Community-based services: Virtual Dental Home
program.
SUMMARY: Appropriates $4 million to the Department of Public
Health (DPH) to establish the Virtual Dental Home (VDH) program.
Specifically, this bill:
1)Appropriates $4 million to DPH to establish a VDH program to
expand the VDH model of community-based delivery of dental
care to the residents of this state who are in greatest need.
2)Requires the VDH program to be administered by the Director of
the State Oral Health Program.
3)Requires the VDH program to facilitate and encourage
development and expansion of the delivery of dental health
services in schools, head start and preschool programs, and
community clinics.
4)Encourages the use of teledentistry in VDH programs.
AB 648
Page 2
5)Requires the development of related training modules and the
establishment of community-based learning collaboratives.
6)Provides grants to fund essential VDH technology and
equipment.
7)Requires the program administrator to secure funds that can be
used along with other private and public funding
opportunities.
8)Requires the VDH program to focus on providing needed services
in geographic areas of highest need.
EXISTING LAW:
1)Establishes the Medi-Cal program under which qualified
low-income persons receive health care benefits.
2)Requires DPH to maintain a dental program that develops a
comprehensive dental health plan to maximize utilization of
all resources.
3)Establishes a community dental disease prevention program
offered to school children in preschool through sixth grade,
and in classes for individuals with exceptional needs, when
sponsored by a city or county health department, county office
of education, superintendent of schools office, school
district, or other public or private nonprofit agency approved
by DPH.
AB 648
Page 3
4)Requires the DPH Director to appoint a licensed dentist to
administer the dental program.
5)Provides, to the extent federal financial participation is
available, face-to-face contact between a health care provider
and a patient is not required under the Medi-Cal program for
teleophthalmology and teledermatology by store and forward.
Indicates that services appropriately provided through the
store and forward processes are subject to billing and
reimbursement policies developed by DHCS.
FISCAL EFFECT: This bill has not yet been analyzed by a fiscal
committee.
COMMENTS:
1)PURPOSE OF THIS BILL. According to the author, good dental
health is critical to a child's ability to grow up healthy.
Yet, tooth decay is the most common chronic disease and unmet
health care need of children in California. According to the
Journal of the California Dental Association, California's
oral health disparities are more severe than the national
average, particularly among low-income and disabled
populations. One-quarter of children in California have never
seen a dentist and approximately 65% of elementary school
children are in need of dental care.
The author also state that California has identified 341
Dental Health Professional Shortage Areas (DHPSA), areas so
designated because the dentist-to-population ratio is below
the threshold set by the federal government. By their very
nature, DHPSAs identify areas throughout the state where
patients frequently experience barriers to comprehensive
dental care. The author concludes that this bill supports the
expansion of an innovative and cost-effective model for
providing dental care to the residents of this state who are
AB 648
Page 4
in greatest need by establishing the Virtual Dental Home grant
program.
2)BACKGROUND.
a) Virtual Dental Home. According to an article published
in July 2012 in the Journal of the California Dental
Association (CDA Journal), "The Virtual Dental Home:
Bringing Oral Health to Vulnerable and Underserved
Populations," the traditional office and clinic-based oral
health delivery system is failing to reach a large and
increasing segment of the population. The CDA Journal
article states that in California, oral health disparities
are more severe than the national average, particularly
among low-income and disabled populations. Children in
particular do not have regular access to dental services,
with over half of minority elementary school children
needing dental care.
From 2009 to 2011, the number of Medi-Cal beneficiaries who
received any dental service declined by 8%. A decrease was
expected for adults since most adult dental benefits were
eliminated in 2009, however there was also a decrease for
children. Approximately 6.3 million children, or two-thirds
of all children in the state, have not had any dental care
by the time they reach the third grade, resulting in missed
school time. Approximately 7% of California children missed
school due to a dental problem in 2007, excluding time for
cleaning or routine check-up.
b) State Auditor's Report. On December 11, 2014, the
California State Auditor issued a report titled "California
Department of Health Care Services: Weaknesses in Its
AB 648
Page 5
Medi-Cal Dental Program Limit Children's Access to Dental
Care". The report stated that insufficient number of
dental providers willing to participate in Medi-Cal, low
reimbursement rates and a failure to adequately monitor the
program, led to limited access to care and low utilization
rates for Medi-Cal beneficiaries across the state. The
Audit found that 16 counties either have no active
providers or do not have providers willing to accept new
Medi-Cal patients, and 16 other counties have an
insufficient number of providers.
Recent changes in federal and state laws that have expanded
Medi-Cal coverage could increase the number of children and
adults who can receive additional covered dental services
from 2.7 million to as many as 6.4 million, bringing into
question the State's ability to provide timely and adequate
care to beneficiaries.
3)SUPPORT. The sponsors of the bill, CDA, state that VDH has
the potential to become a sustainable and scalable model for
dental care delivery, but needs an upfront investment in
training, equipment, technical assistance, and other support
to develop the critical mass needed to spread statewide and
truly be integrated into California's dental deliver system.
CDA notes that tooth decay is the number one chronic disease
among children; it accounts for persistent pain, trouble
eating and sleeping, missed school days, and expensive
emergency room visits for preventable dental problems. The
sponsor argues that children, low-income families and other
vulnerable populations experience disproportionate levels of
dental disease in large part due to difficulties accessing
early preventive and routine dental care.
The Children's Partnership states that VDH uses technology to
connect allied dental team members, located at community sites
AB 648
Page 6
- such as schools and Head Start sites - with dentists in
offices or clinics, to facilitate the provision of
comprehensive dental care for children and adults who face
barriers to accessing that care in traditional dental offices.
4)RELATED LEGISLATION.
a) AB 1357 (Bloom) establishes the Children and Family
Health Promotion Program in DPH that would provide
competitive grants to appropriate agencies and non-profits
that seek to invest in childhood obesity and diabetes
prevention activities and oral health programs. AB 1357 is
in the Assembly Health Committee.
b) AB 1018 (Cooper) requires the Department of Health Care
Services (DHCS) to permit county mental health plans to
contract with local educational agencies, as defined, to
provide services for Medi-Cal eligible pupils under Early
and Periodic Screening, Diagnosis, and Treatment (EPSDT).
EPSDT services include screening services, vision services,
dental services, hearing services, and other necessary
services to correct or ameliorate defects and physical and
mental illnesses and conditions discovered by the screening
services. AB 1018 is in the Assembly Health Committee.
5)PREVIOUS LEGISLATION.
a) AB 1174 (Bocanegra), Chapter 662, Statutes of 2014,
authorizes certain allied dental professionals to perform
additional activities using telehealth; extends the
duration of the Health Workforce Pilot Project No. 172
until January 1, 2016; and prohibits Medi-Cal from
requiring a face-to-face visit between a patient and
provider before allowing for teledentistry services.
b) AB 1733 (Logue), Chapter 782, Statutes of 2012, updates
several code sections to replace the term "telemedicine"
with "telehealth" and expands the potential for the use of
telehealth in additional health care programs administered
by DHCS such as the Program of All-Inclusive Care for the
AB 648
Page 7
Elderly.
c) AB 415 (Logue), Chapter 547, Statutes of 2011,
establishes the Telehealth Advancement Act of 2011 to
revise and update existing law to facilitate the
advancement of telehealth as a service delivery mode in
managed care and the Medi-Cal program.
d) AB 2120 (Galgiani), Chapter 260, Statutes of 2008,
extends the Medi-Cal telemedicine reimbursement
authorization until January 1, 2013.
e) AB 329 (Nakanishi), Chapter 386, Statutes of 2007,
authorizes the Medical Board of California (MBC) to
establish a pilot program to expand the practice of
telemedicine and to convene a working group. AB 329
specifies that the purpose of the pilot program is to
develop methods, using a telemedicine model, of delivering
health care to those with chronic diseases and delivering
other health information, and requires MBC to make
recommendations regarding its findings to the Legislature
within one calendar year of the commencement date of the
pilot program.
f) AB 1224 (Hernandez), Chapter 507, Statutes of 2007, adds
optometrists to the list of health care providers covered
under laws governing telemedicine services.
g) AB 354 (Cogdill), Chapter 449, Statutes of 2005, expands
telemedicine provisions by providing that, from July 1,
2006 through December 31, 2008, face-to-face contact
between a health care provider and a patient is not
required for the Medi-Cal program for "store and forward"
teleophthalmology and teledermatology services.
REGISTERED SUPPORT / OPPOSITION:
AB 648
Page 8
Support
California Dental Association (sponsor)
The Children's Partnership (cosponsor)
CA Dental Hygienists' Association
California Primary Care Association
Children's Defense Fund - California
LIBERTY Dental Plan of California, Inc.
Maternal and Child Health Access
North County Health Services
Opposition
None on file.
AB 648
Page 9
Analysis Prepared by:Paula Villescaz / HEALTH / (916) 319-2097