BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 648|
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THIRD READING
Bill No: AB 648
Author: Low (D), et al.
Amended: 9/1/15 in Senate
Vote: 27
SENATE HEALTH COMMITTEE: 8-0, 6/24/15
AYES: Hernandez, Nguyen, Mitchell, Monning, Nielsen, Pan,
Roth, Wolk
NO VOTE RECORDED: Hall
SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/27/15
AYES: Lara, Bates, Beall, Hill, Leyva, Mendoza, Nielsen
ASSEMBLY FLOOR: 79-0, 6/1/15 - See last page for vote
SUBJECT: Community-based services: Virtual Dental Home
program.
SOURCE: California Dental Association
The Childrens Partnership
DIGEST: This bill establishes the Virtual Dental Home (VDH)
grant program at the California Health Facilities Financing
Authority and appropriates $3 million from the California Health
Facilities Financing Authority Hospital Equipment Loan Program
to expand the VDH model of community-based delivery of dental
care to California residents in greatest need.
ANALYSIS:
Existing law:
1)Permits the Office of Statewide Health Planning and
Development (OSHPD) to designate experimental health workforce
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projects as approved projects where the projects are sponsored
by community hospitals or clinics, nonprofit educational
institutions, or government agencies engaged in health or
education activities. Permits, notwithstanding any other
provision of law, a trainee in an approved project to perform
health care services under the supervision of a supervisor
where the general scope of the services has been approved by
OSHPD.
2)Requires, no later than January 1, 2018, regulations to be
promulgated related to establishing criteria for approval of
courses of instruction for the procedures using the
competency-based training protocols established by Health
Workforce Pilot Project No. 172 (HWPP No. 172) through OSHPD.
3)Requires OSHPD to extend HWPP No. 172 until January 1, 2016,
in order to maintain the competence of the clinicians trained
during the course of the project, and to authorize training of
additional clinicians in the duties specified in HWPP No. 172.
Sunsets this provision on January 1, 2016.
This bill:
1)Establishes the VDH grant program, to expand the VDH model of
community-based delivery of dental care to California
residents who are in greatest need.
2)Requires the grant program to facilitate, coordinate, and
encourage development and expansion of the delivery of dental
health services through the use of the VDH model by providing
grants to:
a) Develop training modules and Web-based technical
assistance;
b) Establish community-based learning collaboratives;
c) Fund essential VDH technology and equipment; and,
d) Develop and fund other services, as determined by the
grant administrator, as required by this bill.
3)Authorizes the California Health Facilities Financing
Authority (CHFFA) to seek additional private or public funds
to expand access to the VDH program.
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4)Requires the VDH program to be focused on providing needed
services in geographic areas of highest need, as determined by
the program administrator.
5)Authorizes CHFFA to grant funds directly to the public and
private educational institutions or nonprofit entities as
required to meet the requirements of this bill.
6)Appropriates $3 million from California Health Facilities
Financing Authority Hospital Equipment Loan Program for
purposes of the VDH program.
7)Makes this bill operative only if SB 315 (Monning) is enacted
and takes effect on or before January 1, 2016.
Comments
1)Author's statement. According to the author, in 2014, the VDH
pilot project was made permanent as a sustainable and scalable
model for delivering dental care in California. The project
demonstrated that early dental disease prevention can be
provided safely and effectively in community-based sites by
allied dental team members who are connected to a dentist at
an off-site location via "teledentisty." Patients served by
VDH systems have access to comprehensive dental care,
including diagnosis, treatment planning and restorative care,
as well as other complex care as needed. Through the project,
nearly 3,000 patients have been seen at more than 50 sites
around California with overwhelmingly positive results and
approximately two-thirds of the patients seen were able to
receive the care they needed at the community site. 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.
California has identified 341 Dental Health Professional
Shortage Areas (DHPSAs), 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. This bill
is an innovative and cost-effective model for providing dental
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services to the residents of this state who are in need of
receiving dental care.
2)HWPP No. 172 and VDH. The HWPP No. 172 was approved by OSHPD
in December 2010, and patient care with the new HWPP No. 172
duties began in January of 2011. The purpose of the pilot was
to test two new duties to be performed by allied dental
personnel to demonstrate that these duties could be performed
safely and effectively and contribute to the development of a
community-based oral health delivery system using
telehealth-connected teams in a system called the VDH. The
system was designed to reach and improve the oral health of
underserved and vulnerable populations not fully participating
in the current dental care delivery system. HWPP No. 172 was
funded by public and private grants and was sponsored by the
Pacific Center for Special Care at the University of the
Pacific (UOP) School of Dentistry.
The HWPP No. 172 provided dental services to approximately
3,000 patients in 13 California communities, operating at more
than 50 sites, including in elementary school-based
facilities, Head Start Preschools, a nursing home, residential
care facilities and a community center. Ninety percent of
patients seen were eligible for Denti-Cal. In addition to the
allied dental personnel, there were 23 dentists that
participated, serving as "collaborating dentists" in the
various community sites.
Under the VDH and HWPP No. 172, registered dental assistants
(RDAs), registered dental hygienists (RDHs) or registered
dental hygienists in alternative practice( RDHAPs) use
portable imaging equipment and an Internet-based dental record
system to collect electronic dental records such as X-rays,
photographs, charts of dental findings, and dental and medical
histories, and upload the information to a secure website,
where they are reviewed by a collaborating dentist. The
dentist reviews the patient's information and creates a
tentative dental treatment plan. The RDHAP, RDH or RDA then
carries out the aspects of the treatment plan that can be
conducted in the community setting. After the dentist reviews
the electronic dental records, the RDHAP, RDH or RDA refers
patients to dental offices for procedures that require the
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skills of a dentist. When these visits occur, the patient
arrives with health history and consent arrangements
completed, a diagnosis and treatment plan already determined,
preventive practices in place and preventive procedures having
been performed. As of April 30, 2015 there were 2,858
patients seen, 2,083 radiographs taken, and 994 interim
therapeutic restorations placed. All procedures were rated as
acceptable and there were no reports of adverse outcomes.
With regard to patient satisfaction, 86% who responded to the
survey were very satisfied with the overall dental care
received.
3)Dental Access. According to OSHPD's Health Care Atlas,
approximately five percent of Californians live in a DHPSA;
DHPSAs are Medical Service Study Areas that meet federally
mandated criteria to qualify facilities for benefit programs,
such as loan repayment programs. The designation is based on
the availability of dentists and dental auxiliaries. A July
2010 article published in Health Affairs, indicates, children
in Medicaid, especially Latinos and African Americans,
experience high rates of tooth decay, yet they visit dentists
less often than privately insured children. Even Latino and
African American children with private insurance are less
likely than white children to visit dentists and have longer
intervals between dental visits. Furthermore, Latino and
African American children in Medicaid are more likely than
white children in Medicaid to have longer intervals between
visits. According to a 2008 publication from the California
HealthCare Foundation, the burden of oral disease continues to
fall more heavily on children from poor, minority households.
And despite growing awareness of the lifelong effects of poor
oral care, nearly one quarter of California children have
never been to a dentist, including half of all children under
the age of five.
4)State Audit. The California State Auditor published audit
results in December 2014 of an audit conducted on the
Department of Health Care Services (DHCS) administration of
dental services for children on Medi-Cal which raises issues
with access to services. According to the audit, although the
proportion of children who had at least one dental procedure
performed during the year increased by as much as 1.2
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percentage points each year from 2011 to 2013, annual
utilization rates are still lower than those of many other
states. Data from the federal Centers for Medicare and
Medicaid Services (CMS) indicate that nearly 56% of the 5.1
million children enrolled in Medi-Cal in federal fiscal year
2013 (October 1, 2012, through September 30, 2013) did not
receive dental care through the program. The CMS data indicate
that the national average utilization rate was 47.6% and
ranged from a low of 23.7% in Ohio to a high of 63.4% in Texas
for that same federal fiscal year. CMS's data also indicate
that California's utilization rate of 43.9% was the 12th worst
among the states that submitted data. The auditor's review of
DHCS' data for 2011 through 2013 found similar results.
Studies reviewed suggested several reasons for low utilization
rates, including an uneven distribution of dentists nationwide
and a relatively small number of dentists who participate in
Medicaid.
5)State Budget. SB 75 (Committee on Budget and Fiscal Review,
Chapter 18, Statutes of 2015) eliminates the 10% Medi-Cal
payment reductions pursuant to AB 97 (Committee on Budget,
Chapter 3, Statutes of 2011) for dental providers effective
July 1, 2015.
6)VDH Grant Program. According to a representative of UOP, the
grant funds anticipated in this bill might include funding to
cover the following start-up costs: The equipment and
instrument cost is about $35,000 - $40,000 as a one-time
expense; there are supported salaries, decreasing over time,
during the ramp up to a fully billable and sustainable model
at a total of around $70,000 - $80,000, spread over three
years; and, the costs for site selection and enrollment,
program planning, system training, procedure training,
monitoring, technical assistance and evaluation could be
expected to be around a total of $80,000 - $90,000 spread over
three years.
Related Legislation
SB 315 (Monning) authorizes the CHFFA to transfer up to $3
million from its Hospital Equipment Loan Program for use in a
second California Health Access Model Program competitive grant
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selection process. SB 315 passed out of the Assembly
Appropriations Committee on August 27, 2015, and was amended to
reduce the appropriation to up to $3 million (was $6.5 million)
and make it operative contingent upon this bill.
FISCAL EFFECT: Appropriation: Yes Fiscal
Com.:YesLocal: No
According to the Senate Appropriations Committee:
1)One-time authorization of $3 million (CHFFA Fund). (Because
the Fund is continuously appropriated in law, the spending
authorization in this bill appropriates $3 million for the
purposes of this bill.)
2)Unknown increase in Medi-Cal spending for dental procedures
(General Fund and federal funds). The Medi-Cal program
provides dental coverage for children and limited coverage for
adults. According to a report by the State Auditor,
utilization of dental services by Medi-Cal beneficiaries is
low compared to other states. In part, this is due to limited
availability of dental providers willing to see new patients
at the rates paid by the Medi-Cal program. The VDH model has
the potential to increase access, by bringing care to
individuals who are not otherwise being served. To the extent
this happens, it could increase Medi-Cal expenditures for
dental service. On the other hand, early interventions through
a VDH model may reduce future costs by catching problems
early. The extent to which the savings from early
interventions will offset the costs of overall increases in
utilization is unknown.
SUPPORT: (Verified8/31/15)
California Dental Association (co-source)
The Children's Partnership (co-source)
Alameda County Board of Supervisors
Alameda County Developmental Disabilities Council
California Chronic Care Coalition
California Dental Hygienists' Association
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California Society of Pediatric Dentistry
Children Now
Community Clinic Association of Los Angeles County
Community Health Systems, Inc.
Delta Dental
Dental Hygiene Committee of California
East Bay Developmental Disabilities Legislative Coalition
First 5 Sonoma County
Liberty Dental Plan of California, Inc.
Maternal and Child Health Access
Mendocino Community Health Clinic, Inc.
Neighborhood Mobile Dental Van Prevention Program
Shasta Community Health Center
State Council on Developmental Disabilities
United Ways of California
Venice Family Clinic
OPPOSITION: (Verified8/31/15)
None received
ARGUMENTS IN SUPPORT: Proponents support this bill because
it would provide upfront investment necessary for the VDH to
become a sustainable and scalable model for dental care
delivery. Without an upfront investment in training, equipment,
technical assistance, and other support that providers need to
get started, the system will not be able to develop a critical
mass needed to spread statewide and truly be integrated into
California's dental delivery system. The Children's Partnership
cosponsors this bill to ensure the VDH - an innovative and
cost-effective system for providing dental care to California's
most vulnerable children and adults in community settings- can
spread across the state. The California Dental Association also
cosponsors this bill, because the VDH model of dental care uses
technology to connect allied dental team members located at
community sites with dentists in offices or clinics,
facilitating the provision of comprehensive dental care to
underserved children and adults.
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ASSEMBLY FLOOR: 79-0, 6/1/15
AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom,
Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang,
Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle,
Daly, Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina
Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez,
Gordon, Gray, Grove, Harper, Roger Hernández, Holden, Irwin,
Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low,
Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin,
Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Perea,
Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago,
Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber,
Wilk, Williams, Wood, Atkins
NO VOTE RECORDED: Hadley
Prepared by:Teri Boughton / HEALTH /
9/1/15 21:30:36
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