BILL ANALYSIS                                                                                                                                                                                                    



                                                                    AB 2207


                                                                    Page  1





          Date of Hearing:  April 19, 2016


                            ASSEMBLY COMMITTEE ON HEALTH


                                   Jim Wood, Chair


          AB 2207  
          (Wood) - As Introduced February 18, 2016


          SUBJECT:  Medi-Cal:  dental program.


          SUMMARY:  Makes changes to the Medi-Cal dental program  
          (Denti-Cal) provider enrollment and disenrollment process,  
          increases access and utilization oversight responsibility of the  
          Department of Health Care Services (DHCS) over Denti-Cal  
          contracts, and aligns Denti-Cal fee-for-service (FFS) and Dental  
          managed care (DMC) annual and quarterly data reporting  
          requirements. Specifically, this bill:  


          1)Requires DHCS to expedite the enrollment of Denti-Cal  
            providers by streamlining the Medi-Cal provider enrollment  
            process through the following activities:



             a)   Create a dental-specific enrollment form;



             b)   Pursue an alternative automatic enrollment process for a  
               provider already commercially credentialed by either a  
               dental FFS contractor or an administrative services  
               contractor for the purpose of providing services as a  








                                                                    AB 2207


                                                                    Page  2





               commercial provider;



             c)   Discontinue requiring providers to resubmit an  
               enrollment application that has been deemed incomplete if  
               the missing information is available elsewhere within the  
               application packet; and,



             d)   Require DHCS to publish the criteria to expedite the  
               enrollment of Denti-Cal providers in applicable provider  
               bulletins and manuals.



          2)Requires DHCS to disenroll a provider who has not participated  
            in the dental program, as determined by DHCS, for more than a  
            continuous one-year period.  Permits DHCS to exercise  
            additional measures as appropriate in order to improve the  
            quality of the dental provider network, including, but not  
            limited to, temporary suspensions.



          3)Requires DHCS to monitor access and utilization of Denti-Cal  
            services in the FFS and DMC delivery systems to assess  
            opportunities to improve access and utilization and assess  
            opportunities to develop and implement innovative payment  
            reform proposals within Denti-Cal.



          4)Requires DHCS to explore additional opportunities in  
            consultation with stakeholders, to improve the Denti-Cal,  
            including, but not limited to, the following:










                                                                    AB 2207


                                                                    Page  3






             a)   Aligning the provision of dental anesthesia services  
               with that of medical anesthesia services, including the  
               ability to bill for applicable facility fees and ancillary  
               services;



             b)   Adjusting other utilization controls for specialty  
               services, as appropriate, to promote access to care while  
               still protecting program integrity; and,



             c)   Expanding the scope of beneficiary outreach activities  
               required by an entity that is contracted with the  
               department to more broadly address underutilization  
               throughout the state.



          5)Requires DHCS to work with DMC plans that contract with DHCS  
            for the purposes of implementing the Denti-Cal to provide  
            beneficiaries with access to plan liaisons to assist in the  
            coordination of care for enrolled members.



          6)Requires a Medi-Cal managed care health plan to do all of the  
            following:



             a)   Provide dental screenings for every eligible beneficiary  
               as a part of the beneficiary's initial health assessment;



             b)   Ensure that an eligible beneficiary is referred to an  








                                                                    AB 2207


                                                                    Page  4





               appropriate Medi-Cal dental provider; and, 



             c)   Identify plan liaisons available to DMC contractors and  
               dental FFS contractors to assist in coordination of care.



          7)Requires DHCS to post any proposed action on its Internet  
            Website at least 30 days prior to implementing an action as  
            required in 6) above.



          8)Exempts any amendments, modifications or changes to Denti-Cal  
            contracts entered into by DHCS from certain contracting  
            provisions in order to increase the efficiency and timeliness  
            of changes.  Specifies that these exemptions do not exempt  
            DHCS from establishing a competitive bid process for awarding  
            new Denti-Cal contracts.



          9)Requires DHCS to consult with, and provide notification to,  
            stakeholders, including representatives from counties, local  
            dental societies, nonprofit entities, legal aid entities, and  
            other interested parties prior to implementation of new  
            requirements.



          10)Permits DHCS to implement, interpret, or make specific  
            policies and procedures pertaining to the dental FFS program  
            and DMC plans, as well as applicable federal waivers and state  
            plan amendments, by means of all-county letters, plan letters,  
            plan or provider bulletins, or similar instructions until  
            regulations are adopted.  Requires thereafter DHCS to adopt  
            regulations in accordance with the requirements of the  








                                                                    AB 2207


                                                                    Page  5





            Administrative Procedures Act.



          11)Requires DHCS to provide a status report to the Legislature  
            six months after the effective date of the statute and on a  
            semiannual basis thereafter until regulations have been  
            adopted.



          12)Makes the implementation of this bill conditional upon DHCS  
            obtaining any federal approvals necessary, any federal  
            matching funds to the extent permitted by federal law, and an  
            appropriation in the annual Budget Act each fiscal year.



          13)Requires the list of performance measures established by DHCS  
            along with the data of the dental FFS program to be posted on  
            the department's Internet Website commencing January 31, 2017,  
            for the 2015-16 fiscal year, and annually on or before January  
            31 each year thereafter.



          14)Requires DHCS to post dental FFS performance data on a  
            quarterly basis commencing April 30, 2017 on their Internet  
            Website.


          EXISTING LAW:  


          1)Requires DHCS to establish a list of performance measures  
            designed to evaluate utilization, access, availability, and  
            effectiveness of preventive care and treatment to ensure the  
            dental FFS program meets quality and access criteria created  
            by DHCS after consultation with key stakeholders as specified.  








                                                                    AB 2207


                                                                    Page  6








          2)Requires DHCS to prepare, on an annual basis, a summary report  
            of the nature and types of complaints and grievances regarding  
            access to, and quality of, dental services, including the  
            outcome and requires the report to be posted on their Internet  
            Website.


          3)Requires DHCS to establish a list of performance measures to  
            ensure dental health plans meet quality criteria required by  
            DHCS including but not be limited to provider network  
            adequacy, overall utilization of dental services, annual  
            dental visits, use of preventive dental services, use of  
            dental treatment services, use of examinations and oral health  
            evaluations, and other measures as specified. 





          4)Requires the performance measures to specify the benchmarks  
            used by DHCS to determine whether and the extent to which a  
            dental health plan meets each performance measure. Requires  
            the Department of Managed Health Care (DMHC) and the DHCS  
            stakeholder advisory committee to have access to all  
            performance measures and benchmarks used by DHCS.


          5)Requires that the survey of member satisfaction with plans and  
            providers be the same dental version of the Consumer  
            Assessment of Healthcare Providers and Systems (CAHPS) survey  
            as used by the previously established Healthy Families  
            Program.


          6)Requires DHCS to notify dental health plans at least 30 days  
            prior to the implementation date of performance measures and  








                                                                    AB 2207


                                                                    Page  7





            requires DHCS to include the initial list of performance  
            measures and benchmarks in any dental health contracts entered  
            into between the department and a dental health plan.


          7)Requires DHCS to update performance measures and benchmarks  
            and establish additional performance measures and benchmarks,  
            as specified. 


          8)Requires DHCS to, when evaluating performance measures and  
            benchmarks for retention on, addition to, or deletion from the  
            list, consider all of the following criteria:


             a)   Monthly, quarterly, annual, and multiyear DMC trended  
               data;


             b)   County and statewide Medi-Cal dental FFS performance and  
               quality ratings;


             c)   Other state and national dental program performance and  
               quality measures; and,


             d)   Other state and national performance ratings.


          9)When establishing and updating the performance measures and  
            benchmarks, requires DHCS to consult the existing managed care  
            stakeholder advisory committee well as dental health plan  
            representatives and other stakeholders, including  
            representatives from counties, local dental societies,  
            nonprofit entities, legal aid entities, and other interested  
            parties.










                                                                    AB 2207


                                                                    Page  8





          10)Requires, when evaluating a dental health plan's ability to  
            meet the criteria established through the performance measures  
            and benchmarks, DHCS to select specific performance measures  
            as the basis for establishing financial or other incentives or  
            disincentives, including, but not limited to, bonuses, payment  
            withholds, and adjustments to beneficiary assignment to plan  
            algorithms. 


          11)Requires DHCS to designate an external quality review  
            organization (EQRO) to conduct external quality reviews for  
            any dental health plan contracting with DHCS.


          12)Requires dental health plans, at least annually, to arrange  
            for an external quality of care review with the EQRO  
            designated by DHCS that evaluates the dental health plan's  
            performance in meeting the performance measures, as specified.  
             Permits DMHC direct access to all external quality of care  
            review information upon request to DHCS.


          13)Requires all marketing methods and activities to be used by  
            dental plans to be in compliance with state regulations and  
            requires each dental plan to submit its marketing plan to DHCS  
            for review and approval.


          14)Requires each dental plan to submit its member services  
            procedures, beneficiary informational materials, and any  
            updates to those procedures or materials to DHCS for review  
            and approval.  Requires DHCS to ensure that member services  
            procedures and beneficiary informational materials are clear  
            and provide timely and fair processes for accepting and acting  
            upon complaints, grievances, and disenrollment requests,  
            including procedures for appealing decisions regarding  
            coverage or benefits.










                                                                    AB 2207


                                                                    Page  9





          15)Requires each dental plan to submit its provider compensation  
            agreements to DHCS for review and approval.


          16)Requires DHCS to post to its Internet Website a copy of all  
            final reports completed by DMHC dental managed care plans.


          FISCAL EFFECT:  This bill has not yet been analyzed by a fiscal  
          committee.


          COMMENTS:  


          1)PURPOSE OF THIS BILL.  According to the author, dental care  
            consistently ranks with the public as the most important type  
            of health care after medical.  The impact that good dental  
            hygiene and health has on people's self-esteem and quality of  
            life cannot be understated.  Dentistry is about prevention in  
            order to avoid costly intervention at a later date; however,  
            our system for participation and enrollment does not currently  
            reflect that.  Participation and entry to the program as a  
            participating provider should be easy with restrictions and  
            limiting parameters put in place only when a dentist's pattern  
            of behavior warrants such.  The limited number of private  
            practitioners able to participate in the program is concerning  
            due to the geographic limitations this can create.  There are  
            counties in California with just a couple of dentists  
            participating in the program and too often these are older  
            dentists who will be retiring soon, with no dentists able to  
            take their place.



            The author states that the Denti-Cal system is so broken that  
            many dentists provide pro-bono care as opposed to taking  
            Denti-Cal because they both give back to their community and  
            society and manage it in a way that it is not financially  








                                                                    AB 2207


                                                                    Page  10





            devastating to their practices.  The real loss in this system  
            rests with beneficiaries.  A 2014 California State Auditor  
            report indicated that the insufficient number of dental  
            providers willing to participate in Denti-Cal, low  
            reimbursement rates, and a failure to adequately monitor the  
            program, led to limited access to care and low utilization  
            rates for Denti-Cal beneficiaries across the state.  The Audit  
            found that almost half of eligible beneficiaries did not  
            receive dental care they were eligible for.  Additionally, an  
            April 2016 Little Hoover Commission (LHC) Report indicated  
            that with dreadful reimbursement rates for dentists and slow,  
            outdated paper-based administrative and billing processes that  
            compare poorly with those of commercial insurers, Denti-Cal  
            has thoroughly alienated its partners in the dental  
            profession.  Most California dentists want nothing to do with  
            Denti-Cal and consequently, more than 13 million people  
            eligible for coverage have limited or no access to dentists.





            This is unacceptable, and we must take action to change the  
            system.  While the provisions in this bill seem modest, they  
            are significant steps towards improving the Denti-Cal system.   
            The author concludes that this measure will streamline the  
            enrollment process for providers, ensure that provider  
            networks are up-to-date so that beneficiaries can more easily  
            access providers, improve coordination of care for  
            beneficiaries, and increase DHCS oversight of the Denti-Cal  
            program.





          2)BACKGROUND. 










                                                                    AB 2207


                                                                    Page  11





             a)   Denti-Cal.  States are federally required to provide  
               dental benefits to children covered by Medicaid (Medi-Cal  
               in California) and the Children's Health Insurance Program.  
                Denti-Cal is the Medicaid program that provides  
               comprehensive dental care to pediatric and pregnant  
               Medi-Cal beneficiaries and limited emergency services to  
               adult beneficiaries.  While Medicaid covers dental services  
               for all child enrollees as part of a comprehensive set of  
               benefits, referred to as the Early and Periodic Screening,  
               Diagnostic and Treatment benefit, states may choose whether  
               to provide dental benefits for adults.  Minimum federal  
               requirements for pediatric dental Medicaid programs include  
               relief of pain and infections, restoration of teeth and  
               maintenance of dental health.  For children in Medi-Cal,  
               dental care is provided on a FFS basis in all counties,  
               with Sacramento and Los Angeles Counties also offering  
               services through DMC plans. 



               For more than 40 years Medicaid-enrolled Californians of  
               any age were eligible for basic diagnostic, preventive,  
               restorative and emergency dental procedures provided by  
               participating dentists through Denti-Cal.  In 2007,  
               Denti-Cal provided comprehensive oral health care to more  
               than eight million people.  However, from July 2009 to May  
               2014, California eliminated funding for most adult  
               non-emergency Denti-Cal benefits, effectively eliminating  
               California's oral health safety-net.  A partial restoration  
               of benefits, primarily diagnostic and preventative  
               services, was enacted in the 2013 Budget Act and became  
               effective May 1, 2014. 





             b)   Denti-Cal FFS Performance.  In 2012, dental health plans  
               contracted with Barbara Aved Associates to conduct research  








                                                                    AB 2207


                                                                    Page  12





               on Medi-Cal's FFS dental care.  The study found, in part,  
               that:  i) 97% of non-participating dentists cited low  
               reimbursement rates as the reason for not participating;  
               ii) 90% of general dentists said it was somewhat or very  
               difficult to find a pediatric dentists accepting Medi-Cal  
               referrals; and, iii) 38% of general dentists and 69% of  
               pediatric dentists who take Medi-Cal have 15% or less of  
               their patient population in Medi-Cal.  The researcher  
               concluded that children in Medi-Cal are getting inadequate  
               dental care, largely due to insufficient provider  
               participation, reflecting low reimbursement rates.  The  
               researcher recommended:  i) streamlining the provider  
               enrollment process; ii) increasing rates; iii) adopting  
               more quality measures; iv) increasing monitoring of  
               utilization data; and, v) increasing public oral health  
               education to families



             c)   Denti-Cal Managed Care Performance.  Under the FFS  
               model, providers are reimbursed according to a rate  
               schedule set by DHCS.  The Medi-Cal Dental Managed Care  
               Program contracts with three Geographic Managed Care (GMC)  
               Plans and five Prepaid Health Plans that provide dental  
               services to enrolled beneficiaries.  Each dental plan  
               receives a negotiated monthly per capita rate from the  
               state for every recipient enrolled in their plan. Medi-Cal  
               beneficiaries residing in Los Angeles County can access  
               dental care either through the FFS delivery system or  
               through prepaid health plans, while Medi-Cal beneficiaries  
               residing in Sacramento County (with the exception of  
               specific populations) are mandatorily enrolled in prepaid  
               health plans for dental care.  If Sacramento County  
               beneficiaries are unable to secure services through their  
               prepaid health plan in accordance with the applicable  
               contractual time frames and the Knox-Keene Health Care  
               Service Plan Act of 1975, they can qualify for the  
               beneficiary dental exemption, which allows them to move  
               into the FFS delivery system. In 2012, about 143,000 child  








                                                                    AB 2207


                                                                    Page  13





               beneficiaries received services under the DMC plans  
               operating in the counties of Los Angeles and Sacramento.   
               In 2010, First 5 of Sacramento commissioned the "Sacramento  
               Deserves Better" report, produced by Barbara Aved  
               Associates, which analyzed access, utilization, and quality  
               of dental care under Sacramento's GMC Dental Services  
               model.  Key findings from this report include the  
               following:



               i)     Only 20% of children in GMC dental services used a  
                 dental service in 2008, as compared to over 40% of  
                 children in Medi-Cal statewide who are predominately in  
                 FFS;
               ii)    Only 30% of children in GMC dental services received  
                 a dental service in 2010;


               iii)   Sacramento GMC dental services is consistently one  
                 of the lowest-ranking counties for Medi-Cal dental access  
                 in the entire state;


               iv)    Dental plans have not complied with a "first  
                 tooth/first birthday" recommendation for the initial  
                 dental visit;


               v)     Inadequate prevention services were provided; and,


               vi)    The state provided minimal oversight of GMC dental  
                 services contracts.













                                                                    AB 2207


                                                                    Page  14





               Early in 2012, through a series of articles and editorials,  
               the Sacramento Bee (Bee) brought attention to the dire  
               conditions of Sacramento County's pediatric DMC program.   
               The Bee coverage focused on the findings of the report  
               commissioned by First 5 of Sacramento, which revealed  
               shockingly low utilization rates and highlighted a series  
               of examples of specific children who had been in desperate  
               need of dental care, yet unable to access the care they  
               needed without significant delays, worsening conditions,  
               prolonged pain, and a significant amount of fear,  
               frustration, and relentless advocacy on the part of their  
               parents.





             d)   Legislative Hearings.  A series of legislative hearings  
               in 2012 found a lack of oversight of the DMC programs in  
               Sacramento and Los Angeles counties by DHCS, resulting in  
               significant underutilization by pediatric beneficiaries. On  
               March 8, 2012, the Assembly Select Committee on Workforce  
               and Access to Care convened a meeting to examine the state  
               of the dental safety net, followed by a Senate Budget  
               Hearing on March 22, 2012, that directly examined the  
               Sacramento GMC dental program.  As a result, 2012 budget  
               trailer bill provided for the beneficiary dental exemption  
               process, which allows beneficiaries who are not receiving  
               adequate or timely access to care to opt out of the GMC  
               dental program, requires DHCS to establish performance  
               measures and benchmarks for dental health plans, requires  
               DHCS to utilize dental health plan performance data for  
               contracting purposes, and requires the establishment of  
               contract incentives and disincentives, along with enacting  
                                        other oversight mechanisms.
               


             e)   Office of Inspector General Report. In January 2016, the  








                                                                    AB 2207


                                                                    Page  15





               federal Department of Health and Human Services Officer of  
               the Inspector General (OIG) published a report titled "Most  
               Children with Medicaid in Four States are Not Receiving  
               Required Dental Services."  The study focused on four  
               states:  California, Indiana, Louisiana, and Maryland and  
               analyzed Medicaid dental claims with service dates in 2011  
               and 2012, beneficiary enrollment files, and conducted  
               structured interviews with state officials.  The OIG report  
               found that three out of four children did not receive all  
               required dental services, with one in four children failing  
               to see a dentist at all.  All four states reported that  
               they do not routinely track whether children are receiving  
               all the required services.  In addition, two of the four  
               states had policies that do not allow payment for  
               particular services in accordance with their periodicity  
               schedules.  All states reviewed reported facing shortages  
               of participating dental providers and challenges in  
               educating families about the importance of regular dental  
               care. 



             f)   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  
               Denti-Cal 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  








                                                                    AB 2207


                                                                    Page  16





               timely and adequate care to beneficiaries.


             g)   LHC Report.  On April 1, 2016, the LHC published a  
               report titled "Fixing Denti-Cal."  The LHC initiated an  
               examination of the state's Denti-Cal program after  
               receiving formal requests for a review from Legislators in  
               April of 2015 and following the findings of the 2014 State  
               Auditor's Report.  Lawmakers requested that the LHC  
               "undertake a review of the Denti-Cal program and identify  
               the necessary steps to assure this vital program meets its  
               purpose to provide access to dental care for many of the  
               most vulnerable Californians including children."  The LHC  
               Report highlighted the lack of providers in the Denti-Cal  
               program, inadequate and low provider reimbursement rates,  
               enrollment, billing, and administrative challenges.  The  
               LHC provided 11 recommendations on how to improve the  
               Denti-Cal program, as follows:





                 i)       The Legislature should set a target of 66% of  
                   children with Denti-Cal coverage making annual dental  
                   visits; 
                 ii)      DHCS should simplify the Denti-cal provider  
                   enrollment forms and put them online in 2017;


                 iii)     DHCS should overhaul the process of treatment  
                   authorization requests;


                 iv)      DHCS should implement a customer focused program  
                   to improve relationships with its providers;


                 v)       DHCS should purge outdated regulations;








                                                                    AB 2207


                                                                    Page  17







                 vi)      The Legislature and Governor should enact and  
                   sign legislation in 2016 to create an evidence-based  
                   advisory group for the Denti-Cal program;


                 vii)     The Legislature and Governor should fund a  
                   statewide expansion of teledentistry and the virtual  
                   dental home;


                 viii)    State government, funders, and non-profits  
                   should lead a sustained statewide "game changer" to  
                   reorient the oral health care system for Denti-Cal  
                   beneficiaries toward preventative care;


                 ix)      The Legislature and DHCS should expand the  
                   concepts of Washington State's Access to Baby and Child  
                   Dentistry program and Alameda County's Healthy Kids,  
                   Healthy Teeth program to more regions of California;


                 x)       DHCS and California counties should steer more  
                   Denti-Cal eligible patients into Federally Qualified  
                   Health Centers with capacity to see them; and,


                 xi)      Medical societies and non-profit organizations  
                   should recruit more pediatricians to provide  
                   preventative dental checkups during well-child visits.





             h)   Transformation Waiver.  The new "Medi-Cal 20-20 Waiver"  
               includes provisions to implement the "Dental Transformation  








                                                                    AB 2207


                                                                    Page  18





               Initiative" (DTI), which aims to improve dental health for  
               Medi-Cal children by focusing on high-value care, improved  
               access, and utilization of performance measures to drive  
               delivery system reform.  The DTI provides incentive  
               payments to Medi-Cal dental providers who meet certain  
               requirements and benchmarks.  The DTI provides $148 million  
               annually in funding for five years for a maximum of $750  
               million.  More specifically, DTI will include three  
               domains:  preventive service, caries risk assessment and  
               management, and continuity of care.  Specific incentive  
               payments within each domain will be available to qualified  
               providers, along with messaging and education to providers  
               and beneficiaries about programs and efforts in their local  
               communities. 
               


          3)SUPPORT.  The LHC states that in its 2016 report, Fixing  
            Denti-Cal, the LHC found the program to be lacking in multiple  
            areas.  The LHC made several recommendations aimed at  
            expanding access to Denti-Cal services, with an ultimate goal  
            of 66% of Denti-Cal-eligible children making annual dental  
            visits.  Several of those recommendations would require DHCS  
            to take action to improve Denti-Cal from within.  This bill  
            would call on DHCS to expedite provider enrollment by creating  
            a dental-specific enrollment form and pursuing alternative  
            automatic enrollment for dentists already established  
            commercially.  This bill would also require DHCS to monitor  
            access and utilization and explore additional opportunities to  
            improve Denti-Cal.  The LHC concludes that because this bill  
            requires DHCS to improve and expand Denti-Cal provider  
            enrollment, and shares the LHC's overall goal of expanding  
            access to care, it supports this measure.



            The County Health Executives Association of California state  
            that this bill proposes modest changes to the program,  
            including expediting dental provider enrollment into the  








                                                                    AB 2207


                                                                    Page  19





            Medi-Cal program, ensuring screenings are provided for every  
            eligible Medi-Cal beneficiary as part of their initial health  
            assessment, and ensuring beneficiaries are referred to  
            appropriate Medi-Cal dental providers, which could improve the  
            delivery of dental services to those most in need in  
            California.  


          4)SUPPORT IF AMENDED.  The Maternal and Child Health Access  
            strongly supports the provisions of this bill, but urge  
            amendments to clarify the intent that all pregnant women in  
            Medi-Cal benefit from this bill's reforms, add performance  
            measures unique to pregnant and postpartum beneficiaries,  
            include maternal and infant health advocates in the  
            stakeholder group and require DHCS to report access, and  
            quality data for pregnant beneficiaries. 


            Western Center on Law and Poverty also supports this bill, and  
            urge amendments that add quality performance measures for  
            adults, require the Denti-Cal provider referral list to be  
            updated, and review ways to stream the Treatment Authorization  
            Requests process. 


          5)RELATED LEGISLATION.  


             a)   AB 648 (Low) establishes the Virtual Dental Home program  
               to expand the virtual dental home model of community-based  
               delivery of dental care and directs the California Health  
               Facilities Financing Authority to administer the grant  
               program.  AB 648 is on the Senate Inactive File. 



             b)   AB 2108 (Waldron) requires DHCS, on or before January 1,  
               2018, to submit a report to the Legislature on the cost and  
               feasibility of restoring full adult dental services as a  








                                                                    AB 2207


                                                                    Page  20





               covered benefit under the Medi-Cal Program and sunsets  
               those provisions on January 1, 2019.  AB 2108 is pending in  
               the Assembly Health Committee.


          6)PREVIOUS LEGISLATION.  AB 1467 (Committee on Budget), Chapter  
            23, Statutes of 2012, allows Sacramento County to establish a  
            stakeholder advisory committee (SC-SAC) to provide input on  
            the delivery of oral health and dental care and required DHCS  
            and the Sacramento County Department of Health and Human  
            Services advisory committee to meet with the SC-SAC.   
            Authorizes the Director of DHCS to establish a beneficiary  
            dental exception process in which Medi-Cal beneficiaries who  
            are mandatorily enrolled in dental health plans in Sacramento  
            County can move to FFS Denti-Cal.  Requires DHCS to establish  
            a list of performance measures to ensure that dental health  
            plans meet quality criteria and required DHCS to post on its  
            Website on a quarterly basis, beginning January 1, 2013, the  
            list of performance measures and each plan's performance and  
            made other changes to DMC as specified.


          7)COMMITTEE AMENDMENTS.


             a)   Disenrollment process clarification.  The Committee  
               recommends an amendment clarifying that if 12 months have  
               passed since an enrolled Denti-Cal provider has made a  
               claim for services rendered to a Denti-Cal beneficiary, a  
               notice should be provided to that provider informing them  
               that within 6 months they will be disenrolled from the  
               Denti-Cal program.


             b)   Distribution of providers and services.  The author  
               wishes to amend the bill to add to the list of performance  
               measures established by DHCS data regarding the number of  
               patients seen by a Dent-Cal provider in one calendar year,  
               and the number of services rendered by that provider.








                                                                    AB 2207


                                                                    Page  21







          REGISTERED SUPPORT / OPPOSITION:




          Support


          California Dental Association


          Children Now


          California Primary Care Association


          Children's Partnership


          County Health Executives Association of California


          First 5 Association of California


          National Association of Social Workers - California Chapter


          The Little Hoover Commission




          Opposition










                                                                    AB 2207


                                                                    Page  22





          None on file.




          Analysis Prepared by:Paula Villescaz / HEALTH / (916) 319-2097