BILL ANALYSIS Ó AB 2207 Page 1 Date of Hearing: May 11, 2016 ASSEMBLY COMMITTEE ON APPROPRIATIONS Lorena Gonzalez, Chair AB 2207 (Wood) - As Amended April 26, 2016 ----------------------------------------------------------------- |Policy |Health |Vote:|16 - 0 | |Committee: | | | | | | | | | | | | | | ----------------------------------------------------------------- Urgency: No State Mandated Local Program: NoReimbursable: No SUMMARY: This bill makes a number of changes to the Department of Health Care Service's (DHCS's) administration of the Medi-Cal dental program (Denti-Cal). Specifically, this bill: 1)Requires DHCS to expedite the enrollment of Denti-Cal providers by streamlining the provider enrollment process through a dental-specific enrollment form, implementing automated enrollment processes for credentialed dentists, and implementing other processes. AB 2207 Page 2 2)Requires DHCS to monitor access and utilization of Denti-Cal services in the fee-for-service (FFS) and Dental managed care (DMC) delivery systems, and to assess opportunities to improve access and utilization, as well as to assess opportunities to develop and implement innovative payment reform proposals within Denti-Cal. 3)Requires DHCS to explore additional opportunities, in consultation with stakeholders, to improve the Denti-Cal program. 4)Requires a Medi-Cal managed care health plan to perform certain activities, including providing dental screening as part of a beneficiary's initial health assessment, ensure that an eligible beneficiary is referred to an appropriate dental provider; and identify plan liaisons available to DMC contractors and dental FFS contractors to assist in coordination of care. 5)Requires DHCS to consult with and provide notification to specified stakeholders prior to implementation of new requirements. 6)Allows DHCS to implement, interpret, or make specific policies and procedures by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions, requires DHCS to thereafter adopt regulations, and requires DHCS to update the legislature until regulations are adopted. 7)Makes implementation of most of its provisions contingent upon federal approval, availability of federal matching funds, and AB 2207 Page 3 an appropriation in the annual Budget Act each fiscal year for the specific purpose of implementation. 8)Contains other provisions to improve Denti-Cal accountability, transparency, and quality. FISCAL EFFECT: 1)DHCS states most activities required by this bill are simply aligning statute with their current contracts or current activities to improve Denti-Cal, and that this bill does not result in a direct staff cost increase. Despite this, the bill makes implementation of the bill's major provisions contingent on an appropriation for the specific purpose of its implementation. 2)This bill also contains a provision that could result in ongoing state cost pressure, namely the requirement that DHCS assess opportunities to improve access and utilization. Improving access and boosting utilization, however appropriate, is likely to have unknown, significant, ongoing costs for increased Denti-Cal services, likely offset to some extent by a reduction in costs to treat more serious dental disease (GF/federal). 3)This bill also requires DHCS to assess opportunities to implement innovative payment reform proposals, which are unlikely to result in a net ongoing cost increase, but could result in significant one-time development and implementation costs (GF/federal). AB 2207 Page 4 COMMENTS: 1)Purpose. According to the author, this bill is responsive to recent reports that have detailed significant problems in Denti-Cal. The author states this measure will make modest changes to streamline enrollment of providers, ensure provider networks are up-to-date so beneficiaries can find providers, improve coordination of care, and increase DHCS oversight of the Denti-Cal program. 2)Background. A 2014 California State Auditor report indicated Denti-Cal was plagued by an insufficient number of dental providers willing to participate in the program, low reimbursement rates, and a failure to adequately monitor access and utilization. According to the auditor, limited access to care resulted in low utilization rates for Denti-Cal beneficiaries across the state. The audit found almost half of eligible beneficiaries did not receive any dental care. Additionally, an April 2016 Little Hoover Commission report stated, "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." The report also notes millions eligible for Denti-Cal coverage have limited or no access to dentists. This bill codifies a number of improvements to which DHCS has committed, in order to respond to the identified problems. 3)Staff Comment. According to DHCS, this bill should not result in direct increase in costs, as it aligns with current activities. Thus, the provision making implementation of a number of the bill's major provisions contingent on an annual AB 2207 Page 5 budget appropriation should be deleted. Analysis Prepared by:Lisa Murawski / APPR. / (916) 319-2081