BILL ANALYSIS                                                                                                                                                                                                    



                                                                    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