BILL ANALYSIS Ó
AB 2207
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Date of Hearing: May 11, 2016
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez, Chair
AB
2207 (Wood) - As Amended April 26, 2016
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|Policy |Health |Vote:|16 - 0 |
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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.
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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
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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).
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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
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budget appropriation should be deleted.
Analysis Prepared by:Lisa Murawski / APPR. / (916)
319-2081