BILL ANALYSIS Ó
AB 2207
Page 1
ASSEMBLY THIRD READING
AB
2207 (Wood)
As Amended April 26, 2016
Majority vote
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|Committee |Votes|Ayes |Noes |
| | | | |
| | | | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Health |16-0 |Wood, Maienschein, | |
| | |Bonilla, Campos, | |
| | |Chiu, Dababneh, | |
| | |Gomez, Roger | |
| | |Hernández, Lackey, | |
| | |Nazarian, Olsen, | |
| | |Patterson, Rodriguez, | |
| | |Santiago, Steinorth, | |
| | |Waldron | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Appropriations |20-0 |Gonzalez, Bigelow, | |
| | |Bloom, Bonilla, | |
| | |Bonta, Calderon, | |
| | |Chang, Daly, Eggman, | |
| | |Gallagher, Eduardo | |
| | |Garcia, Roger | |
| | |Hernández, Holden, | |
| | |Jones, Obernolte, | |
| | |Quirk, Santiago, | |
AB 2207
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| | |Wagner, Weber, Wood | |
| | | | |
| | | | |
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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 by creating a dental-specific enrollment form,
pursuing an alternative automatic enrollment process for a
provider already commercially credentialed, and other
activities, as specified;
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
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consultation with stakeholders, to improve the Denti-Cal, as
specified;
5)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.
6)Makes implementation of most of its provisions contingent upon
federal approval, availability of federal matching funds, and
an appropriation in the annual Budget Act each fiscal year for
the specific purpose of implementation.
7)Contains other provisions to improve Denti-Cal accountability,
transparency, and quality.
FISCAL EFFECT: According to the Assembly Appropriations
Committee:
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
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costs for increased Denti-Cal services, likely offset to some
extent by a reduction in costs to treat more serious dental
disease (General Fund (GF)/federal funds).
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 funds).
COMMENTS: 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
devastating to their practices. The real loss in this system
rests with beneficiaries.
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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.
Office of Inspector General Report. In January 2016, the
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
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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.
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 timely and adequate care
to beneficiaries.
Little Hoover Commission (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
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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.
Analysis Prepared by:
Paula Villescaz / HEALTH / (916) 319-2097 FN:
0003288