BILL ANALYSIS Ó AB 2207 Page 1 ASSEMBLY THIRD READING AB 2207 (Wood) As Amended April 26, 2016 Majority vote ------------------------------------------------------------------ |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 Page 2 | | |Wagner, Weber, Wood | | | | | | | | | | | | ------------------------------------------------------------------ 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 AB 2207 Page 3 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 AB 2207 Page 4 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. AB 2207 Page 5 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 AB 2207 Page 6 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 AB 2207 Page 7 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