BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
AB 2207 (Wood) - Medi-Cal: dental program
-----------------------------------------------------------------
| |
| |
| |
-----------------------------------------------------------------
|--------------------------------+--------------------------------|
| | |
|Version: June 28, 2016 |Policy Vote: HEALTH 9 - 0 |
| | |
|--------------------------------+--------------------------------|
| | |
|Urgency: No |Mandate: No |
| | |
|--------------------------------+--------------------------------|
| | |
|Hearing Date: August 1, 2016 |Consultant: Brendan McCarthy |
| | |
-----------------------------------------------------------------
This bill meets the criteria for referral to the Suspense File.
Bill
Summary: AB 2207 would enact an number of changes to the
operation of the Denti-Cal program, relating to provider
enrollment, program monitoring, and reporting.
Fiscal
Impact:
One-time costs of $370,000 and ongoing costs of $340,000 per
year for additional collection, analysis, and reporting of new
performance measures by the Department of Health Care Services
(General Fund and federal funds).
Unknown costs to make administrative changes to the system for
enrolling Denti-Cal providers (General Fund and federal
funds). The bill requires the Department to make several
changes to the processes and systems for enrolling dental
providers into the program, such as requiring the use of a
dental-specific enrollment form, pursuing an automatic
enrollment process for commercially-credentialed providers,
and improving the system for maintaining the provider network.
The Department has already began some of these processes, such
AB 2207 (Wood) Page 1 of
?
as simplifying the paper enrollment application. Other
activities, such as automatically enrolling
commercially-credentialed providers have not begun and will
impose unknown administrative costs to implement. On the other
hand, improvements to the system for provider enrollment may
reduce future administrative workload to process enrollment
applications, which are currently very labor intensive to the
Department and its fiscal intermediary.
Unknown costs to provide additional Denti-Cal services, to the
extent that the changes in the bill improve participation
rates by dental providers, increasing the utilization of
Denti-Cal services (General Fund and federal funds).
Currently, the state spends about $1.2 billion per year on
Denti-Cal for adults and children. Estimates of the
utilization rates, but are all generally low. There are strong
indications that low reimbursement rates and cumbersome
administrative requirements on providers result in low
participation rates by providers. To the extent that the
administrative changes in the bill improve provider
participation, there could be increased utilization. For
example, for every 5% increase in annual utilization by
children, the cost would be about $35 million per year.
Unknown potential cost-savings due to increased use of
preventative dental services (General Fund and federal funds).
Regular dental care, particularly for children, is likely to
prevent dental conditions, such as cavities, from becoming
more serious health problems that require more costly
interventions later. To the extent that the bill results in
increased utilization of preventative dental services in
Denti-Cal, there are likely to be reduced costs for more
serious dental services. Whether those avoided costs are
greater than the cost of providing greater access to
preventative services is unknown.
Background: Under state and federal law, the Department of Health Care
Services operates the Medi-Cal program, which provides health
care coverage to low income individuals, families, and children.
Medi-Cal provides coverage to childless adults and parents with
household incomes up to 138% of the federal poverty level and to
children with household incomes up to 266% of the federal
poverty level. The federal government provides matching funds
AB 2207 (Wood) Page 2 of
?
that vary from 50% to 90% of expenditures depending on the
category of beneficiary.
Medi-Cal coverage includes full dental coverage for children and
limited dental coverage for adults. (Adult coverage had been
eliminated from the program in 2009 but was partially restored
in 2013.) Dental services in Medi-Cal, referred to as Denti-Cal,
are provided through the fee-for-service system in most of the
state. Denti-Cal services are provided through dental managed
care in Sacramento and Los Angeles Counties (enrollment in
dental managed care is mandatory in Sacramento but optional in
Los Angeles).
Recent analyses of the Denti-Cal program by the Bureau of State
Audits and the Little Hoover Commission have found low levels of
utilization (particularly by children), low provider
reimbursement rates, and a complicated system for providers to
navigate. Estimates of the annual usage vary. According to the
Little Hoover Commission, in 2014 only 26% of eligible adults
saw a dentist. According to the Department, 52% of eligible
children saw a dentist in 2015. According to the federal
government, 38% of eligible children saw a dentist in 2014.
Proposed Law:
AB 2207 would enact an number of changes to the operation of
the Denti-Cal program, relating to provider enrollment, program
monitoring, and reporting.
Specific provisions of the bill would:
Require additional reporting of Denti-Cal performance
measures, particularly reporting of provider-specific
utilization measures;
Require quarterly posting of Denti-Cal performance measures
(rather than the current annual posting);
Require expedited enrollment of Denti-Cal providers, for
example by requiring a dental-specific enrollment form,
pursuing automatic enrollment for providers who are already
commercially credentialed with a Department of Health Care
Services contractor (e.g. the state's fiscal intermediary),
and making other streamlining changes;
Require the Department to disenroll a provider who has not
submitted a claim for more than one year, with specific
AB 2207 (Wood) Page 3 of
?
notification requirements;
Require additional monitoring of access and utilization of
Denti-Cal services;
Require the Department to assess opportunities for payment
reform proposals;
Require the Department to consult with stakeholders on ways to
improve the program, including several specific issues such as
utilization controls and outreach activities;
Require Medi-Cal managed care plans to provide dental
screenings, make referrals for necessary dental care, and
assist with referrals;
Authorize the Department to initially implement the
requirements of the bill without adopting regulations, but
require implementing regulations to be adopted by December 31,
2018;
Make implementation of the changes to the provider enrollment
process and other actions to improve access to Denti-Cal
contingent on federal approvals and receiving federal matching
funds;
Codify reporting requirements related to the Dental
Transformation Initiative (a dental-specific program within
the state's new Medi-Cal 2020 waiver).
Related
Legislation:
SB 1098 (Canella) would establish a Denti-Cal Advisory Group
within the Department of Health Care Services to study and
oversee the policies and priorities of the Denti-Cal program.
That bill is pending in the Assembly.
AB 1051 (Maienschein) would require the Department of Health
Care Services to increase certain Denti-Cal rates to those
paid under commercial dental coverage. That bill will be heard
in this committee.
Staff
Comments: The Department of Health Care Services has begun
several of the activities required in the bill, such as reforms
to the Denti-Cal provider enrollment system. The reporting
requirements relating to the Dental Transformation Initiative
are requirements of the Medi-Cal 2020 waiver and so would occur
with or without this bill.
AB 2207 (Wood) Page 4 of
?
-- END --