BILL ANALYSIS Ó
AB 2207
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CONCURRENCE IN SENATE AMENDMENTS
AB
2207 (Wood)
As Amended August 15, 2016
Majority vote
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|ASSEMBLY: | 80-0 |(May 31, 2016) |SENATE: | 38-0 |(August 18, |
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Original Committee Reference: HEALTH
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 quarterly (instead of annual) posting of the data of
the Denti-Cal FFS and DMC program performance measures to be
posted on DHCS' Internet Web site, beginning April 1, 2017.
Aligns the timing of the Denti-Cal FFS and managed care
reports.
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2)Requires DHCS to ensure, to the greatest degree possible, that
the categories of data and performance measures selected for
Denti-Cal FFS are consistent with the categories of data and
performance measures selected for DMC plans.
3)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.
4)Requires DHCS to maintain the provider network by disenrolling
a billing and rendering provider who has not, over a
continuous 12-month period, submitted a claim for
reimbursement for services rendered.
5)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.
6)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.
7)Requires DHCS to explore additional opportunities in
consultation with stakeholders, to improve the Denti-Cal, as
specified.
8)Allows DHCS to implement, interpret, or make specific policies
and procedures by means of all-county letters, plan letters,
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plan or provider bulletins, or similar instructions, requires
DHCS to thereafter adopt regulations, and requires DHCS to
update the legislature until regulations are adopted.
9)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.
10)Contains other provisions to improve Denti-Cal
accountability, transparency, and quality.
The Senate amendments
1)Require DHCS, no sooner than July 1, 2019, to annually publish
the following utilization data from the preceding calendar
year and post the information on its internet Web site:
a) Number of patients seen on a per-provider basis;
b) Number of annual preventative dental services dental
treatment services, examinations, and oral health
evaluations rendered by each provider during each calendar
year; and,
c) The number of beneficiaries who received general
anesthesia services.
2)Require DHCS to maintain the provider network on a monthly
basis and clarify procedures regarding the deactivation and
disenrollment of Denti-Cal providers.
3)Specify that a provider who has not submitted a claim for
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reimbursement of services rendered in one continuous 12 month
period be deactivated and, at the time of deactivation,
require DHCS to send a notification to the provider informing
them of their ability to request reactivation.
4)Specify that a Denti-Cal provider be disenrolled 6 months
after DHCS has notified them of their deactivation status.
5)Make provisions in 2) through 4) above, operational once DHCS
has implemented necessary system changes to the California
Dental Medicaid Management Information or July 1, 2017,
whichever is later.
6)Specify requirements for DHCS to work with Denti-Cal managed
care plans that contract with DHCS to provide beneficiaries
with access to dental plan liaisons to assist with referrals
to health plan covered services.
7)Codify the Dental Transformation Initiative (DTI) data
reporting and evaluation quality measure requirements required
to be reported to the federal government and made publicly
available for each of the four DTI domains contained in the
Special Terms and Conditions of Medi-Cal 2020, the state's
Section 1115 Medicaid waiver.
FISCAL EFFECT: According to the Senate Appropriations
Committee:
1)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).
2)Unknown costs to make administrative changes to the system for
enrolling Denti-Cal providers (General Fund and federal
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funds). This 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 begun some of these processes,
such 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.
3)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.
4)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
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greater than the cost of providing greater access to
preventative services is unknown.
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.
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
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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.
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
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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
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:
0004210