BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | SB 1098| |Office of Senate Floor Analyses | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- UNFINISHED BUSINESS Bill No: SB 1098 Author: Cannella (R) Amended: 8/15/16 Vote: 21 SENATE HEALTH COMMITTEE: 9-0, 4/20/16 AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen, Pan, Roth, Wolk SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/27/16 AYES: Lara, Bates, Beall, Hill, McGuire, Mendoza, Nielsen SENATE FLOOR: 38-0, 6/2/16 AYES: Allen, Anderson, Bates, Beall, Berryhill, Block, Cannella, De León, Fuller, Gaines, Galgiani, Glazer, Hall, Hancock, Hernandez, Hertzberg, Hill, Hueso, Huff, Jackson, Lara, Leno, Leyva, McGuire, Mendoza, Mitchell, Monning, Moorlach, Morrell, Nguyen, Nielsen, Pan, Pavley, Roth, Stone, Vidak, Wieckowski, Wolk NO VOTE RECORDED: Liu, Runner ASSEMBLY FLOOR: 79-0, 8/24/16 - See last page for vote SUBJECT: Medi-Cal: dental services: advisory group SOURCE: Author DIGEST: This bill requires the Department of Health Care Services (DHCS) to report to the Legislature on progress towards the goal of raising the Denti-Cal utilization rate among eligible child beneficiaries to 60% or greater and to identify a date by which DHCS projects this utilization goal will be met. Sunsets the provisions of this bill on January, 1, 2021. SB 1098 Page 2 Assembly Amendments delete provisions establishing in DHCS the 13-member Denti-Cal Advisory Group (Advisory Group), and specifying the duties of the Advisory Group, and instead insert the above-described reporting requirement. ANALYSIS: Existing law: 1)Establishes the Medi-Cal program, which is administered by the DHCS, under which qualified low-income individuals receive health care services, including certain dental services, as specified. 2)Requires the Department of Public Health (DPH) to maintain a dental program including, but not limited to, the following: a) Development of comprehensive dental health plans within the framework of the State Plan for Health to maximize utilization of all resources; b) Provide the consultation necessary to coordinate federal, state, county, and city agency programs concerned with dental health; c) Encourage, support, and augment the efforts of city and county health departments in the implementation of a dental health component in their program plans; d) Provide evaluation of these programs in terms of preventive services; and, e) Provide consultation and program information to the health professions, health professional educational institutions, and volunteer agencies. 3)Requires the director of DPH to appoint a California-licensed dentist to administer the dental program in 2) above. This bill: 1)Requires DHCS, by October 1, 2017, to report to the Legislature on progress towards the goal of raising the Denti-Cal utilization rate among eligible child beneficiaries to 60 percent or greater and identify a date by which DHCS projects this utilization goal will be met. SB 1098 Page 3 2)Permits DHCS to include in the report any recommendations for legislative consideration that would assist DHCS in meeting the goal by the specified date, and, if applicable, requires DHCS to engage relevant stakeholders in the development of those recommendations. 3)Sunsets the provisions of this bill on January 1, 2021. Comments 1)Author's statement. According to the author, in a state audit of DHCS' Denti-Cal Program released in 2014, the auditor concluded that "DHCS' information shortcomings and ineffective actions are putting children enrolled in Medi-Cal at higher risk of dental disease." It is unacceptable that a program established to provide the most vulnerable population of children with oral health services is placing those children at risk of dental disease. The same report also highlights the program's low children utilization rates. The "program's statewide utilization rates for child beneficiaries was 41.4% in 2013 accounting for fee for service, managed care delivery models, and from centers and clinics. In a report entitled "Fixing Denti-Cal," released in April 2016, the Little Hoover Commission recommends that the Legislature set a utilization target rate. This bill sets a target rate of 60% or greater, as is the case in approximately 20 percent of U.S. states. DHCS must also identify a date by which it projects this utilization goal will be met, and it would be authorized to include in the report recommendations for legislative consideration that would assist DHCS to meet the goal by the specified date. 2)Medi-Cal has two different models for delivering dental services. The Medi-Cal Program is administered by DHCS and covers dental services for children under age 21 and a more limited benefit for adults. Adult dental coverage was eliminated in 2009 in AB 5 (Committee on Budget, Chapter 20, Statutes of 2009), which also eliminated other optional benefits for adults that had been covered under Medi-Cal. A more limited adult dental benefit was restored in AB 82 (Budget Committee, Chapter 23, Statutes of 2013), the 2013-14 SB 1098 Page 4 budget health trailer bill. Medi-Cal uses two different models for delivering dental services to children: fee-for-service (FFS) and Dental Managed Care in two counties. 3)Denti-Cal utilization. Denti-Cal utilization is low with different estimates for different time frames. According to the Little Hoover Commission report, only 26% of eligible California adults with fee-for-service Denti-Cal coverage saw a dentist in 2014, according to February 2016 DHCS data. DHCS stated that 51.8% of children 20 and under with Denti-Cal fee-for-service coverage had a dental visit from October 2014 through September 2015. In December 2015, the Centers for Medicare and Medicaid Services (CMS), in approving the California Medi-Cal 2020 waiver, cited a figure of 37.8% of children 20 and under making a dental visit during the calendar year 2014. In December 2014, the California State Auditor cited CMS data to report that only 44% of California's 5.1 million Denti-Cal-eligible children aged 20 and under saw a dentist from October 2012 through September 2013. DHCS currently has a small workgroup effort regarding implementation of the Dental Transformation Initiative under the Medi-Cal 2020 Waiver. The purpose of this workgroup is to collaborate with DHCS on the planning and implementation efforts that are needed to ensure the success of the dental component of the waiver. FISCAL EFFECT: Appropriation: No Fiscal Com.:YesLocal: No According to the Assembly Appropriations Committee: According to the Assembly Appropriations Committee, to the extent this bill results in additional utilization of dental services based on the specific utilization goal of 60%, unknown, potentially significant costs to the Denti-Cal program, as well as potential cost avoidance through prevention of more severe dental problems by improving access to dental preventive care (General Fund/federal). The net effect is unknown. SB 1098 Page 5 SUPPORT: (Verified8/24/16) California Dental Association California Dental Hygienists' Association California Health + Advocates California Pan-Ethnic Health Network Little Hoover Commission OPPOSITION: (Verified8/24/16) None received ARGUMENTS IN SUPPORT: California Health+ Advocates (CH+A) writes in support that California's community clinics and health centers (CCHC), provide approximately one-third of Medi-Cal dental care to adults and children in California, and thus understand the value of oral health. CH+A states that the Little Hoover Commission's report, "Fixing Denti-Cal," made clear the need for immediate action to improve Denti-Cal policies and priorities with the aim of increasing timely access to quality oral health services. CH+A states that it supports efforts to document improvements to access and continue legislative engagement on Denti-Cal. ASSEMBLY FLOOR: 79-0, 8/24/16 AYES: Achadjian, Alejo, Travis Allen, Arambula, Atkins, Baker, Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang, Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray, Grove, Hadley, Harper, Roger Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Quirk, Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk, Williams, Wood, Rendon SB 1098 Page 6 NO VOTE RECORDED: Daly Prepared by:Scott Bain / HEALTH / (916) 651-4111 8/26/16 8:51:16 **** END ****