BILL ANALYSIS                                                                                                                                                                                                    Ó




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          |SENATE RULES COMMITTEE            |                       SB 1098|
          |Office of Senate Floor Analyses   |                              |
          |(916) 651-1520    Fax: (916)      |                              |
          |327-4478                          |                              |
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                                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.









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          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. 








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          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  








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            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.  








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          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








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           NO VOTE RECORDED: Daly


          Prepared by:Scott Bain / HEALTH / (916) 651-4111
          8/26/16 8:51:16


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