BILL ANALYSIS �
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|Hearing Date:January 9, 2012 |Bill No:SB |
| |694 |
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS
AND ECONOMIC DEVELOPMENT
Senator Curren D. Price, Jr., Chair
Bill No: SB 694Author:Padilla
As Amended:January 4, 2012Fiscal: Yes
SUBJECT: Dental care.
SUMMARY: Repeals existing law requiring the State Department of
Public Health (DPH) to maintain a dental program and replaces this
with the Statewide Office of Oral Health (Office of Oral Health).
Establishes within the Office of Oral Health a Dental Director with
specified duties. Requires the Office to design and implement a study
on irreversible dental procedures performed by traditional and
nontraditional providers for future decisions relating to scope of
practice changes, as specified.
Existing law:
1)Requires DPH to maintain a dental program including, but not limited
to, the following:
(Health & Safety Code � 104750)
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
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services; and,
e) Provide consultation and program information to the health
professions, health professional educational institutions, and
volunteer agencies.
2)Establishes the Dental Board of California to license and regulate
the practice of dentistry.
This bill:
1)Repeals existing law requiring DPH to maintain a dental program and
replaces this with the Office of Oral Health.
2)Requires the Office of Oral Health to maintain a licensed dentist to
serve as a Dental Director, and establishes certain
responsibilities for the Dental Director, including, but not
limited to:
a) Advancing and protecting the oral health of all Californians.
b) Developing a comprehensive and sustainable state oral health
action plan to address the state's unmet oral health needs.
c) Encouraging private and public collaboration to meet the oral
health needs of Californians.
d) Securing funds to support infrastructure statewide and local
programs.
e) Promoting evidence-based approaches to increase oral health
literacy.
f) Establishing a system for surveillance and oral health
reporting.
3)Provides that the state may accept public funds and private funds
for the Office of Oral Health and that the Office of Oral Health
shall be established only after a determination has been made by
the Department of Finance (DOF) that federal or private funds are
sufficient to fully support the activities of the Office, including
start-up funds for the Office having been deposited with the
state.
4)Provides that if DOF makes a determination that the amount of
federal or private funds deposited with the state is not sufficient
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to support the activities of the Office, it is the intent of the
Legislature that provisions of this measure creating the Office
will become inoperative.
5)Requires the Office of Oral Health, if established, to be
responsible for identifying and securing funding sources, and if
the Office does not secure sustainable funding sources, the Office
shall become inoperative on January 1, 2016.
6)Finds and declares that, as part of a comprehensive integrated
system of dental care, with the dentist as the head of that system,
additional dental providers who provide basic preventive and
restorative oral health care to underserved children, located at or
near where children live or go to school, may have the potential to
reduce the oral health disease burden in the population most in
need.
7)Requires the Office of Oral Health to design and implement a
scientifically rigorous study to assess the safety, quality,
cost-effectiveness, and patient satisfaction of irreversible dental
procedures performed by the traditional and nontraditional
providers for the purpose of informing future decisions about scope
of practice changes in the dental workforce that include
irreversible or surgical procedures. Requires the research
parameters of the study to include public health settings, multiple
models of dentist supervision, multiple pathways of education and
training, and multiple dental providers, including dentists and
nondentists.
8)Requires the Dental Director to convene an advisory group on study
design and implementation, provide input regarding study design and
implementation, receive all study data and reports, and develop a
report and recommendations to be submitted to the Legislature based
on the study findings.
9)Provides that no General Fund money shall be used to implement the
study, and that moneys to fund the study, including analysis and
findings, shall be secured from other public or private sources.
10)Sunsets the study by January 1, 2014, if it is not sufficiently
funded and commenced by that date.
11)Finds and declares the need to address unmet dental needs,
especially with the full implementation of the federal Patient
Protection and Affordable Care Act (PPACA).
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FISCAL EFFECT: Unknown. This bill has been keyed "fiscal" by
Legislative Counsel.
COMMENTS:
1.Purpose. The Children's Partnership (TCP) is the sponsor of this
measure. According to TCP, this measure is intended to help begin
to address the dental health access dilemma in California,
especially its impact on children. TCP points out that tooth decay
is the most common chronic disease and unmet health care need of
children in California, and about 71% of California's children
experience tooth decay by the time they reach the third grade.
Additionally, about one million children live in federal dental
health professional shortage areas or areas where there is a
shortage of dental providers. The access problem is only expected
to get worse with the implementation of the PPACA as approximately
1.2 million additional children are expected to gain dental coverage
over time, leading to an even greater mismatch between the number
and location of available providers and their ability to provide
services for the increasing number of children needing dental care.
As a result, there is a need for a comprehensive coordinated
strategy based on state oral health leadership that can coordinate
essential dental public health functions, including assessing need
and capacity to address that need. This measure would authorize a
scientifically rigorous study to assess the safety, quality, cost
effectiveness, and patient satisfaction of irreversible dental
procedures performed by traditional and non-traditional providers,
for the purpose of informing future decisions about scope of
practice changes in the dental workforce that include
irreversible/surgical procedures.
2.Background.
a) Impact of Federal Health Care Reform on the Dental Workforce.
Last year, one of the issues raised by the background paper for
the sunset process for the Dental Board of California was whether
California will be able to meet the increased demand for dental
services with the enactment of PPACA. A brief summary of the
dentist workforce was included in the background paper,
specifically, a June 2009 Health Policy Fact Sheet (Health Policy
Fact Sheet) by the University of California, Los Angeles Center
for Health Policy Research which indicated that California has
about 14% of the total number of dentists nationwide (the largest
percentage of any state). The dentist-to-population ratio in
California is estimated as 3.5 dentists per 5,000 or a dentist
for every 1,440 persons. This ratio is higher than the national
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estimate of three dentists per 5,000, or a dentist for every
1,660 persons. However, the Health Policy Fact Sheet revealed
that although there is a large number of practicing dentists in
California, many areas in the state continue to have a shortage
of dentists, and these areas are mostly located in rural areas,
including Yuba, Alpine, Colusa, Mariposa, Mono and San Benito
Counties. Additionally, according to the United States Health
and Human Services Agency, there are 333 dental health
professional shortage areas statewide. These designated areas
generally have a dentist-to-population ratio of one per 5,000 or
lower; a high population need with a ratio of at least 1.25
dentists per 5,000 (or 1 per 4,000); and a public or non-profit
health center that provides dental services to shortage areas or
populations. Additionally, the Health Policy Fact Sheet
indicated that the percentage of dentists who may be nearing
retirement age is greater than the percentage of newly licensed
dentists. In some counties, far fewer are newly licensed and
many more are nearing retirement age. As the background paper
indicated, these shortages could potentially impact the
implementation of the PPACA.
In California, implementation of the PPACA is under way with the
enactment last year of AB 1602 (Perez), Chapter 655, Statutes of
2010, and SB 900 (Alquist, Steinberg), Chapter 659, Statutes of
2010, establishing the California Health Benefits Exchange within
the California Health and Human Services Agency. According to
advocates, an estimated 1.2 million California children will soon
gain dental coverage due to the recent enactment of the PPACA.
However, advocates argue that California will not be able to
fulfill the promise of improving children's dental health if
there are not enough dental providers to meet this growing
demand.
The following provisions are included in the PPACA and will impact
dental workforce in California:
Requires that insurance plans offered under the Exchange
to include oral care for children.
Expands school-based sealant programs.
Authorizes $30 million for fiscal year 2010 to train oral
health workforce.
Establishes 5-year, $4 million demonstration projects to
test alternative dental health care providers.
Establishes a public health workforce track, including
funding for scholarships and loan repayment programs for dental
students and grants to dental schools.
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Establishes three-year, $500,000 grants to establish new
primary care residency programs, including dental programs.
Provides funding for new and expanded graduate medical
education, including dental education.
a) Oral Health Unit within DPH. The Oral Health Unit within DPH
(formerly the Office of Oral Health), currently has one staff and
among other functions, is charged with maintaining a dental
program that develops a comprehensive dental health plans,
coordinates federal, state, county, and city agency programs
related to dental health, and encourages, supports, and augments
the efforts of city and county health departments in the
implementation of a dental health component. This bill will
eliminate this unit and will replace it with the Statewide Office
of Oral Health.
1. Prior Legislation. SB 540 (Price) Chapter 385, Statutes of 2011,
among other provisions extended the sunset date of the Dental Board
of California.
2. Arguments in Support: The California Dental Association (CDA)
states that it is committed to a comprehensive approach to reducing
barriers to dental care in California while maintaining patient
safety as a top priority. CDA points out that California needs a
Dental Director with a public health background and a vision for
how to improve the oral health status of the state. Additionally,
CDA states that as part of a comprehensive integrated system for
dental care, with the dentist as the head of that system,
additional dental providers who provide basic preventive and
restorative oral health care to low-income children may have the
potential to reduce the oral health disease burden in the
population most in need. However, clear evidence has not been
established through qualified research regarding the safety,
quality, cost effectiveness, and patient satisfaction of such
procedure performed by non-dentist providers. Such a study is the
appropriate next step in building the necessary evidence base for
any new provider or scope of practice considerations.
Children Now points out that this measure is a first step to begin
addressing California's dental access issues. This bill will help
identify strategies the help strengthen the state's dental
workforce to meet the current and growing demand for care by the
most vulnerable children and strengthen the state's oral health
leadership.
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NOTE : Double-referral to Senate Health Committee
SUPPORT AND OPPOSITION:
Support:
The Children's Partnership (Sponsor)
California Coverage and Health Initiatives
California Dental Association
Children Now
Los Angeles Area Chamber of Commerce
Mendocino Community Health Clinic, Inc
Venice Family Clinic
Western Dental Services, Inc
Worksite Wellness LA
Opposition:
None on file as of January 4, 2012
Consultant:Rosielyn Pulmano