BILL ANALYSIS �
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
SB 694 (Padilla)
Hearing Date: 1/17/2012 Amended: 1/12/2012
As proposed to be amended
Consultant: Bob Franzoia Policy Vote: B&P 7-0 Health 7-0
_________________________________________________________________
____
BILL SUMMARY: SB 694 would create a Statewide Office of Oral
Health within the Department of Public Health (department) with
a licensed dentist serving as dental director. This bill would
provide that no General Fund moneys shall be used to implement
these provisions, but would authorize the state to accept public
and private funds for the purpose of implementing the provisions
of this bill and would provide that the provisions would become
inoperative if federal or private funds sufficient to support
the office are not received. This bill would suspend existing
law which requires the department to maintain a dental program.
This bill would permit the office to conduct a study to assess
the safety, quality, cost-effectiveness, and patient
satisfaction of irreversible dental procedures performed by
traditional and nontraditional providers. The provisions of
this bill would sunset on January 1, 2016.
_________________________________________________________________
____
Fiscal Impact (in thousands)
Major Provisions 2012-13 2013-14 2014-15 Fund
Creation of new Statewide
Office of Oral Health
- personnel Up to $1,000 initially, up to $500
ongoing Private/
- information technology Up to $2,000 one time, minor
ongoing Federal
system
Study of dental procedures $100 $100 Private
Increase in Denti-Cal benefits Unknown, potentially
significant to major General/
utilization cost increase annually Federal
_________________________________________________________________
____
SB 694 (Padilla)
Page 1
STAFF COMMENTS: This bill meets the criteria for referral to the
Suspense File.
The department's Office of Oral Health helps to ensure oral
health needs especially within low-income families, are
addressed. Currently, this is done by local maternal, child and
adolescent health (MCH) programs working collaboratively with
existing dental and health-related programs. Funding is
provided by Federal Title V MCH block grant funds. The office's
Children's Dental Disease Prevention Program was eliminated in
2009-10 and the program is suspended indefinitely. The office
also administers a community water fluoridation program.
Statewide Office of Oral Health
This analysis estimates creating a Statewide Office of Oral
Health will require five to ten personnel for first year program
implementation and to establish an oral health infrastructure.
This infrastructure would include a surveillance system and
database for collecting oral health data thereby requiring a
major information technology investment. Given the goals of the
program (including the requirement for a licensed dentist),
higher levels of personnel compensation will be required. Once
the program is established, personnel requirements should
decrease to an estimated five personnel annually. Actual costs
are unknown and will be governed by the level of funding the
Department of Finance determines is sufficient to support the
activities of the office and the availability of federal and
private funds. The Department of Finance could initially
determine sufficient funds are not available though the statute
implementing the office would not be inoperative until January
1, 2016.
Study
Under this bill, the dental director may design and implement a
scientifically rigorous study to assess the safety, quality,
cost-effectiveness, and patient satisfaction of irreversible
dental procedures performed by 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. The research parameters of
the study shall include public health settings, multiple models
of dentist supervision, multiple pathways of education and
training, and multiple dental providers, including dentists and
SB 694 (Padilla)
Page 2
nondentists. The dental director shall convene an advisory
group on study design and implementation.
The dental director shall 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. In order to ensure the
study is conducted objectively staff recommends this bill be
amended to prohibit any one provider group or interest from
providing more than half the private funding for the study,
specify that the advisory group shall be comprised of
representative of all dental practices, traditional and
nontraditional, and nondentists, and require the director to
consult with the Legislative Analyst's Office in designing the
study and selecting any contractors.
Another way to ensure objectivity would be to conduct a more
generalized study focusing on how to meet the state's unmet oral
health needs which would reflect the action plan developed by
the dental director (page 3, lines 10-11). For example, Health
and Safety Code 104751 (b) would read:
(b) The office may design and implement a scientifically
rigorous study to assess the safety, quality,
cost-effectiveness, and
patient satisfaction of irreversible dental procedures performed
by
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
how to meet the state's unmet oral health needs.
The research parameters of the study shall include public health
settings, multiple models of dentist supervision, multiple
pathways
of education and training, and multiple dental providers,
including
dentists and nondentists .
This option may provide the dental director and the advisory
group more flexibility on study design and implementation.
Increased access to dental care
SB 694 (Padilla)
Page 3
The Medi-Cal Dental Program (Denti-Cal) provides comprehensive
dental care to children 21 years and younger. The scope of
available services for children includes dental sealants as a
covered benefit. Beginning June 1, 2011, Denti-Cal implemented
a 10 percent provider payment reduction for all dental services
as mandated by Chapter 3/2011.
Chapter 20/2009 eliminated most dental services for adults 21
years and older. Dental services that are still benefits for
adults are Federally Required Adult Dental Services, dental
services for pregnant beneficiaries for treatment of conditions
that might complicate the pregnancy, dental services that are
necessary as either a condition precedent to other medical
treatment or in order to undergo a medical surgery, and dental
services provided to beneficiaries who reside in a licensed
skilled nursing facility or intermediate care facility.
Denti-Cal fee for service expenditures (50 percent federal/50
percent state) for 2010-11 are as follows:
Total adults and children program expenditures: $467,197,164
Children only: $420,931,453, including:
- Prophylaxis: $8,660,769 (dental prophylaxis consists of
removing plaque and cleaning the teeth to prevent cavities and
gum disease)
- Topical application of fluoride, including prophylaxis:
$48,032,150
- Topical application of fluoride, no prophylaxis: $366,196
- Sealant - per tooth $21,637,243
- Total $78,696,358
Increasing oral health outreach will likely result in increased
Denti-Cal utilization. A one percent increase in children's
prophylaxis, fluoride and sealant benefits would increase costs
approximately $400,000 annually. Other Denti-Cal benefits would
also likely have increased utilization. These costs may be
offset by unknown Denti-Cal savings if the cost of treating
advanced dental disease is reduced.
The proposed author amendments would:
- change federal (funds) to public (funds).
- suspend, not eliminate, the existing oral health unit if the
SB 694 (Padilla)
Page 4
new statewide office of oral health secures sufficient funding.
- The Department of Finance will make determinations if there
are sufficient funds to state the new statewide office of oral
health and will make a determination on an annual basis.
- Add Senator Price as a coauthor.