BILL ANALYSIS �
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|SENATE RULES COMMITTEE | SB 694|
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THIRD READING
Bill No: SB 694
Author: Padilla (D), et al.
Amended: 1/12/12
Vote: 21
SENATE BUS., PROF. & ECON. DEVEL. COMMITTEE : 7-0, 1/9/12
AYES: Price, Emmerson, Corbett, Correa, Hernandez, Negrete
McLeod, Vargas
NO VOTE RECORDED: Walters, Wyland
SENATE HEALTH COMMITTEE : 7-0, 1/11/12
AYES: Hernandez, Alquist, Blakeslee, De Le�n, DeSaulnier,
Rubio, Wolk
NO VOTE RECORDED: Strickland, Anderson
SENATE APPROPRIATIONS COMMITTEE : 8-0, 1/19/12
AYES: Kehoe, Walters, Alquist, Emmerson, Lieu, Pavley,
Price, Steinberg
NO VOTE RECORDED: Runner
SUBJECT : Dental care
SOURCE : The Childrens Partnership
DIGEST : This bill creates, provided the Department of
Finance memorializes in writing that sufficient funds have
been deposited with the state, a Statewide Office of Oral
Health (Office) within the Department of Public Health.
Establishes within the Office a Dental Director with
specified duties. Permits the Office to conduct a study to
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assess the safety, quality, cost-effectiveness, and patient
satisfaction of irreversible dental procedures performed by
traditional and nontraditional providers. The provisions
of this bill sunset on January 1, 2016.
ANALYSIS :
Existing law:
1. 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.
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. Suspends existing law, provided the Department of
Finance (DOF) memorializes in writing that sufficient
funds have been deposited with the state, requiring DPH
to maintain a dental program and replaces this with the
Office.
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2. Requires the Office 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 no General Fund moneys shall be used for
the Office, but the state may accept public funds and
private funds for the Office and that the Office shall
be established only after a determination has been made
by the DOF that public or private funds are sufficient
to fully support the activities of the Office, are
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 to support the activities of the
Office, DOF shall file a written statement with the
Secretary of the Senate, the Chief Clerk of the
Assembly, and the Legislative Counsel memorializing that
this determination has been made.
5. Requires the Office, 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.
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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. Allows the Office to design and implement a
scientifically rigorous study to assess the safety,
quality, cost-effectiveness, and patient satisfaction of
expanded dental procedures for the purpose of informing
future decisions about how to meet the state's unmet
oral health need for the state's children. 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. Requires procedures
performed during the study be performed only by
providers within the confines of a university based
study.
8. Requires the Dental Director to convene an advisory
group, as specified, 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. Requires the Dental
Director to consult with the Legislative Analyst's
Office in designing the study and selecting contractors.
9. Provides that no General Fund money shall be used to
implement the study, and that monies to fund the study,
including analysis and findings, shall be secured from
other public or private sources. Provides that no one
providers group or interest group may provide more than
half the private funding for the study
10.Sunsets the study by January 1, 2014, if it is not
sufficiently funded and commenced by that date.
11.Sunsets the entire bill on January 1, 2016.
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Background
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 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 one 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
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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 five-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.
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.
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 eliminates this unit and will
replace it with the Statewide Office of Oral Health.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
Fiscal Impact (in thousands)
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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 tech. Up to
$2,000 one time, minor ongoing
Federal
system
Study of dental proc. $100 $100
Private
Increase in Unknown,
potentially significant t
General/
Denti-Cal Benefits cost
increase annually
Federal
utilization
SUPPORT : (Verified 1/23/12)
The Children's Partnership (source)
American Academy of Pediatrics
California Association of Rural Health Clinics
California Coverage and Health Initiatives
California Dental Association
California School Health Centers Association
California Society of Pediatric Dentistry
Children Now
Children's Defense Fund of California
Los Angeles Area Chamber of Commerce
Mendocino Community Health Clinic, Inc.
The 100% Campaign
Venice Family Clinic
Western Dental Services, Inc.
Worksite Wellness LA
OPPOSITION : (Verified 1/23/12)
California Nurses Association
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Machado Maxillofacial Surgery
ARGUMENTS IN SUPPORT : 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.
ARGUMENTS IN OPPOSITION : The California Nurses
Association writes, "The skill and maturity that's acquired
through four years of undergraduate plus four years of
dental school is the MINIMUM required to safely treat our
children. Anything less would be unconscionable. To use
the state's time and resources create a new Office of Oral
Health and to set up a study to test the efficacy of
under-educated non-dentist providers practicing on children
is irresponsible. SB 694 is an unnecessary and dangerous
piece of legislation.
"California has the best dentist patient ratio in the
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country; there is no shortage in the workforce. This
problem is due to the lack of funding in our state budgets.
Dental and other health programs are on the chopping block
every budget cycle."
JJA:do 1/25/12 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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