BILL ANALYSIS �
SB 694
Page 1
Date of Hearing: August 8, 2012
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Felipe Fuentes, Chair
SB 694 (Padilla) - As Amended: August 6, 2012
Policy Committee: HealthVote:19-0
Business and Professions Vote: 8-0
Urgency: No State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill, contingent on a declaration by the Department of
Finance that sufficient funds are available, creates a Statewide
Office of Oral Health (Office) within the Department of Public
Health (DPH), defines the Office's duties, and authorizes the
Office to oversee a large study assessing the ability of
midlevel dental practitioners to perform specified additional
procedures. Specifically, this bill:
1)Establishes the Office contingent on the receipt of adequate
funding.
2)Establishes a dental director to oversee the office, and
describes the director's qualifications.
3)Establishes duties for the Office, 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 and
statewide and local programs.
e) Promoting evidence-based approaches to increase oral
health literacy.
f) Establishing a system for surveillance and oral
health reporting.
SB 694
Page 2
g) Duties assigned to DPH under current law, including
supporting and augmenting the efforts of city and county
health departments in the implementation of a dental
health component in their program plans.
h) Identifying and securing funding sources in order to
maintain the office.
i) Overseeing the design and implementation of a
workforce study to assess the ability of trained
mid-level dental practitioners to perform a list of seven
procedures, including convening an advisory group and
reporting on findings to the Legislature.
4)Specifies Office duties shall be prioritized contingent on
available funds.
5)Allows DPH to receive financial aid from any source to carry
out the bill's provisions.
6)Prohibits GF moneys from being used for this bill's purposes.
7)Requires the Department of Finance (DOF) to make a
determination within 90 days of receiving funds, and annually
thereafter, regarding the funding status of the office.
8)Makes the establishment of a dental director contingent on a
determination by DOF that sufficient funds are available.
9)Describes in detail a workforce study the Office is authorized
to oversee, and requires a California university dental school
to design and implement the study.
10)Requires all funding for the workforce study and evaluation
to be secured from non-GF public or private sources. Prohibits
any one interest group from providing more than half the
private funding for the study.
11)Makes provisions describing the study inoperative on January
1, 2014 if the study has not commenced by that date.
12)Repeals the bill's provisions on January 1, 2017.
FISCAL EFFECT
1)Annual costs of up to $750,000 (donations/GF cost pressure)
through 2016 to establish and staff the Office, including a
SB 694
Page 3
dental director, research scientist, and other program and
support staff.
2)One-time costs to develop a surveillance system would be at
least $2 million (donations/GF cost pressure) based on
development costs of similar systems. Ongoing costs to
maintain the system would likely be in the hundreds of
thousands of dollars.
3)The bill envisions study costs in the range of several million
dollars to $10 million would be funded by non-state dollars,
such as federal and foundation money. The Office would absorb
the cost of overseeing the design and implementation of the
study within the staff budget listed in (1).
4)Although the bill includes a prohibition on GF funding, it
creates significant and ongoing state cost pressure (further
discussed below).
5)Minor costs to the DOF to monitor and issue determinations
regarding the funding status of the Office.
COMMENTS
1)Rationale . The author indicates this bill is intended to
address the dental health access dilemma in California. He
cites high rates of tooth decay among children, as well as
shortages of pediatric dental providers that are expected to
worsen as additional children gain dental coverage in 2014
under federal law. He indicates a need to study innovative
policies to determine the best way to bring basic oral health
care to underserved children in the state. In addition, he
believes state oral health leadership is crucial to draw down
federal dollars and coordinate essential dental public health
functions, including assessing need and capacity to address
that need. This bill is sponsored by The Children's
Partnership, a national nonprofit child advocacy organization.
2)Fiscal Comments . This bill creates significant ongoing fiscal
pressure on the state regardless of its prohibition on GF
funding, as it intends to create ongoing state leadership in
oral health, as well as an ongoing surveillance
infrastructure. The bill requires DOF to make a determination
regarding whether funding is sufficient to establish the
Office, but the bill lacks clarity as to how much funding is
SB 694
Page 4
sufficient (for example, it is common for federal grants for
infrastructure projects similar to that envisioned by this
bill to provide ongoing funding for three to five years).
The bill also creates state fiscal risk because it lacks a
strong mechanism for abolishing the Office and surveillance
functions if non-GF funding is inadequate. The bill does
indicate that duties can be prioritized based on available
funding, but the dental director position and support at a
minimum would cost the state $300,000 annually. If a
surveillance system were established, there would be strong
fiscal pressure to maintain the system.
In addition, it is unclear which state entity has initial
responsibility to solicit funds in order to establish the
Office. Finally, the bill does not create a special fund or
account to receive donations and fund the Office. Presumably,
donations would be made to the GF in absence of a special fund
or account to receive donations for this purpose.
3)Support . Children's health advocacy groups support this bill
as a way to increase access to children's dental care. The
California Dental Association states they support establishing
the Office as long as sufficient federal and private funds are
secured, and points out that a study as specified in the bill
is the appropriate next step in building the necessary
evidence base prior to any consideration of expanded or
increased scope of practice.
4)Opposition . The Hispanic Dental Association, California
Academy of General Dentists, and individual dentists oppose
the provision in this bill relating to the workforce study
because the study would include non-dentists doing surgical or
irreversible procedures.
The California Nurses Association states this bill allows
non-dentist providers to provide care outside of their scope
of licensure, contending this is a dangerous precedent for our
health care delivery system and for our educational system
which is set up to train appropriately licensed practitioners.
Analysis Prepared by : Lisa Murawski / APPR. / (916) 319-2081
SB 694
Page 5