BILL ANALYSIS �
AB 1174
Page 1
Date of Hearing: January 23, 2014
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
AB 1174 (Bocanegra and Logue) - As Amended: January 6, 2014
Policy Committee: Business and
Professions Vote: 12-0
Health Vote: 17-0
Urgency: No State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill allows certain allied dental professionals to perform
additional functions, and addresses Medi-Cal reimbursement for
teledentistry services that are otherwise covered by the
program. Specifically, this bill:
1)Allows registered dental assistants (RDAs) in extended
functions (RDA-EF), registered dental hygienists (RDH), and
registered dental hygienists in alternative practice (RDH-AP)
to place interim therapeutic restorations (ITRs) and choose
which x-rays to take for purposes of diagnosis by a dentist.
2)Allows RDAs to choose which x-rays to take.
3)Prescribes, until 2018, training requirements for dental
personnel who perform the additional functions.
4)Adds teledentristy to a list of specialty health care services
for which face-to-face contact is not required in order to
claim reimbursement from Medi-Cal. Subjects such
reimbursement to billing and reimbursement policies developed
by the Department of Health Care Services (DHCS).
FISCAL EFFECT
1)Annual fee-supported special fund costs to the Dental Hygiene
Committee of California (DHCC) and the Dental Board of
California (DBC) to approve training courses and to oversee
the expanded scope of dental personnel would be incurred as
follows:
AB 1174
Page 2
a. $150,000 to the DBC, which regulates RDAs (State
Dental Assistant Fund).
b. $80,000 to the DHCC (State Dental Hygiene Fund).
2)Minor one-time Information Technology (IT) costs to
incorporate changes to the licensing system (State Dental
Assistant Fund/State Dental Hygiene Fund).
3)Denti-Cal, the dental program within Medi-Cal, may incur
additional costs, potentially in the hundreds of thousands of
dollars, as a result of increased utilization of dental
services. Increased costs are more likely if personnel
performing the expanded functions, and/or using teledentistry,
reach populations that may otherwise forgo dental care. Given
utilization rates of Denti-Cal services are extremely low,
there appears to be ample opportunity to increase utilization,
leading to commensurate cost increases.
Any additional costs would likely be relatively small at first
and could grow with time, as the expanded functions and
reimbursement for teledentistry became the norm. A credible
fiscal estimate for initial years developed by the principal
investigators of Health Workforce Pilot Project (HWPP) #172,
based upon the number of participants in the project, pegged
increased Denti-Cal costs at about $300,000 annually, likely
growing slowly over time (GF/federal funds, majority federal
funds). This estimate may overstate costs directly resulting
from this bill, as existing law authorizes DHCS to reimburse
for teledentistry services.
In practice, however, it appears as though ambiguity as to
whether providers are allowed to bill Medi-Cal for
teledentistry services has limited provider interest in
developing these systems and billing Medi-Cal.
4)If this bill leads to greater utilization of relatively
low-cost preventive interventions such as ITRs, the state may
eventually experience some level of future cost savings by
avoiding more costly dental diseases and emergencies. However,
an estimate of the magnitude and likelihood of any such
savings are beyond the scope of this analysis.
COMMENTS
AB 1174
Page 3
1)Purpose . The intent of this bill is to expand, statewide,
components of a pilot program that has allowed allied dental
professionals to provide additional functions in community
settings as part of a telehealth-enabled dental care team.
The author hopes this bill will expand the development of the
piloted model of community dental care, termed the "Virtual
Dental Home," and that the deployment of this model will
improve access for hard-to-reach populations such as
low-income children, individuals living in institutions, and
the developmentally disabled. This may help address extremely
low utilization of Denti-Cal.
2)Background . The Office of Statewide Health Planning and
Development (OSHPD) oversees health workforce programs in the
state. The HWPP program within OSHPD allows organizations to
test and evaluate new or expanded roles for health care
professionals. Because HWPPs allow small-scale testing of
changes to a health care professional's scope in a safe and
controlled manner, they can provide a reasonable basis to
guide statutory changes that affect an entire licensure
category.
HWPP #172 piloted the "Virtual Dental Home" model by
implementing the expanded scope, along with technology that
enables the allied dental professionals to provide services in
a community setting. The pilot ran for three one-year
periods, ending December 31, 2013. A number of reports have
evaluated various aspects of the pilot. Approximately 2,000
patients were seen in settings ranging from preschools to
long-term care facilities. University of the Pacific, which
conducted the project, reported no adverse occurrences and
reported that individuals served were generally satisfied with
the service. They also found equipment and overheard costs
for the services were relatively low, and thus project this
model can be deployed economically even if providers rely
largely on Denti-Cal reimbursement.
3)Related Budget Proposal . To address low utilization of
Denti-Cal services among children, the governor's 2014-15
budget proposes $17.5 million (California Children and
Families Commission Proposition 10 funds /federal funds) to
increase dental outreach activities.
4)Concern . The California Association of Oral and Maxillofacial
Surgeons has concerns with the provisions allowing mid-level
AB 1174
Page 4
professionals to place ITRs, and would support this bill if
these provisions were amended out.
The California Dental Association indicates it has been
working with the author on several of the details of the bill,
including supervision and settings for the new duties, and
would be in support if these issues are addressed.
The California Dental Hygienists Association opposes the bill
unless amended to remove certain provisions related to x-rays,
contending their scope already allows them to perform
procedures explicitly authorized by this bill.
Analysis Prepared by : Lisa Murawski / APPR. / (916) 319-2081