The COVID-19 pandemic has highlighted the ability of medical and dental plans to make record profits during a public health emergency by collecting premiums while paying fewer claims as patients receive less care. CDA is supporting SB 242 by Senator Josh Newman (D-Fullerton), which would require insurance plans to reimburse health care providers for costs related to the procurement of critical safety supplies, such as personal protective equipment (PPE). The costs of PPE vary throughout the state and have been exacerbated by product scarcity, supply chain disruptions and price gouging. Many providers are paying in the range of $10-$25 per patient, adding up to thousands of dollars of new costs every month. Although mask mandates and social distancing requirements are easing, these requirements will not be lifted in medical or dental offices any time soon. Federal and state financial assistance is not sufficient to cover the ongoing costs. With the increased economic burden of safely operating in the current circumstances, there is a risk of patients losing access to care and a constriction of the dental network in our state. SB 242 is needed to ensure that provider practices, which have endured over a year of sustained financial losses, are not also required to bear the cost of these new, medically necessary expenditures entirely on their own. SB 242 passed out of the Senate and is now moving through the Assembly. While SB 242 focuses on near term relief for health care providers, CDA and the California Medical Association also co-sponsored AB 454 by Assemblymember Freddie Rodriguez (D-Pomona), which, in the event of a future catastrophic public health emergency, would give authority to the Department of Managed Health Care and California Department of Insurance to require plans to support providers through various means such as grants, increased rates or payments for increased costs of mandatory infection control measures. AB 454 was held in the Assembly Appropriations Committee and will not move forward this year.
The state’s record revenues and federal stimulus funding provide an important opportunity to address oral health needs across the state. CDA advocated strongly for the following ongoing investments in oral health that are included in the 2021-2022 state budget:
CDA is sponsoring AB 526 by Assemblymember Jim Wood, DDS, (D-Healdsburg), which amends the Dental Practice Act to allow dentists to administer COVID-19 and flu vaccines. This bill would codify the existing Department of Consumer Affairs waiver that allows dentists to administer COVID-19 vaccines during the current COVID-19 public health emergency. Specifically, it would allow a dentist to independently prescribe and administer influenza and COVID-19 vaccines approved by the FDA in compliance with federal vaccination schedule guidelines. Additionally, AB 526 would align the California Department of Public Health regulations with federal law so dentists can obtain the appropriate state licensure alongside their Clinical Laboratory Improvement Amendments certificate, which will allow them to conduct COVID-19 rapid tests to screen their patients and dental team members when such tests become widely available and appropriate for use in the dental office. AB 526 passed out of the Assembly and is currently moving through the Senate.
The Medical Injury Compensation Reform Act allows injured patients to receive unlimited economic damages for all past and future medical costs, lost wages and lifetime earning potential. MICRA also allows up to $250,000 in noneconomic damages and includes a limit on attorneys’ fees, stabilizes liability costs and reduces incentives for frivolous lawsuits against health care providers. A group of trial lawyers have qualified a ballot measure for the November 2022 election that would essentially eliminate MICRA’s protections. This measure would undeniably raise health care costs and reduce access to care for those who need it most, including people who use Medi-Cal, county health programs, safety-net providers and school-based health centers. CDA is part of Californians to Protect Patients and Contain Health Care Costs, a broad coalition including physicians, nurses, hospitals, safety-net clinics and other health care providers committed to fighting this initiative.
CDA and the California Dental Hygienists Association are co-sponsoring a collaborative effort to help improve access to care for Medi-Cal dental beneficiaries without a dental home. AB 733 by Assemblymember David Chiu (D-San Francisco) seeks to expand access to oral health care for Medi-Cal-enrolled children and pregnant people by allowing RDHAPs to partner with physicians in medical settings to provide fluoride treatments and oral health education and to coordinate care with dental providers and the dental care system. CDA and CDHA are working with stakeholders including the California Society of Pediatric Dentists, CMA, Children Now and the American Academy of Pediatrics-California on this collaborative effort to expand access to care and improve medical-dental integration. AB 733 is a two-year bill as CDA continues to work with stakeholders.
CDA is committed to improving the state’s health care delivery system and to extending health coverage to all Californians. We are eager to work with lawmakers on solutions the state is capable of implementing to achieve universal coverage and protect the significant progress made under the Affordable Care Act (ACA), which allowed California to achieve a larger reduction in its uninsured rate than any other state. Introduced by Assemblymembers Kalra, Lee and Santiago, AB 1400 would replace Medicare, Medi-Cal, all private insurance and the Covered California exchange with one state health care program. CDA has numerous concerns with such a proposal including the lack of any funding details and the great difficulty the state has meeting its existing obligations to underserved patients in the Medi-Cal program. Creating the single-payer health care system proposed in AB 1400 would also require passage of a ballot measure by voters and approval from the federal government and could require hundreds of billions of dollars in new tax revenues. The bill did not receive a hearing this year and will not move forward.
Sugar-sweetened beverages are the single largest source of added sugar in the American diet. They are also a significant driver of various health conditions including tooth decay, which affects more than two-thirds of California children (making dental caries the most common chronic childhood disease). CDA and a coalition of more than a dozen leading health care organizations are pursuing legislation, AB 1163 by Assemblymember Adrin Nazarian (D-North Hollywood), to return power to local cities and counties, allowing them to pass local sugary drink excise taxes if they are appropriate for their communities. When the legislature passed a statewide preemption on these local taxes in 2018, the state eliminated a popular and helpful tool that municipalities could use to raise additional revenue and improve public health — dual policy objectives especially important in the wake of the COVID-19 pandemic. AB 1163 did not receive a hearing this year and may be reconsidered next year.
Providing dental care that involves the movement of teeth without a proper evaluation, including X-rays, can lead to serious patient harm, such as loose or cracked teeth, bleeding tongue and gums, gum recession or a misaligned bite. With the emergence of new direct-to-consumer (DTC) business models offering various dental services that are ordered without an in-person clinical examination, it is imperative that dental treatment continues to meet a uniform standard of care regardless of whether a dentist provides treatment through telehealth or in person. CDA continues to advocate for consumer protections that ensure that DTC orthodontic business models have the same level of dentist oversight and patient safety as the virtual dental home model and in-person dental care. CDA will continue to work with the appropriate enforcement entities, including the dental board, to push for increased patient safety while pursuing improved statutory and regulatory enforcement.
Over the past several years, CDA has worked to improve transparency of dental benefit plans for dentists and consumers. AB 1962 (2014) required commercial dental plans to annually disclose to the state how much premium revenue they spend on patient care versus administrative costs, known as a dental loss ratio (DLR). The reported data show a wide range of premium revenue spent on patient care, with a quarter of all California dental plans spending less than 50% of premiums on care and some plans even falling below 10%. SB 1008 (2018) built upon this by requiring all dental plans to use a uniform matrix to disclose their benefits directly to consumers, similar to the one used by medical plans. This provides plan beneficiaries with a uniform summary of plan details, including covered services, reimbursement levels, estimated enrollee cost share, limitations and exceptions. In 2019, CDA successfully sponsored AB 954 (Wood, D-Santa Rosa), which requires dental benefit plans to be more transparent about the common practice of “leasing” access to a network of contracted dentists from another dental benefit plan to provide clarity for patients and providers, reduce confusion and help preserve trust in the dentist-patient relationship. These transparency measures help level the playing field for consumers and providers, are consistent with standards that apply to medical plans and help hold dental plans accountable for how they spend premium dollars.
Updated July 2021
Public Affairs Specialist