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CA Dental Board Report July 2015
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The California Society of Pediatric Dentistry is the state’s leading advocate and recognized authority on oral health issues affecting infants, children, adolescents and patients with special health care and developmental needs. The Society interacts with the state legislature, regulatory bodies, licensing bureaus, institutions of dental education, media outlets, and policy makers at all levels of public and private participation to promote and ensure optimal pediatric oral health in the state.

Medi-Cal / Denti-Cal Program Benefits
Late last year the California State Auditor, at the direction of the legislature, released an analysis of the Denti-Cal program which found that 56 percent of the 5.1 million enrolled children received no services the previous year. In addition, the majority of counties have insufficient numbers of Denti-Cal providers and the Department of Health Care Services (DHCS) does not provide adequate program oversight.  The report went on to blame Denti-Cal reimbursement rates as the likely primary reason for low provider participation.

Partly in response to the State Auditor and partly in response to prior legislation, the DHCS has begun to increase data collection and public reporting. Under SB 857 (2014), the DHCS is required to post annually on its website certain fee-for-service program performance measures. Those measures for 2013 are posted at http://www.denti-cal.ca.gov/provsrvcs/managed_care/FFS_perf_meas_2013.pdf. The 2014 performance measures will be posted October 1.

Under a separate section of the Welfare and Institutions Code, the DHCS is required to annually review Denti-Cal provider reimbursement and to assess the effect of payment rates on beneficiary access to services. This review has been performed only once in the last 14 years.  On July 1, the DHCS, in compliance with the law, posted the results of an internal  review that compared reimbursement rates for the 25 most common Denti-Cal Fee-For-Service (FFS) procedures with that of five comparable states’ Medicaid Programs and to commercial rates in the five ADA geographic regions. The report reveals that California’s dental Medicaid reimbursement rates fall significantly below those in the similarly-sized states of New York, Texas and Florida and are only 31 percent of the national average for commercial insurance. In addition, the DHCS reported that while there has been a nearly 40 percent increase in childhood enrollment and a 77 percent increase in enrolled adults since 2008, there has been a double-digit decrease in providers in that same timeframe. The report is available online at http://www.dhcs.ca.gov/Documents/2015_Dental-Services-Rate-Review.pdf.

In what can be reported as positive movement, the legislature and the Governor reached agreement in the final fiscal year 2015-2016 state budget adopted in July to cease implementation of the 2008 10 percent FFS rate cut to Denti-Cal providers, which will take effect as soon as approval is obtained from the federal Centers for Medicare and Medicaid Services (CMS). There is still much work to be done, however, to address reimbursement issues for the 51 percent of all children in the state and the one-third of all adults now eligible for Medi-Cal / Denti-Cal coverage, who experience difficulty, if not downright obstacle, in accessing oral health services under the state Medicaid program.

Dental Board of California Sunset Review
The Dental Board of California is undergoing this year the “sunset review” process, in which the legislature evaluates the need for the continued existence of a state program or an agency. The “sunset review” allows for an assessment of effectiveness and performance, focusing on the overall necessity of the agency and its cost-effectiveness, successes and failures.

One of the issues attracting the attention of the Joint Sunset Review Committee is the long-range financial viability of the Board and the appropriate initial licensure and biannual renewal fees. The Board has recently sustained substantial fiscal deficits due primarily to increased enforcements costs mandated by the Department of Consumer Affairs for all health related boards and bureaus. Last year the Board raised licensure fees for dentists to $525, the maximum amount allowed under current statute. Under SB 179 (Bonilla), currently under consideration by the legislature, the cap would increase to $650 in 2016 and to $800 in 2018. The proposed fee caps come after an independent audit of the Board’s finances last year which found that the Board expends more on enforcement activities than all other functions combined and that without significant increase in revenue the Board would be unable to carry out its licensing and enforcement responsibilities

State Dental Director
After years of lobbying by the dental profession and by oral health advocates across the spectrum of child and adult welfare, led by CDA, the 2014-15 fiscal year state budget included establishment and ongoing funding of a state Office of Oral Health within the California Department of Public Health (DPH). In June of this year, Dr. Jayanth Kumar was appointed as the new State Dental Director to head the office and manage California’s oral health programs within the DPH. Dr. Kumar was previously the Dental Director for the state of New York, where he developed the state’s first comprehensive oral health plan. In addition to developing a similar oral health plan for California, Dr. Kumar’s responsibilities will include establishing and obtaining federal and other funding for statewide oral health education and prevention projects with an emphasis on infants and children. He will take office on August 1.

Covered California – Patient Protection and Affordable Care Act
Last year marked the first year under the Affordable Care Act that most Americans were required to obtain health insurance, including essential pediatric oral health benefits for children, or pay a penalty. More than 4.5 million Californians obtained that coverage through Medi-Cal eligibility expansion and through the Covered California Health Benefits Exchange. In 2014 pediatric oral health benefits were sold exclusively through separate stand-alone pediatric dental plans. Disappointingly, only about one third of parents purchased such plans for their minor dependents.

To increase the number of children obtaining dental coverage, the Exchange this year is requiring all health plans to include embedded pediatric dental benefits. Medical plans have partnered with separate dental plans --- capitated and fee-for-service --- to provide this coverage. Although it was the intent of Covered California to offer for separate purchase stand-alone family dental plans this year, so that adults could obtain dental benefits through the Exchange, these products will not be available until 2016.

 

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