CDA Major Issues & Priorities 2020
1. COVID-19’s Impacts on Dentistry
Dental Plan Provider Network Stabilization
CDA continues to urge Governor Newsom and legislators to protect access to dental care in their response to the COVID-19 pandemic. Approximately 97% of California dental offices completely closed or were only seeing emergency patients from March through May. Now that dental practices are reopening, they are facing significantly increased overhead costs combined with decreased patient volume due to strict COVID-19 safety guidelines (additional personal protective equipment (PPE), heightened infection controls and physical distancing of patients). According to the most recent survey data, nearly one-third of dental offices in California are seeing less than 50% of their typical patient volume. The high cost of PPE is exacerbated by extreme scarcity due to supply chain disruptions that have led to price gouging by some suppliers. Meanwhile, dental benefit plans continue to collect millions in premiums from employers and enrollees throughout the crisis. CDA is asking the legislature to require that dental plans:
Provide three rounds of provider stabilization grants to in-network contracted providers, based on a percentage of average claims, to cover the significant reduction in claims paid in 2020;
Provide a $25 minimum PPE payment per patient, per visit through the end of 2021;
Extend 2020 annual plan maximums through the end of 2021 to allow enrollees to receive some of the dental care they were unable to receive during shelter-in-place restrictions.
With the state facing the possibility of widespread closures of dental practices, dental plans must be called on to share in the high costs of additional PPE, without which dental care is not currently possible. This proposal is targeted, time-limited relief that will help keep provider networks intact and prevent massive disruption to dental care access in California.
CDA is also working with the Legislature to ensure that once reliable rapid testing technology is available, dentists can obtain and use COVID-19 test kits to identify asymptomatic patients and route them to the appropriate venue for care, obtain all applicable lab licenses and receive reasonable reimbursement for administering tests.
2. Proposition 56 and the Medi-Cal dental program
In the midst of a global health care crisis, the 2020-21 state budget preserves critical safety-net health care funding in the Medi-Cal dental (Denti-Cal) program. The COVID-19 pandemic has led to significant revenue losses for California’s economy, and Governor Newsom laid out a budget proposal in May that slashed billions of dollars to close a $54 billion deficit. Included in these cuts were reduced Medi-Cal adult dental benefits, cutting provider reimbursement rates by 40% and eliminating other recently restored adult Medi-Cal benefits. CDA, with support from thousands of members who participated in our grassroots efforts, successfully advocated for the preservation of adult dental benefits, Proposition 56 supplemental payments and the CalHealthCares student loan repayment program. Proposition 56 funds have led to a steady increase of over 1,500 newly enrolled Medi-Cal dental providers since 2017, after decades of declining participation. The cuts proposed by the governor in May would have resulted in a significant rate cut to dental reimbursements and worsened the damage already done to Medi-Cal dentists as a result of the pandemic. CDA will continue to work closely with the Legislature and governor’s office to protect the Medi-Cal dental program as the state’s budget situation develops.
3. AB 1998: Direct-to-Consumer Orthodontic Protections – Support
AB 1998 by Assemblymember Evan Low (D-Silicon Valley) builds upon direct-to-consumer (DTC) orthodontic consumer protections in last year’s dental board sunset review bill by:
Refining diagnostic record requirements for orthodontic treatment
Codifying dental record retention requirements
Further defining at what point during treatment a patient must be given contact information for their treating dentist
Expanding the prohibition for any person, including an employee, to enter into a contract that limits their ability to submit complaints to a regulator
Establishing explicit rights to request copies of any documents signed by a patient.
Providing dental care that involves the movement of teeth without a proper evaluation can lead to serious patient harm, including loose or cracked teeth, bleeding tongue and gums, gum recession or a misaligned bite. With the emergence of new 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 which 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.
4. MICRA Repeal Ballot Measure – Oppose
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. This year, a group of trial lawyers began collecting signatures to qualify a ballot measure for the November 2020 election that would essentially eliminate the MICRA law’s protections. Due to the COVID-19 pandemic, the group has now submitted the initiative for the November 2022 ballot and are awaiting official qualification. Regardless of when it appears, 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 who are committed to fighting this initiative.
5. AB 2164: Improving Access to Care Through Telehealth – Support
CDA is supporting AB 2164 by Assemblymembers Robert Rivas (D-Hollister) and Rudy Salas (D-Bakersfield) this year to facilitate access to dental care through telehealth, specifically in federally qualified health centers using the virtual dental home model. This bill clarifies that an FQHC can establish a new patient and bill for a virtual dental home visit when a billable Medi-Cal provider employed by the FQHC supervises or provides the services for the patient via telehealth either in real-time or with store-and-forward technology. Recent guidance published by the Department of Health Care Services would significantly hinder the continuation and expansion of virtual dental homes in FQHCs. CDA was a co-sponsor of previous legislation that authorized the virtual dental home model and supports its continued use to increase access to care among some of the most vulnerable populations in California.
6. SB 793: Flavored Vaping/Tobacco Ban – Support
CDA supports SB 793 by Senator Jerry Hill (D-San Mateo) which will prohibit the sale of flavored tobacco products, including electronic cigarettes, in California. Flavored products, especially e-cigarettes, have the potential to reverse years of decline in tobacco usage in the state. Of greater concern is the alarming rise in vaping and e-cigarette use among youth, who often use these flavored nicotine-filled products. According to the California Department of Public Health, youth who would otherwise not have smoked cigarettes or used other tobacco products are still choosing to use flavored, electronic smoking devices. While research is still in process on vaping devices, we know that traditional tobacco use is estimated to account for over 90% of cancers in the oral cavity and pharynx and represents the greatest single preventable risk factor for oral cancer. It also contributes to periodontal disease, heart disease and other cancers of the body.
7. Dental Plan Transparency
Over the past several years, CDA has worked to improve transparency of dental 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, which is 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 2020
ADA Response to "The Truth About Dentistry" article in The Atlantic
ADA communications staff is currently preparing a response to a story in The Atlantic titled, “The Truth About Dentistry.” The article alleges dentistry lags behind the medical profession and is not largely scientific and evidence-based in regard to diagnoses and treatment. The story also serves to reinforce negative stereotypes of dentists and focuses on one example of a dentist (now a retired life ADA member) who is currently being prosecuted for insurance fraud and has settled multiple lawsuits related to overtreatment and fraudulent billing activity.
ADA communications staff was not contacted by the reporter, who began working on this story two years ago. We learned of the story when he contacted an employee in the ADA Science Institute. The reporter interviewed this ADA employee, but he was not quoted – likely because his quotes did not support the apparent slant the reporter was pursuing.
ADA staff is currently working on a response to the article. A standby statement is in development and we will share when it’s finalized. If you receive a media inquiry and would like assistance, please don’t hesitate to contact me. These pages on MouthHealthy.org may also be helpful if you see any negative chatter on social media and would like to respond:
The ADA is engaging a number of communications tactics to share positive stories about the amazing work dentists are doing, including posting on Facebook and Twitter, which you can feel free to share from your own channels. We are also spreading the word to the public about how to be an informed consumer of dental care – look for a new infographic on social media in the next couple days. When sharing these positive stories, we would advise against mentioning The Atlantic story, as we do not want to give it more credence than it’s already received.
Thanks for your time. As always, please let me know if we can be of assistance. Thank you!
Mike Bittner email@example.com
Division of Integrated Marketing & Communications