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Delta Advocacy

Approximately 14,000 dentists are expected to receive payments by the end of October as part of CDA’s settlement agreement with Delta Dental. The agreement, which was approved by the court in May and followed by a 60-day appeal period, provides $65 million to Premier providers who had their fees impacted by Delta Dental’s “inflationary adjustment percentage.” Under the agreement, Delta Dental has 120 days from the end of the appeal period to distribute the payments to eligible providers. Dentists who did not have their fees reduced improperly by the inflationary adjustment percentage will not receive payments.

Among Premier providers receiving awards, individual settlement payments vary from $500 to many thousands of dollars and are based on Delta Dental’s record of requests for fee increases submitted to Delta, any application of the inflationary adjustment percentage to those requested fee increases, and detailed and individualized claims history for services performed between Jan. 1, 2011, and Sept. 14, 2017.

CDA has received inquiries from Premier providers who did not receive settlement allocations or thought their award amounts should be higher. In many of those instances, Delta Dental records show those dentists did not file for fee increases or did not file at regular intervals. CDA Practice Support recommends that providers file a fee proposal every 12 months from their last fee request, as allowed under the terms of their Premier provider agreement. An office should propose their usual fee at the time of submission. This provides Delta Dental with “true” fee data for a region.

In addition to the monetary settlement, Delta Dental must provide:

  • 120 days’ written notice of material changes to participating dentist agreements to all contracted providers.    
  • Each Premier provider affected by any attempt to reduce reimbursement rates with an individualized illustration of how those reductions would potentially affect the dentist’s practice. 
  • CDA with 12 days’ advance notice of changes to participating dentist agreements to prepare for questions from members.

Although this agreement does not prevent future rate reductions, CDA successfully blocked Delta Dental’s attempt to reduce Premier provider reimbursement rates during the five-year litigation, which saved dentists — even those not receiving settlement payments — more than $600 million in Premier plan fee reductions.

For settlement details, visit Members with questions about the terms or meaning of the settlement may contact CDA at 800.232.7645.

Silver diamine fluoride bill passes
CDA-sponsored legislation, Senate Bill 1148 (Pan, D-Sacramento), which if passed would allow dentists who provide care in the Medi-Cal dental program to be reimbursed when they use silver diamine fluoride for dental caries treatment, passed out of its first committee hearing — the Senate Health Committee — in April and was due to be heard by the Senate Appropriations Committee in late May.Read more

•    AB 3087 puts a new government bureaucracy in charge of health care.
The bill would create a state government commission of 11 political appointees to cap commercial provider payments.
•    AB 3087 would decimate California’s health care delivery system and limit patient access to care. The bill does not address underlying health care cost drivers, will lead to further consolidation of the health care industry, and will harm patient access by reducing the number of providers willing to practice in the state.
•    AB 3087 would create an expensive and undefined appeals process. Providers may challenge the price caps, however many dentists are sole proprietors or practice in small groups, making this process prohibitively inaccessible or expensive for all but the largest providers.
•    AB 3087 would not solve the fundamental problems of the health care payment system. The proposal does nothing to address the state’s low Medi-Cal reimbursement rates or true cost drivers like provider consolidation and rising pharmaceutical costs.
•    AB 3087 is self-serving. The commission would have to pay consumer advocates who come before the commission, diverting precious health care dollars away from patients.
•    AB 3087 would harm our economy. This bill would cause an estimated 175,000 health care workers to lose their jobs, as well as limit capital investment in communities throughout the state.
    AB 3087 would take California backwards. The bill would destroy what Californians like about their health care and move us to an antiquated, “volume over value” model that discourages contracting and stifles innovation.

CDA Major Issues & Prioritiescda_logo

  1. Medi-Cal – Proposition 56 Funding
    More than half of children and a third of adults — over 13 million Californians — now rely on the state’s Medi-Cal program for their medical and dental coverage. The passage of Prop. 56 in 2016 — a tobacco tax increase co-sponsored by CDA — is leading to significant Medi-Cal funding improvements. Medi-Cal patients have faced major barriers to care for many years, including long delays for appointments, trouble finding specialists and traveling long distances to receive care. A primary reason for this has been that California’s reimbursement rates to Medi-Cal providers have been among the lowest in the nation, resulting in a lack of providers able to participate in the program. The 2018-19 state budget includes $210 million in additional dental provider reimbursements from Prop. 56 funds — a 50 percent increase over last year’s allocation. The current budget increases rates for adult prevention and periodontal treatment, as well as for the top 25 most commonly billed services, anesthesia and sedation, and paying for extra time when treating patients with special needs. This builds upon last year’s funding, which resulted in 40 percent rate increases for hundreds of dental procedures including restorative, prosthodontics, surgical and adjunctive services. Furthermore, the 2018-19 budget includes $30 million from Prop. 56 funds for a new dental school loan repayment program, which should improve access to dentists in underserved areas. The criteria of the program will be developed in the months ahead. While fixing Medi-Cal will be a long-term process, CDA is very pleased with the progress made since the passage of Prop. 56 and is working to ensure this progress is sustained.
  2. SB 1008: Dental Plan Transparency – Sponsor
    Californians deserve transparency, accountability and value from their dental benefit plan. CDA-sponsored legislation in 2014 (AB 1962) required commercial dental plans to annually disclose how much premium revenue they spend on patient care versus administrative costs, known as a dental loss ratio (DLR). The data reported since shows a wide range of premium revenue spent on patient care, raising serious questions about what value these plans provide to consumers (click here for a full list of DLRs). A quarter of all dental plans in California spend less than 50 percent of premiums on patient care, and some plans even fall below 10 percent. SB 1008 (Skinner) will increase transparency for consumers in several ways. The bill requires all dental plans to use a uniform matrix to disclose their benefits, similar to the one used by medical plans. The matrix will provide plan beneficiaries with a uniform summary of plan details, including covered services, reimbursement levels, estimated enrollee cost share, limitations, and exceptions. SB 1008 will help level the playing field for consumers and providers by holding plans accountable to comparable standards as medical plans. SB 1008 passed with bipartisan support and was signed by the governor.
  3. SB 1148: Silver Diamine Fluoride – Sponsor
    CDA sponsored SB 1148 (Pan), which would have required the Department of Health Care Services to reimburse dentists who use silver diamine fluoride (SDF) as a dental caries treatment when applied as part of a comprehensive treatment plan. SDF is a topical medication used to slow down or stop dental decay in both primary and permanent teeth. The use of SDF is a nonsurgical approach to treating dental decay, does not require local anesthetic and can be applied quickly and painlessly. SDF is a colorless liquid that contains both silver and fluoride and although it stains the decayed portion of a tooth, it is becoming more widely used, especially in posterior and primary teeth. In California, Medi-Cal is already using SDF as part of a broader pilot project in 11 rural counties to manage dental decay in children under 6 years old. While SDF may not fully eliminate the need for additional care, it gives Medi-Cal providers a new and effective tool to treat dental decay among the growing Medi-Cal population. Although SB 1148 passed unanimously out of the legislature, Governor Brown vetoed the bill due to its costs to the state. CDA will continue working to improve access to SDF as an effective, non-invasive and low-cost tool to treat dental decay.
  4. Pediatric Dental Anesthesia
    The use of general anesthesia during a dental procedure is necessary in certain cases to allow for the provision of care, particularly for young children or patients with special needs. California has long-required a variety of safeguards along with written informed consent of the associated risks of anesthesia. The Dental Board of California recently completed a review of existing state policies on pediatric dental anesthesia and issued a number of recommendations to improve patient safety including: creating new permit categories and additional training, further strengthening enforcement and data collection, and codifying specified personnel that must be present during such procedures. The Dental Board also recommended that there be an analysis of the effects of any proposed new legislation or regulation on access to care for pediatric dental patients prior to the implementation of any changes. CDA supported SB 501 (Glazer) this year, which adopts the Dental Board’s recommendations and calls for a study from the board on the cost and access implications of requiring a separate anesthesia provider during general anesthesia for children under seven years old. The bill passed out of the legislature with bipartisan support and was signed by the governor. CDA also sponsored AB 2643 (Irwin) this year to expand health plan coverage for general anesthesia provided in a dental office for certain populations: children under 7, people who are developmentally disabled and people of any age with physical or medical conditions that require general anesthesia for the provision of dental care. Currently, private health plans are required to cover general anesthesia for the populations listed above, but current law limits the treatment setting to either a hospital or surgery center. The Assembly Appropriations Committee held AB 2643 and it will not move forward this year. CDA will continue working to improve access and affordability for patients who need this type of care.
  5. Sugar-Sweetened Beverage Tax
    CDA and the California Medical Association are co-sponsoring a ballot measure for the November 2020 election to establish a statewide two-cent-per-ounce tax on the distribution of sugar-sweetened beverages (SSB), such as sodas, energy drinks and sugar added juices. SSBs are the single largest source of added sugar in the American diet and a primary cause of diabetes and dental decay—the most common chronic childhood disease, experienced by more than two-thirds of children in California. The frequency of consumption, along with the combination of high levels of sugar and acid, make these beverages uniquely damaging to teeth and overall health. SSBs are also displacing consumption of milk, the principle source of calcium in the diet, which is critical to the development of healthy teeth. The ballot measure follows the passage of local SSB taxes in four California cities since 2014 and responds to recent legislation that enacted a 12-year moratorium on any new local SSB taxes. That legislation passed in exchange for the withdrawal of a ballot measure backed by the beverage industry that would have required a two-thirds vote on any local tax increase. The CDA/CMA-sponsored initiative would raise at least $2 billion in revenue for critical health programs and reverse the moratorium on local SSB taxes, preserving the ability of local communities to make their own decisions on combating SSB consumption.
  6. AB 3087: Provider Rate Regulation – Oppose
    CDA is part of a large coalition of organizations that opposed AB 3087 (Kalra), which sought to regulate and cap commercial payment rates for health care providers. AB 3087 stalled in the Assembly Appropriations Committee and did not move forward. The bill would have created a state government commission of 11 political appointees to set provider payments based on a percentage of Medicare rates. AB 3087 did not address underlying health care cost drivers, would have led to further consolidation of the health care industry, and would have harmed patient access by reducing the number of providers willing to practice in the state. CDA is committed to expanding access to care and containing rising costs. However, AB 3087 was a short-sighted, simplistic regulatory scheme that would have created massive disruption across the entire health care system.
  7. Universal Health Care/Single Payer (SB 562)
    CDA and the Coalition to Protect Access to Care, which includes community clinics, physicians, nurse practitioners, Kaiser Permanente and other health care organizations, are committed to building upon the existing health care delivery system to extend health coverage to the remaining 3 million uninsured Californians. The coalition is committed to working with lawmakers on solutions that the state is capable of implementing to achieve universal coverage and that 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. The coalition opposed the single payer health care system proposed in SB 562, which would have replaced Medicare, Medi-Cal, all private insurance and the Covered California exchange with one health care program managed by the state. This is especially concerning as the state has had great difficulty meeting its existing obligations to underserved patients in the Medi-Cal program. Creating the single payer health care system proposed in SB 562 would require approval from the federal government, passage of a ballot measure by voters and, according to the state Legislative Analyst’s Office, could require new tax revenues of up to $200 billion.
  8. Federal Health Care Reform
    Under the ACA, California created the country’s largest and most robust state health insurance exchange (Covered California), which includes stand-alone family dental plans, and expanded Medicaid eligibility to millions of new beneficiaries. The federal government currently contributes approximately $60 billion of California’s $100 billion Medi-Cal budget, a significant portion of which is due to the ACA expansion. While Congress has not been successful in fully repealing and replacing the ACA, the recently passed tax reform bill eliminated the financial penalty for individuals who choose not to purchase health insurance, known as the individual mandate. Estimates are that the resulting increase in premiums and enrollment reductions will result in 13 million fewer people with health insurance nationwide and 1.2 million in California. Discussions continue in Congress on fully repealing and replacing the ACA, and CDA is working to protect California’s current Medi-Cal funding at both the federal and state levels, maintain state flexibility to provide coverage, prevent erosion of networks, and protect the overall dental safety net.
  9. State Office of Oral Health – Proposition 56 Funding
    CDA’s Access Plan to reduce barriers to oral health care prioritizes the need for a comprehensive state oral health program led by a state dental director. The state began providing ongoing funding for a dental director and Office of Oral Health (based in the Dept. of Public Health) in the 2014-15 budget for the first time in decades, and Jay Kumar, DDS, MPH was appointed to the position in 2015. Dr. Kumar came to California with more than 25 years of experience in the New York State Bureau of Dental Health, where he also held the position of state dental director and developed the first comprehensive state oral health plan for New York. Dr. Kumar and stakeholders, including CDA, spent the first half of 2016 developing a state oral health plan, which was officially released earlier this year. The plan includes objectives such as building community-clinical linkages, expanding access to fluoride, dental sealants and screenings, dental coverage, tobacco use counseling and interventions, and developing programs that promote oral health literacy and healthy habits. These efforts will receive a strong boost from the passage of Prop. 56, which includes an annual $30 million for the state oral health program—a tenfold funding increase and the first time the program has ever had a dedicated revenue source.

Updated October 4, 2018