CDA Major Issues & Priorities 2020
1. COVID-19’s Impact 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. Since dental practices have reopened, they continue to face significantly increased overhead costs combined with decreased patient volume due to COVID-19 safety guidelines (additional personal protective equipment, heightened infection controls and physical distancing of patients). The high cost of PPE is exacerbated by product scarcity and supply chain disruptions. Meanwhile, dental benefit plans have continued to collect millions in premiums from employers and enrollees without pause. CDA is pushing for dental plans to:
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 working with the governor’s office, the California Department of Public Health and the legislature to ensure that once reliable rapid testing technology is available, dentists can obtain and use COVID-19 test kits to identify positive, asymptomatic patients and route them to the appropriate venue for care, obtain all applicable lab licenses and receive reasonable reimbursement for administering tests.
Dental Student Licensure
CDA staff, in coalition with the California dental school deans and dental school student leadership, advocated throughout spring 2020 for a pathway to timely dental licensure after patient-based licensure examinations were postponed indefinitely due to the pandemic. The Western Regional Examination Board and the American Board of Dental Examiners, the only testing agencies accepted by the Dental Board of California, announced that newly developed mannikin-based exam formats would be offered during the summer instead of patient-based exams.
After CDA advocacy to the DBC, the governor’s office and legislative staff, including multiple grassroots letter writing campaigns by dental students, the dental board approved the new exam formats as a pathway to licensure. Effective May 28, 2020, the DBC began to accept mannikin-based WREB and ADEX examinations on a permanent basis, allowing all six California dental schools to offer the tests and more than 800 graduating dental students across the country to take the requisite clinical examinations throughout summer 2020. This advocacy effort has resulted in California becoming one of the first states in the country to begin to move away from patient-based licensure examinations.
In late March, after advocacy from CDA, the California Department of Consumer Affairs temporarily waived the license-renewal continuing education requirements for dental professionals whose licenses expired between March 31 and June 30, giving them until Sept. 30 to satisfy any waived C.E. requirements. That waiver was extended to include licenses expiring through Oct. 31 and gave affected licenses until Feb. 27, 2021, to complete the needed C.E., although licensure renewals must still be paid for on their original renewal dates. At the beginning of September, CDA advocated and successfully obtained a third waiver to ensure that live C.E. courses that incorporated prerecorded lectures would be accepted by the dental board, as a way to counter any technological or internet provider shortages that could affect the quality of the course offerings.
CDA’s consistent advocacy efforts helped to secure all three C.E. waivers for dental professionals after cancellations of required in-person courses and testing because of the COVID-19 pandemic.
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) sought to build upon direct-to-consumer orthodontic consumer protections in last year’s dental board sunset review bill by refining X-ray requirements for orthodontic treatment, codifying dental record retention requirements, clarifying when a patient must be given contact information for their treating dentist, expanding the prohibition for any person to enter into a contract that limits their ability to file a complaint with a regulator and establishing explicit rights for patients to request copies of any documents they have signed.
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 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. AB 1998 stalled in the Senate Business & Professions Committee and did not move forward. 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.
4. SB 793: Flavored Vaping/Tobacco Ban – Support
CDA supported SB 793 by Senator Jerry Hill (D-San Mateo) which prohibits 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. SB 793 passed out of the legislature and was immediately signed by Governor Newsom, highlighting his strong commitment to this issue.
In response, the tobacco industry has already filed a referendum for the November 2022 ballot that would ask voters to decide the fate of the bill. The industry must collect more than 600,000 signatures, and tobacco companies have already committed $5 million to qualify the referendum for the ballot. If the signature gathering is successful, SB 793 would be suspended until the election, allowing tobacco companies to continue selling these addictive products for two more years.
5. SB 1383: Expands California Family Rights Act – Oppose
The California Family Rights Act (CFRA) and the federal Family Medical Leave Act (FMLA) have provided eligible employees up to 12 work weeks of protected, unpaid leave. CFRA only applies to employers with 50 or more employees, and this leave can be taken for the birth, adoption or foster care placement a child or for the employee’s own serious health condition or that of a child, parent or spouse. SB 1383 will reduce the CFRA employee threshold to businesses with five or more employees, applying CFRA’s provisions to nearly all employers, including a large percentage of dental practices.
CDA worked in coalition with other employer organizations to oppose the bill and express the unique concerns of dental practices. Approximately 80% of dental practices have 10 or less employees, and unlike larger businesses where staff duties can be adjusted to cover the work of an employee on a leave of absence, there is often little cross over between roles in a dental office. Dental assistants are not licensed to do the work of a dental hygienist, nor can an office manager, who is not already trained, take over the duties of a dental assistant. This specialization makes it very difficult to continue to see the existing volume of patients without hiring a new employee to fill the role of the employee on leave. Expansion of parental and family leave has been a high priority of Governor Newsom, and SB 1383 narrowly passed the legislature before being signed into law. CDA Practice Support will be preparing resources to ensure CDA members are prepared when the law takes effect in January 2021.
6. 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. 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 who are committed to fighting this initiative.
7. AB 2164: Improving Access to Care Through Telehealth – Co-Sponsor
CDA was a co-sponsor of AB 2164 by Assemblymembers Robert Rivas (D-Hollister) and Rudy Salas (D-Bakersfield) which aimed to facilitate access to dental care through telehealth, specifically in federally qualified health centers using the virtual dental home model. This bill would have clarified 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. AB 2164 passed out of the legislature with unanimous support but was vetoed by Governor Newsom due to potential state costs.
8. SB 653: Dental Hygienists – Support
CDA supported SB 653 by Senator Ling Ling Chang (R-Diamond Bar), which permits registered dental hygienists to apply fluoride varnish without the supervision of a dentist. It will also allow RDHs to provide services in medical offices through the virtual dental home model of care and in a larger variety of public health programs. Additionally, this bill expands the settings where registered dental hygienists in alternative practice can provide local anesthesia and soft tissue curettage when following specified safety protocols, including the collaboration of a dentist, in order to increase access to dental care in underserved areas and populations throughout California. SB 653 is the result of significant negotiations and collaboration efforts between Senator Chang, CDA and the bill sponsor, the California Dental Hygienists’ Association. SB 653 passed out of the legislature and was signed by the governor.
9. 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 October 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 firstname.lastname@example.org
Division of Integrated Marketing & Communications