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BILLS OF INTEREST SPRING 2017
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CSPD follows a number of bills under consideration by the state legislature which potentially impact pediatric oral health. Members having questions or wishing to comment on these or any other legislative matters are invited to contact CSPD’s Public Policy Advocate, Dr. Paul Reggiardo, at reggiardo@prodigy.net.

AB 15 (Maienschein) - Denti-Cal: Reimbursement Rates. The bill would direct that Denti-Cal provider reimbursement rates for the 15 most common services be doubled beginning in the 2017-2018 fiscal year and that funds derived from the 2016 Proposition 56 Tobacco Tax Initiation be used to pay for the additional costs.

CSPD Position: Support

 Comment: Proposition 56 allocates a specified percentage of tobacco tax revenues to the Department of Health Care Services to increase funding for existing health care services which increase access and improve quality under the Medi-Cal program. This bill would be consistent with these objectives. Passage is unlikely.

AB 224 (Thurmond) - Pediatric Dental Sedation. This bill establishes new permitting requirements for the administration of general anesthesia, deep sedation, moderate sedation and minimal sedation of the dental patient. For deep sedation or general anesthesia of a patient under 7 years of age, the operating dentist, a separate licensed general anesthesia provider or a nurse anesthetist supervised by a general anesthesia permit holder, and one additional anesthesia support staff member would need be present. For moderate sedation of a patient under 7 years of age, at least two trained support staff in addition to the practicing dentist, one of which is a dedicated anesthesia monitor, would need be present. 

CSPD Position: Oppose Unless Amended

Comment: The requirement for a separate designated general anesthesia provider for children under age seven is not required in any other state and goes beyond the recommendations contained in the joint American Academy of Pediatrics / American Academy of Pediatric Dentistry Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation.

AB 753 (Caballero) - Denti-Cal: Improved Access. This bill would allocate $300 million in FY 2017-18 and indicate the intent of the legislature thereafter that at least 15% annually from Proposition 56 Tobacco tax revenues be dedicated to funding increased reimbursement for services under the Denti-Cal program.

CSPD Position: Watch

Comment: The DHCs would be instructed to immediately increase reimbursement rates for the 20 most common services for adults and children and to establish a Dental Transformation Initiative for the Adult program similar to the DTI established for children under the Medi-Cal 2020 Demonstration Project. 

AB 1277 (Daly) - Dental Waterlines. The bill directs the Dental Board of California to adopt final regulations by 12/31/18 to require that water or other irrigates used for procedures that expose the dental pulp to be sterile or contain recognized disinfecting or antibacterial properties.

CSPD Position: Support

Comment: The bill arises out of the cases of mycobacterium abscesses contracted at a dental clinic in Anaheim last year. An earlier provision that would have authorized the Board to “proactively” inspect the premises of a licensed dentist in the absence of a complaint has been removed.

SB 220 (Pan) - Medi-Cal Children’s Health Advisory Panel. This bill would make minor to the changes to the composition of the three Medi-Cal parent members, create member term limits, and provide the ability to remove a panel member for cause.

CSPD Position: Support

Comment: These are changes that do nothing to improve the structure or effectiveness of the panel.

SB 379 (Atkins) - Oral Health Assessments. The bill would require the Department of Education to consult with the State Dental Director in strengthening the reporting requirements of the school-entrance Oral Health Assessment on caries experience and centralizing the reporting of data.

CSPD Position: Support

Comment: The reporting on caries experience is intended as an ongoing measure of the effectiveness of one area (reduction in childhood caries) of the State Dental Plan.

SB 392 (Bates) - Pediatric Dental Patients: Access to Care; Continuing Education. The bill would require the Dental Board to provide to the Legislature an analysis of the effects on access to care for pediatric dental patients as it relates to requiring the addition of a second general anesthesia permitholder during the administration of general anesthesia on a patient seven years of age or younger, if the operator-provider is currently a general anesthesia permitholder. Would also direct the Dental Board to develop curriculum requirements for a course in Pediatric Life Support to be required of anesthesia permit holders.

CSPD Position: Watch

Comment: The course curriculum to be developed by the Dental Board would be consistent with the joint AAP/AAPD Guidelines for the provision of general anesthesia and deep sedation. The reporting requirement closely duplicates that in SB 501 (Glazer).

SB 501 (Glazer): Dentistry: Anesthesia and Sedation. The bill would revise the requirements for the administration of general anesthesia and sedation in the dental setting and require the Dental Board to provide a report to the Legislature of the effects on access to care for pediatric dental patients as it relates to requiring the addition of a second GA permitholder during the administration of GA on a patient seven years of age or younger if the dental provider is currently a GA permitholder before any such requirement is placed into statute.

CSPD Position: Watch

Comment: The bill otherwise closely mimics AB 224 (Thurmond). It would additionally require that for moderate sedation (defined as the administration of two or more drugs) of a patient seven years of age or younger there be at least two support staff in addition to the dentist present at all times during the procedure, one solely dedicated to monitoring the patient and trained in pediatric life support and airway management. The sponsor of the bill, the California Association of Oral and Maxillofacial Surgeons, contends that available data, including that collected by the Dental Board in its 2016 report to the Legislature, does not support an association between adverse outcomes and the type of provider or practice model.

SB 508 (Roth) - Denti-Cal County Managed Dental Care Pilot Project. This bill would authorize a hybrid Medical Managed Care and Dental Managed Care collaboration pilot program in the counties of Riverside and San Bernardino to deliver oral health services to common patients.he bill would require the Department of Education to consult with the State Dental Director in strengthening the reporting requirements of the school-entrance Oral Health Assessment on caries experience and centralizing the reporting of data.

CSPD Position: Watch

Comment: The experience of Denti-Cal dental managed care programs in Sacramento and Los Angeles suggest caution in this approach.

SB 707 (Canella) - Denti-Cal Advisory Group. This bill would establish the Denti-Cal Advisory Group in the Department of Health Services for the purpose of studying the policies and priorities of Denti-Cal with the goal of raising the Denti-Cal utilization rate among eligible child beneficiaries to 60% or greater. 

CSPD Position: Watch

Comment: The bill names a representative of CSPD as one of the 11 designated panel members. It is essentially identical to a bill introduced by Senate Member Canella last year, which was modified before passage to remove the advisory panel.    

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