LEGISLATIVE UPDATE

Fee-Cap Ban
Signed Into Law

Governor signs CDA-sponsored
legislation that prohibits fee caps

CDA successfully sponsored legislation, AB 2275 (Hayashi), that prohibits dental plans from
capping fees dentists may charge for non-covered services.

The bill, which was signed into law by Governor Schwarzeneggeron September 30, 2010
allows dentists to reasonably cover their costs of providing non-covered services by
enabling them to charge up to their usual and customary fees that would apply to most
private-pay patients.  It also requires dental plans to provide a disclosure statement in
their enrollees' evidence of coverage document explaining the law and encouraging them
to contact their plan or insurance broker for further information.

The law, which goes into effect Jan. 1, 2011, is the result of a resolution passed by the
CDA House of Delegates in November 2009 that directed CDA to consider options, including
legislation, to ban these fee restrictions on non-covered services.

Healthcare Reform: Your
Guide to Understanding
the Reform Provisions
and Timeline
<Read More>

Infection Control Requirements

Good news.....

The Dental Board of California confirmedon Friday, February 26, 2010 that, under the new
dental assisting law created by AB 2637 (Eng) two years ago, dentists must ensure that
only newly hired dental assistants that are unlicensed must complete aboard-approved,
eight hour infection control course within their first year of employment in that office. 

The California Dental Association and the California Association of Orthodontists – Partners in Advocacy

Michelle Rivas

Legislative Advocate &

Manager, External Affairs

California Dental Association

Members of the California Dental Association and the California Association of Orthodontists have worked together over the years for the benefit of all dentists in the state.

Legislation is introduced every year in Sacramento that has a direct impact on the dental profession and the patients you treat.   The CDA Public Policy department has staff that reads every bill introduced by the Legislature, analyzes it for any impact it may have on dentistry and provides that information to the CDA Government Affairs Council which then decides what position the organization will take and gives direction to staff.

Additionally, we have been directed by the membership to be more proactive in dealing with third-party payer issues.   CDA has sponsored legislation the past few years to deal with specific issues as they relate to insurance issues of concern to the membership.

 Here are a few examples of our successes:

Advertising Restrictions:  Legislation was introduced in 2008 as an attempt to help health care consumers verify the licensure status of their providers, by requiring providers (including dentists) to include in all “public communications” their license number, the web site and telephone number of their licensing agency, and a notice that the consumer can contact that agency for more information.  While sympathetic to the author’s and sponsor’s intentions, CDA expressed serious concern that the bill’s definitions were overly broad in scope and impractical, potentially requiring, for example, dentists to include their license number and the Dental Board’s web site and telephone number on toothbrushes that they provide at community health fairs.  Although CDA offered several amendments to modify the bill’s practical impact on providers, agreement was not reached with the author and sponsor as the bill moved through the Assembly, and CDA was forced to actively oppose the bill on the Assembly floor, where it was defeated on May 29th by a vote of 16-36. 

Mercury/Dental Amalgam Regulation:  In 2008 legislation was introduced which was intended to allow the state Department of Toxic Substances Control to begin regulating “chemicals of concern” that are potentially hazardous to health.  Mercury was included as a chemical of concern that could be regulated by the state.  Because mercury is one of the elements contained in encapsulated form in dental amalgam fillings, CDA was concerned that this bill could result in duplicative state regulation of dental amalgam that could needlessly drive up the cost of restorative materials to patients.  Because chemicals such as mercury already are regulated by the federal Food and Drug Administration, CDA opposed the legislation unless it was amended to exempt all dental restorative materials.  In response to CDA’s opposition, when the bill was taken up for a vote on the Assembly floor, the author pledged to amend the bill in the Senate to exempt dental restorative materials.  That amendment was made on June 17th, at which point CDA removed its opposition to the bill, which then passed both houses and was signed by the governor in late September. 

Dental Practice Ownership Transition:  California’s Dental Practice Act specifies that only a licensed dentist can own and operate a dental practice, including hiring other dentists.  This law is rightly intended to prevent the corporate practice of dentistry, but it had significant, arguably unintended consequences for families and patients when a dentist owner dies unexpectedly or becomes incapacitated and his or her spouse or estate wishes to keep the practice operating while they attempt to sell it permanently, were prohibited from doing so.  To remedy this unique and temporary situation in a way that encourages continuity of care for patients, CDA sponsored legislation to allow an estate, trustee, or other legal representative to employ or contract with dentists and otherwise operate the practice of a deceased or incapacitated dentist for up to 12 months, while assuring that patients are appropriately notified and assuring that the temporary operator of the practice does not interfere with a contracting dentist’s professional judgment.  As the bill moved through the legislature, amendments were adopted to clarify the legal authority for dentists to place their practices into trusteeships as a way to prepare in advance for such an eventuality.  The legislation passed by both houses with unanimous votes and was signed by the governor on October 10th. 

Denti-Cal Orthodontic Billing:   In 2007 CDA met with members of CAO to discuss the issue of Denti-Cal coverage for medically necessary orthodontic services and the requirement of submission of claims based only on monthly patient visits, which is inconsistent with the standard of care.   The requirement for monthly claim submittals forced orthodontists to schedule Denti-Cal patients for monthly visits that do not fit within the ideal sequence of treatment, which created a significant disincentive for orthodontists to participate as Denti-Cal providers.  CDA/CAO therefore sponsored legislation, to allow orthodontists to be reimbursed on a quarterly basis.  This gave participating orthodontists the ability to “bundle” a series of treatment visits into a single quarterly claim submittal, enabling them to schedule their patients’ treatment visits on a schedule fully consistent with the standard of care. 

Dental Plan Coordination of Benefits Policies:  “Coordination of benefits” is the means by which two insurance plans determine their relative responsibilities when a patient has dual coverage.  In recent years, CDA’s members and their patients had seen increasing instances in which dental plans that are the secondary payers were using “non-duplication” clauses and other similar policies to deny any additional reimbursement beyond what the primary plan has already paid.  CDA believed that these policies unfairly short-change patients and employers who have paid premiums to the secondary payer with the expectation that benefits will in fact be provided.  Therefore, CDA sponsored legislation requiring dental plans, when they are secondary payers, to provide supplemental reimbursement for the patient’s out-of-pocket costs under the primary plan for benefits covered by the secondary plan and require all dental plans to clearly disclose their coordination of benefits policies in the evidence of coverage documents they provide to their enrollees.  The legislation passed through both houses of the legislature with unanimous votes and was signed by the Governor. 

Summary of CDC Guidelines for
Infection Control in Dentistry

You can view the full 68 page guideline at: http://www.ada.org/sections/publicResources/pdfs/guidelines_cdc_infection.pdf