Amended  IN  Assembly  March 29, 2017

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Assembly Bill No. 753

Introduced by Assembly Member Caballero

February 15, 2017

An act to add Article 5.8 (commencing with Section 14187) to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, relating to Medi-Cal, and making an appropriation therefor.


LEGISLATIVE COUNSEL'S DIGEST


AB 753, as amended, Caballero. Denti-Cal: improved access.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law provides for a schedule of benefits provided under the Medi-Cal program, which includes certain dental services that are referred to as Denti-Cal. Existing law requires the department to implement the Dental Transformation Initiative (DTI), a component of the Medi-Cal 2020 Medicaid 1115(a) demonstration project, under which DTI incentive payments, as defined, within specified domain categories are made available to qualified providers who meet achievements within one or more of the project domains.
Existing law, the California Healthcare, Research, and Prevention Tobacco Tax Act of 2016, or Proposition 56, which was approved by voters at the November 8, 2016, statewide general election, increases taxes imposed on distributors of cigarettes and tobacco products and allocates a specified percentage of those revenues to the State Department of Health Care Services to increase funding for existing health care programs under the Medi-Cal program. Existing law establishes the Health care Healthcare Treatment Fund for this purpose.
This bill would require the department to implement specified initiatives designed to significantly improve access to dental services for adults and children in the Medi-Cal program consistent with the California Healthcare, Research and Prevention Tobacco Tax Act of 2016. The bill would require the department, in consultation with oral health stakeholders, to develop and implement a DTI for adults consistent with the existing goals and programmatic infrastructure of the DTI under the Medi-Cal 2020 demonstration project, under which incentive payments, as specified, would be made available to qualified providers who achieve contribute to diagnostic and service utilization improvements for adults in specified domains. The bill would require the department to increase reimbursement rates of qualified providers for the 20 most common pediatric diagnostic and restorative services to address identified oral health needs resulting from increased preventive services under the DTI under the Medi-Cal 2020 demonstration project. The bill would require the department to development and implement capacity development and access innovations, such as teledentistry, to build upon oral health service capacity and infrastructure in underserved areas of the state.
This bill would require the department to establish a list of performance measures to ensure the initiatives developed under these provisions meet quality and access criteria required by the department, and would require the department to conduct an evaluation of these initiatives, as specified. The bill would require the department to post the list of performance measures and its evaluation on the department’s Internet Web site.
This bill would appropriate $191,010,000 $300,000,000 for the 2017–18 fiscal year from the Healthcare Treatment Fund to the State Department of Health Care Services Services, subject to an offset or reduction based on the amount of federal matching funds that are available and utilized by the department, for the purpose of implementing these initiatives in accordance with specified allocations. The bill would declare the intent of the Legislature that that, depending on the amount of federal matching funds that may be available in future years, the equivalent of 15% at least 15%, but no more than 30%, of the funds in the Healthcare Treatment Fund shall be appropriated in future fiscal years to continue the initiatives developed under these provisions to improve access to and utilization of essential oral health services for Denti-Cal beneficiaries.
Vote: MAJORITY   Appropriation: YES   Fiscal Committee: YES   Local Program: NO  

The people of the State of California do enact as follows:


SECTION 1.

 The Legislature finds and declares all of the following:
(a) Current Denti-Cal reimbursement rates are significantly lower than commercial insurance rates in California and among the lowest state Medicaid rates paid for the same services.
(b) These extremely low rates, coupled with the high administrative burden of participating in Denti-Cal, have led to low provider participation and limited access for patients, especially in rural and other underserved areas. As a result, most Medi-Cal children and adults cannot find or obtain the timely care they need, often resulting in the use of expensive emergency departments for preventable dental issues.
(c) The recently implemented Dental Transformation Initiative (DTI) in the state’s Medicaid Section 1115(a) demonstration project, referred to as the Medi-Cal 2020 demonstration project, commits potentially significant funding for children’s preventive dental care. As yet, however, there has been no complementary investment in comprehensive services to meet essential oral health needs of children nor any investment in dental services for Medi-Cal adults, many of whom were without access to any affordable dental treatment for more than five years while adult Denti-Cal benefits were suspended during the state’s protracted economic downturn and revenue crisis.
(d) States that have increased dental care reimbursement rates have increased provider participation in the Medicaid program and improved access to care enrollees.
(e) The November 2016 voter enactment of Proposition 56, the California Healthcare, Research, and Prevention Tobacco Tax Act of 2016, makes new resources available to increase Medi-Cal provider rates in California, and among its specific stated objectives is to improve dental provider participation, access to dental care, and improved oral health, which proposals are directly linked to dealing with the health consequences of tobacco use.
(f) Directing an adequate share of new and additional Proposition 56 revenues towards meeting California’s public oral health objectives for children and adults is a sound, necessary, and critically needed public investment. Dental services rate improvements can and should be structured in alignment with the state’s goals of paying for value, expanding access to care throughout the state, and making the most of scarce public dollars, and improvements should be coupled with administrative reforms and efficiencies that further promote and attract significant and lasting growth in Denti-Cal provider participation and services to Medi-Cal members.

SEC. 2.

 Article 5.8 (commencing with Section 14187) is added to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, to read:
Article  5.8. Improved Access to Denti-Cal

14187.
 The department, in consultation with oral health stakeholders, shall develop and implement a Dental Transformation Initiative, or DTI, for adults consistent with the existing goals and programmatic infrastructure of the Dental Transformation Initiative described in Section 14184.70. This DTI for adults is intended to improve utilization of dental services and oral health for adult Medi-Cal beneficiaries. Under this DTI for adults, incentive payments shall be available to qualified providers who achieve contribute to diagnostic and service utilization improvements for adults. These incentive payments shall be 1.75 times existing rates and shall include the following three domains:
(a) Preventive services.
(b) Continuity of care.
(c) Timely access to care.

14187.1.
 The department shall increase reimbursement rates of qualified providers for the 20 most common pediatric diagnostic and restorative services to address identified oral health needs resulting from increased preventive services under the Dental Transformation Initiative described in Section 14184.70. These funds shall be used to expand and complement the children’s Dental Transformation Initiative prevention goals with a more comprehensive oral health focus. These increased reimbursement rates are intended to incentivize comprehensive oral health care for children served under the Dental Transformation Initiative described in Section 14184.70.

14187.2.
 The department shall develop and implement capacity development and access innovations to build upon oral health service capacity and infrastructure in underserved areas of the state. This capacity development and access innovations initiative is intended to improve oral health in the state’s rural areas and dental health professional shortage areas. The department may utilize funds appropriated for this purpose to issue one-time grants to providers who satisfy certain performance measures established pursuant to Section 14187.3. The department shall prioritize and support capacity expansion strategies, which may include, but are not limited to, teledentistry, mobile dental vans, mobile dental teams, such as virtual dental home models, and expanding existing dental office capacity in underserved areas.

14187.3.
 (a) (1) The department shall establish a list of performance measures to ensure the initiatives developed under this article meet quality and access criteria required by the department. The performance measures shall be designed to evaluate utilization, access, availability, and effectiveness of preventive care and treatment.
(2) Prior to establishing the quality and access criteria described in paragraph (1), the department shall consult with stakeholders, including representatives from counties, local dental societies, nonprofit entities, legal aid entities, and other interested parties.
(3) The department shall ensure, to the greatest degree possible, that the categories of data and performance measures selected under this subdivision are consistent with the categories of data and performance measures selected under Sections 14132.915 and 14459.6.
(b) The department shall conduct an evaluation of the initiatives developed under this section. This evaluation shall include, but is not limited to, all of the following:
(1) A detailed description of the number of individual payment incentives paid to adult dental providers under the Dental Transformation Initiative for adults described in Section 14187.
(2) A descriptive assessment of the impact of each initiative on the targeted population for all of the following:
(A) Provision of dental exams.
(B) Use of, and expenditure on, preventive dental services.
(C) Use of, and expenditure on, pediatric diagnostic and restorative dental services for children.
(c) The department shall post the list of performance measures established by the department and its evaluation of the initiatives developed under this article on the department’s Internet Web site.

14187.4.
 (a) The sum of one hundred ninety-one million ten thousand dollars ($191,010,000) three hundred million dollars ($300,000,000), is hereby appropriated for the 2017–18 fiscal year from the Healthcare Treatment Fund to the State Department of Health Care Services in accordance with subdivision (a) of Section 30130.55 of the Revenue and Taxation Code to be used by the State Department of Health Care Services, in combination with the maximum federal financial participation that can be obtained, to increase funding for dental health care programs under the Medi-Cal program to allow the department to undertake the initiatives described in this article in order to significantly improve access to dental services for low-income adults and children in the Medi-Cal program, in accordance with the following allocations:

(a)

(1) Sixty percent for the Dental Transformation Initiative for adults developed pursuant to Section 14187.

(b)

(2) Thirty percent to increase reimbursement rates for children dental providers pursuant to Section 14187.1.

(c)

(3) Ten percent to address geographic shortages of dental services pursuant to Section 14187.2.
(b) The amount of the appropriation described in paragraph (1) of subdivision (a) shall be offset or reduced by the amount of any federal matching funds that are available and utilized by the department for the purposes set forth in this article.

14187.5.
 It is the intent of the Legislature that that, depending on the amount of federal matching funds that may be available in future years, the equivalent of 15 percent at least 15 percent, but no more than 30 percent, of the funds in the Healthcare Treatment Fund established pursuant to subdivision (a) of Section 30130.55 of the Revenue and Taxation Code shall be appropriated in future fiscal years to continue the initiatives developed under this article to improve access to and utilization of essential oral health services for Denti-Cal beneficiaries.