This bill would establish the Virtual Dental Home Grant Program, to be administered by the authority, to expand allocate funds, under the direction of the state dental director, for the virtual dental home (VDH) model of community-based delivery of dental care to the residents of this state who are in greatest in geographic areas of highest need, as prescribed. The bill would also create the California Virtual Dental Home Grant Program Account (VDH account) within the California Health Facilities Financing Authority Fund. The bill would require the program to facilitate, coordinate, and encourage development and expansion of the delivery of dental health services through use of the VDH model by providing grants to, allocate the grants to organizations to, among other things, develop training modules and establish community-based learning collaboratives, as prescribed. The bill would require the authority to evaluate the grant programs progress toward meeting the objective to expand the VDH model of the community-based delivery of dental care and to post the evaluation and a summary of the evaluation, as specified. The bill would require organizations receiving grants to submit an evaluation on the effectiveness of the program to the department and would authorize the department to post the evaluations on its Internet Web site. The bill would transfer up to $6,500,000 from the California Health Facilities Financing Authority Hospital Equipment Loan Program Fund to the VDH account appropriate $4,000,000 from the General Fund to the State Department of Public Health for the purposes of the bill. By expanding the purposes for which a continuously appropriated fund may be used, this bill would make an appropriation.

This bill would establish the Virtual Dental Home grant program Grant Program, to be administered by the authority, to expand the virtual dental home (VDH) model of community-based delivery of dental care to the residents of this state who are in greatest need, as prescribed. The bill would also create the California Virtual Dental Home Grant Program Account (VDH account) within the California Health Facilities Financing Authority Fund. The bill would require the program to facilitate, coordinate, and encourage development and expansion of the delivery of dental health services through use of the Virtual Dental Home VDH model by providing grants to, among other things, develop training modules and establish community-based learning collaboratives, as prescribed. The bill would require the program administrator authority to evaluate the grant programs progress toward meeting the objective to expand the virtual dental home VDH model of the community-based delivery of dental care and to post the evaluation and a summary of the evaluation, as specified. The bill would transfer up to $6,500,000 from the California Health Facilities Financing Authority Hospital Equipment Loan Program Fund to the VDH account for the purposes of the bill. By expanding the purposes for which a continuously appropriated fund may be used, this bill would make an appropriation.

Existing law establishes the State Department of Public Health and sets forth its powers and duties, including, but not limited to, the administration of a state oral health program known as the Office of Oral Health for the purposes of, among other things, establishing community dental disease prevention programs for schoolaged children.

This bill would establish the Virtual Dental Home grant program to expand the virtual dental home model of community-based delivery of dental care to the residents of this state who are in greatest need, as prescribed. The bill would require the program to facilitate, coordinate, and encourage development and expansion of the delivery of dental health services through use of the Virtual Dental Home model by providing grants to, among other things, develop training modules and establish community-based learning collaboratives, as prescribed. The bill would require the program administrator to evaluate the grant programs progress toward meeting the objective to expand the virtual dental home model of the community-based delivery of dental care and to post the evaluation and a summary of the evaluation, as specified.

The bill would appropriate $4,000,000 to the department for the purposes of this program.

Existing law establishes the State Department of Public Health and sets forth its powers and duties, including, but not limited to, the administration of a state oral health program known as the Office of Oral Health for the purposes of, among other things, establishing community dental disease prevention programs for schoolaged children.

This bill would establish the Virtual Dental Home grant program to expand the virtual dental home model of community-based delivery of dental care to the residents of this state who are in greatest need, as prescribed. The bill would authorize the administrator of the program to, among other things, encourage development and expansion of the delivery of dental health services in community clinics and school programs, require the program to facilitate, coordinate, and encourage development and expansion of the delivery of dental health services through use of the Virtual Dental Home model by providing grants to, among other things, develop training modules and establish community-based learning collaboratives, as prescribed.

The bill would appropriate $4,000,000 to the department for the purposes of this program.

Existing law establishes the State Department of Public Health and sets forth its powers and duties, including, but not limited to, the administration of a state oral health program known as the Office of Oral Health for the purposes of, among other things, establishing community dental disease prevention programs for schoolaged children.

This bill would establish the Virtual Dental Home program to expand the virtual dental home model of community-based delivery of dental care to the residents of this state who are in greatest need, as prescribed. The bill would authorize the administrator of the program to, among other things, encourage development and expansion of the delivery of dental health services in community clinics and school programs, as prescribed.

The bill would appropriate $4,000,000 to the department for the purposes of this program.

SENATE COMMITTEE ON APPROPRIATIONS

Senator Ricardo Lara, Chair

2015 - 2016 Regular Session

AB 648 (Low) - Health care access demonstration project grants: Virtual Dental Home Grant Program

This bill meets the criteria for referral to the Suspense File.

Bill Summary:

AB 648 would establish a grant program to provide funding to support virtual dental homes. The bill would appropriate $4 million from the General Fund for the grant program.

Fiscal Impact:

• One-time appropriation of $4 million to support virtual dental home projects (General Fund).
• Unknown increase in Medi-Cal spending for dental procedures (General Fund and federal funds). The Medi-Cal program provides dental coverage for children and limited coverage for adults. According to a report by the State Auditor, utilization of dental services by Medi-Cal beneficiaries is low compared to other states. In part, this is due to limited availability of dental providers willing to see new patients at the rates paid by the Medi-Cal program. The virtual dental home model has the potential to increase access, by bringing care to individuals who are not otherwise being served. To the extent this happens, it could increase Medi-Cal expenditures for dental service. On the other hand, early interventions through a virtual dental home model may reduce future costs by catching problems early. The extent to which the savings from early interventions will offset the costs of overall increases in utilization is unknown.

Background:

Under the virtual dental home model, individuals needing dental care are seen in person by a dental assistant or dental hygienist who is connected via teledentistry with an offsite dentist. This model of care allows allied health professionals to provide dental care within their scope of practice with the ability to interact with a dentist on issues beyond their scope of practice. Supporters of this model of care point out that it allows dental care to be provided in alternative locations such as schools or residential care facilities which expands access to care, while still allowing for access to the skills and training of a dentist via teledentistry.

Under the oversight of the Office of Statewide Health Planning and Development, a Health Workforce Pilot Project (#172) has been undertaken to evaluate the changes in scope of practice and the use of telehealth that would needed to establish a virtual dental home model. According to a review of the Pilot Project by researchers at the University of the Pacific, allied dental professionals are able to perform the duties tested in the Pilot Project safely and effectively with a high level of patient satisfaction. AB 1174 (Bocanegra, Statutes of 2014) expanded the scope of practice for registered dental assistants in extended functions, registered dental hygienists, and registered dental hygienists in alternative practice, to facilitate virtual dental homes.

Proposed Law:

AB 648 would establish a grant program to provide funding related to virtual dental homes. The bill would appropriate $4 million from the General Fund for the grant program.

Specific provisions of the bill would:

• Establish the Virtual Dental Home grant program under the State Dental Director (within the Department of Public Health);
• Require the program to develop training modules, fund virtual dental home technology and equipment, and develop and fund other services to meet the requirements of the bill;
• Require the program to be focused on areas of highest need;
• Require an evaluation of grants awarded;
• Appropriate $4 million from the General Fund for the program.

Staff comments: Previously, this bill was amended in this committee to shift the fund source for the program from the General Fund to the California Health Facilities Financing Authority Fund and require the program to be implemented by the Authority.

Recent amendments revert the source of funding for the bill to the General Fund.

-- END --

 THIRD READING  

Bill No: AB 648

Author: Low (D), et al.

Amended: 9/1/15 in Senate

Vote: 27

SENATE HEALTH COMMITTEE: 8-0, 6/24/15

AYES: Hernandez, Nguyen, Mitchell, Monning, Nielsen, Pan, Roth, Wolk

NO VOTE RECORDED: Hall

SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/27/15

AYES: Lara, Bates, Beall, Hill, Leyva, Mendoza, Nielsen

ASSEMBLY FLOOR: 79-0, 6/1/15 - See last page for vote

SUBJECT: Community-based services: Virtual Dental Home program.

SOURCE: California Dental Association

The Children’s Partnership

DIGEST: This bill establishes the Virtual Dental Home (VDH) grant program at the California Health Facilities Financing Authority and appropriates $3 million from the California Health Facilities Financing Authority Hospital Equipment Loan Program to expand the VDH model of community-based delivery of dental care to California residents in greatest need.

ANALYSIS:

Existing law:

1. Permits the Office of Statewide Health Planning and Development (OSHPD) to designate experimental health workforce projects as approved projects where the projects are sponsored by community hospitals or clinics, nonprofit educational institutions, or government agencies engaged in health or education activities. Permits, notwithstanding any other provision of law, a trainee in an approved project to perform health care services under the supervision of a supervisor where the general scope of the services has been approved by OSHPD.
   
   

2. Requires, no later than January 1, 2018, regulations to be promulgated related to establishing criteria for approval of courses of instruction for the procedures using the competency-based training protocols established by Health Workforce Pilot Project No. 172 (HWPP No. 172) through OSHPD.

3. Requires OSHPD to extend HWPP No. 172 until January 1, 2016, in order to maintain the competence of the clinicians trained during the course of the project, and to authorize training of additional clinicians in the duties specified in HWPP No. 172. Sunsets this provision on January 1, 2016.

This bill:

1. Establishes the VDH grant program, to expand the VDH model of community-based delivery of dental care to California residents who are in greatest need.
   
   

2. Requires the grant program to facilitate, coordinate, and encourage development and expansion of the delivery of dental health services through the use of the VDH model by providing grants to:

1. Develop training modules and Web-based technical assistance;

2. Establish community-based learning collaboratives;

3. Fund essential VDH technology and equipment; and,

4. Develop and fund other services, as determined by the grant administrator, as required by this bill.
   
   

1. Authorizes the California Health Facilities Financing Authority (CHFFA) to seek additional private or public funds to expand access to the VDH program.
   
   

2. Requires the VDH program to be focused on providing needed services in geographic areas of highest need, as determined by the program administrator.
   
   

3. Authorizes CHFFA to grant funds directly to the public and private educational institutions or nonprofit entities as required to meet the requirements of this bill.
   
   

4. Appropriates $3 million from California Health Facilities Financing Authority Hospital Equipment Loan Program for purposes of the VDH program.
   
   

5. Makes this bill operative only if SB 315 (Monning) is enacted and takes effect on or before January 1, 2016.

Comments

1. Author’s statement. According to the author, in 2014, the VDH pilot project was made permanent as a sustainable and scalable model for delivering dental care in California. The project demonstrated that early dental disease prevention can be provided safely and effectively in community-based sites by allied dental team members who are connected to a dentist at an off-site location via “teledentisty.” Patients served by VDH systems have access to comprehensive dental care, including diagnosis, treatment planning and restorative care, as well as other complex care as needed. Through the project, nearly 3,000 patients have been seen at more than 50 sites around California with overwhelmingly positive results and approximately two-thirds of the patients seen were able to receive the care they needed at the community site. Good dental health is critical to a child’s ability to grow up healthy. Yet, tooth decay is the most common chronic disease and unmet health care need of children in California. California has identified 341 Dental Health Professional Shortage Areas (DHPSAs), areas so designated because the dentist-to-population ratio is below the threshold set by the federal government. By their very nature, DHPSAs identify areas throughout the state where patients frequently experience barriers to comprehensive dental care. This bill is an innovative and cost-effective model for providing dental services to the residents of this state who are in need of receiving dental care.

2. HWPP No. 172 and VDH. The HWPP No. 172 was approved by OSHPD in December 2010, and patient care with the new HWPP No. 172 duties began in January of 2011. The purpose of the pilot was to test two new duties to be performed by allied dental personnel to demonstrate that these duties could be performed safely and effectively and contribute to the development of a community-based oral health delivery system using telehealth-connected teams in a system called the VDH. The system was designed to reach and improve the oral health of underserved and vulnerable populations not fully participating in the current dental care delivery system. HWPP No. 172 was funded by public and private grants and was sponsored by the Pacific Center for Special Care at the University of the Pacific (UOP) School of Dentistry.

The HWPP No. 172 provided dental services to approximately 3,000 patients in 13 California communities, operating at more than 50 sites, including in elementary school-based facilities, Head Start Preschools, a nursing home, residential care facilities and a community center. Ninety percent of patients seen were eligible for Denti-Cal. In addition to the allied dental personnel, there were 23 dentists that participated, serving as “collaborating dentists” in the various community sites.

Under the VDH and HWPP No. 172, registered dental assistants (RDAs), registered dental hygienists (RDHs) or registered dental hygienists in alternative practice( RDHAPs) use portable imaging equipment and an Internet-based dental record system to collect electronic dental records such as X-rays, photographs, charts of dental findings, and dental and medical histories, and upload the information to a secure website, where they are reviewed by a collaborating dentist. The dentist reviews the patient’s information and creates a tentative dental treatment plan. The RDHAP, RDH or RDA then carries out the aspects of the treatment plan that can be conducted in the community setting. After the dentist reviews the electronic dental records, the RDHAP, RDH or RDA refers patients to dental offices for procedures that require the skills of a dentist. When these visits occur, the patient arrives with health history and consent arrangements completed, a diagnosis and treatment plan already determined, preventive practices in place and preventive procedures having been performed. As of April 30, 2015 there were 2,858 patients seen, 2,083 radiographs taken, and 994 interim therapeutic restorations placed. All procedures were rated as acceptable and there were no reports of adverse outcomes. With regard to patient satisfaction, 86% who responded to the survey were very satisfied with the overall dental care received.

3. Dental Access. According to OSHPD’s Health Care Atlas, approximately five percent of Californians live in a DHPSA; DHPSAs are Medical Service Study Areas that meet federally mandated criteria to qualify facilities for benefit programs, such as loan repayment programs. The designation is based on the availability of dentists and dental auxiliaries.  A July 2010 article published in Health Affairs, indicates, children in Medicaid, especially Latinos and African Americans, experience high rates of tooth decay, yet they visit dentists less often than privately insured children. Even Latino and African American children with private insurance are less likely than white children to visit dentists and have longer intervals between dental visits. Furthermore, Latino and African American children in Medicaid are more likely than white children in Medicaid to have longer intervals between visits. According to a 2008 publication from the California HealthCare Foundation, the burden of oral disease continues to fall more heavily on children from poor, minority households. And despite growing awareness of the lifelong effects of poor oral care, nearly one quarter of California children have never been to a dentist, including half of all children under the age of five.

4. State Audit. The California State Auditor published audit results in December 2014 of an audit conducted on the Department of Health Care Services (DHCS) administration of dental services for children on Medi-Cal which raises issues with access to services. According to the audit, although the proportion of children who had at least one dental procedure performed during the year increased by as much as 1.2 percentage points each year from 2011 to 2013, annual utilization rates are still lower than those of many other states. Data from the federal Centers for Medicare and Medicaid Services (CMS) indicate that nearly 56% of the 5.1 million children enrolled in Medi-Cal in federal fiscal year 2013 (October 1, 2012, through September 30, 2013) did not receive dental care through the program. The CMS data indicate that the national average utilization rate was 47.6% and ranged from a low of 23.7% in Ohio to a high of 63.4% in Texas for that same federal fiscal year. CMS's data also indicate that California's utilization rate of 43.9% was the 12th worst among the states that submitted data. The auditor’s review of DHCS’ data for 2011 through 2013 found similar results. Studies reviewed suggested several reasons for low utilization rates, including an uneven distribution of dentists nationwide and a relatively small number of dentists who participate in Medicaid.
   
   

5. State Budget. SB 75 (Committee on Budget and Fiscal Review, Chapter 18, Statutes of 2015) eliminates the 10% Medi-Cal payment reductions pursuant to AB 97 (Committee on Budget, Chapter 3, Statutes of 2011) for dental providers effective July 1, 2015.

6. VDH Grant Program. According to a representative of UOP, the grant funds anticipated in this bill might include funding to cover the following start-up costs: The equipment and instrument cost is about $35,000 - $40,000 as a one-time expense; there are supported salaries, decreasing over time, during the ramp up to a fully billable and sustainable model at a total of around $70,000 - $80,000, spread over three years; and, the costs for site selection and enrollment, program planning, system training, procedure training, monitoring, technical assistance and evaluation could be expected to be around a total of $80,000 - $90,000 spread over three years.

Related Legislation

SB 315 (Monning) authorizes the CHFFA to transfer up to $3 million from its Hospital Equipment Loan Program for use in a second California Health Access Model Program competitive grant selection process. SB 315 passed out of the Assembly Appropriations Committee on August 27, 2015, and was amended to reduce the appropriation to up to $3 million (was $6.5 million) and make it operative contingent upon this bill.

FISCAL EFFECT: Appropriation: Yes Fiscal Com.: Yes Local: No

According to the Senate Appropriations Committee:

1. One-time authorization of $3 million (CHFFA Fund). (Because the Fund is continuously appropriated in law, the spending authorization in this bill appropriates $3 million for the purposes of this bill.)

2. Unknown increase in Medi-Cal spending for dental procedures (General Fund and federal funds). The Medi-Cal program provides dental coverage for children and limited coverage for adults. According to a report by the State Auditor, utilization of dental services by Medi-Cal beneficiaries is low compared to other states. In part, this is due to limited availability of dental providers willing to see new patients at the rates paid by the Medi-Cal program. The VDH model has the potential to increase access, by bringing care to individuals who are not otherwise being served. To the extent this happens, it could increase Medi-Cal expenditures for dental service. On the other hand, early interventions through a VDH model may reduce future costs by catching problems early. The extent to which the savings from early interventions will offset the costs of overall increases in utilization is unknown.

SUPPORT: (Verified 8/31/15)

California Dental Association (co-source)

The Children’s Partnership (co-source)

Alameda County Board of Supervisors

Alameda County Developmental Disabilities Council

California Chronic Care Coalition

California Dental Hygienists’ Association

California Society of Pediatric Dentistry

Children Now

Community Clinic Association of Los Angeles County

Community Health Systems, Inc.

Delta Dental

Dental Hygiene Committee of California

East Bay Developmental Disabilities Legislative Coalition

First 5 Sonoma County

Liberty Dental Plan of California, Inc.

Maternal and Child Health Access

Mendocino Community Health Clinic, Inc.

Neighborhood Mobile Dental Van Prevention Program

Shasta Community Health Center

State Council on Developmental Disabilities

United Ways of California

Venice Family Clinic

OPPOSITION: (Verified 8/31/15)

None received

ARGUMENTS IN SUPPORT: Proponents support this bill because it would provide upfront investment necessary for the VDH to become a sustainable and scalable model for dental care delivery. Without an upfront investment in training, equipment, technical assistance, and other support that providers need to get started, the system will not be able to develop a critical mass needed to spread statewide and truly be integrated into California’s dental delivery system. The Children’s Partnership cosponsors this bill to ensure the VDH – an innovative and cost-effective system for providing dental care to California’s most vulnerable children and adults in community settings- can spread across the state. The California Dental Association also cosponsors this bill, because the VDH model of dental care uses technology to connect allied dental team members located at community sites with dentists in offices or clinics, facilitating the provision of comprehensive dental care to underserved children and adults.

ASSEMBLY FLOOR: 79-0, 6/1/15

AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang, Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray, Grove, Harper, Roger Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Perea, Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk, Williams, Wood, Atkins

NO VOTE RECORDED: Hadley

Prepared by: Teri Boughton / HEALTH /

9/1/15 21:30:36

**** END ****

SENATE COMMITTEE ON APPROPRIATIONS

Senator Ricardo Lara, Chair

2015 - 2016 Regular Session

AB 648 (Low) - Community-based services: Virtual Dental Home program

*********** ANALYSIS ADDENDUM – SUSPENSE FILE ***********

The following information is revised to reflect amendments

adopted by the committee on August 27, 2015

Bill Summary:

AB 648 would establish a grant program to provide funding to support virtual dental homes. The bill would authorize $3 million from a specified special fund to be used for the program.

Fiscal Impact:

• One-time authorization of $3 million (California Health Facilities Financing Authority Fund). (Because the Fund is continuously appropriated in law, the spending authorization in this bill appropriates $3 million for the purposes of the bill.)

• Unknown increase in Medi-Cal spending for dental procedures (General Fund and federal funds). The Medi-Cal program provides dental coverage for children and limited coverage for adults. According to a report by the State Auditor, utilization of dental services by Medi-Cal beneficiaries is low compared to other states. In part, this is due to limited availability of dental providers willing to see new patients at the rates paid by the Medi-Cal program. The virtual dental home model has the potential to increase access, by bringing care to individuals who are not otherwise being served. To the extent this happens, it could increase Medi-Cal expenditures for dental service. On the other hand, early interventions through a virtual dental home model may reduce future costs by catching problems early. The extent to which the savings from early interventions will offset the costs of overall increases in utilization is unknown.

Committee Amendments:

Shift the source of funding for the program from the General Fund to an existing special fund, reduce the amount authorized to $3 million, and require the program to be implemented by the California Health Facilities Financing Authority.

-- END --

SENATE COMMITTEE ON APPROPRIATIONS

Senator Ricardo Lara, Chair

2015 - 2016 Regular Session

AB 648 (Low) - Community-based services: Virtual Dental Home program

*********** ANALYSIS ADDENDUM – SUSPENSE FILE ***********

The following information is revised to reflect amendments

adopted by the committee on August 27, 2015

Bill Summary:

AB 648 would establish a grant program to provide funding to support virtual dental homes. The bill would authorize $3 million from a specified special fund to be used for the program.

Fiscal Impact:

• One-time authorization of $3 million (California Health Facilities Financing Authority Fund). (Because the Fund is continuously appropriated in law, the spending authorization in this bill appropriates $3 million for the purposes of the bill.)

• Unknown increase in Medi-Cal spending for dental procedures (General Fund and federal funds). The Medi-Cal program provides dental coverage for children and limited coverage for adults. According to a report by the State Auditor, utilization of dental services by Medi-Cal beneficiaries is low compared to other states. In part, this is due to limited availability of dental providers willing to see new patients at the rates paid by the Medi-Cal program. The virtual dental home model has the potential to increase access, by bringing care to individuals who are not otherwise being served. To the extent this happens, it could increase Medi-Cal expenditures for dental service. On the other hand, early interventions through a virtual dental home model may reduce future costs by catching problems early. The extent to which the savings from early interventions will offset the costs of overall increases in utilization is unknown.

Committee Amendments:

Shift the source of funding for the program from the General Fund to an existing special fund, reduce the amount authorized to $3 million, and require the program to be implemented by the California Health Facilities Financing Authority.

-- END --

SENATE COMMITTEE ON APPROPRIATIONS

Senator Ricardo Lara, Chair

2015 - 2016 Regular Session

AB 648 (Low) - Community-based services: Virtual Dental Home program

This bill meets the criteria for referral to the Suspense File.

Bill Summary:

AB 648 would establish a grant program to provide funding to support virtual dental homes. The bill would appropriate $4 million from the General Fund for the grant program.

Fiscal Impact:

• One-time appropriation of $4 million (General Fund). According to the Department of Public Health, the administrative costs to develop and implement the grant program will be about $400,000. The Department anticipates using $500,000 for technical assistance to potential awardees, leaving about $3 million for grants to support the expansion of the virtual dental home model.

• Unknown increase in Medi-Cal spending for dental procedures (General Fund and federal funds). The Medi-Cal program provides dental coverage for children and limited coverage for adults. According to a report by the State Auditor, utilization of dental services by Medi-Cal beneficiaries is low compared to other states. In part, this is due to limited availability of dental providers willing to see new patients at the rates paid by the Medi-Cal program. The virtual dental home model has the potential to increase access, by bringing care to individuals who are not otherwise being served. To the extent this happens, it could increase Medi-Cal expenditures for dental service. On the other hand, early interventions through a virtual dental home model may reduce future costs by catching problems early. The extent to which the savings from early interventions will offset the costs of overall increases in utilization is unknown.

Background:

Under the virtual dental home model, individuals needing dental care are seen in person by a dental assistant or dental hygienist who is connected via teledentistry with an offsite dentist. This model of care allows allied health professionals to provide dental care within their scope of practice with the ability to interact with a dentist on issues beyond their scope of practice. Supporters of this model of care point out that it allows dental care to be provided in alternative locations such as schools or residential care facilities which expands access to care, while still allowing for access to the skills and training of a dentist via teledentistry.

Under the oversight of the Office of Statewide Health Planning and Development, a Health Workforce Pilot Project (#172) has been undertaken to evaluate the changes in scope of practice and the use of telehealth that would needed to establish a virtual dental home model. According to a review of the Pilot Project by researchers at the University of the Pacific, allied dental professionals are able to perform the duties tested in the Pilot Project safely and effectively with a high level of patient satisfaction. AB 1174 (Bocanegra, Statutes of 2014) expanded the scope of practice for registered dental assistants in extended functions, registered dental hygienists, and registered dental hygienists in alternative practice, to facilitate virtual dental homes.

Proposed Law:

AB 648 would establish a grant program to provide funding related to virtual dental homes. The bill would appropriate $4 million from the General Fund for the grant program.

Specific provisions of the bill would:

• Establish the Virtual Dental Home grant program within the Department of Public Health;

• Require the program to develop training modules, fund virtual dental home technology and equipment, and develop and fund other services to meet the requirements of the bill;

• Authorize the Department to seek additional funds for the program;

• Require the program to be focused on areas of highest need;

• Require an evaluation of the grant program;

• Appropriate $4 million from the General Fund for the program.

-- END --

SENATE COMMITTEE ON HEALTH

Senator Ed Hernandez, O.D., Chair

BILL NO: AB 648

SUBJECT: Community-based services: Virtual Dental Home program.

SUMMARY:

Establishes the Virtual Dental Home (VDH) grant program at the California Department of Public Health and appropriates $4 million from the General Fund to expand the VDH model of community-based delivery of dental care to California residents.

Existing law:

1. Establishes the Dental Practice Act (DPA), administered by the Dental Board of California (DBC).
   
   

2. Permits the DBC to license as a registered dental assistant in extended functions (RDAEF) a person who submits satisfactory written evidence of specified eligibility requirements, such as a current licensure as a registered dental assistant (RDA) or completion of the requirements for licensure as an RDA; successful completion of a DBC-approved course in the application of pit and fissure sealants; successful completion of DBA-approved extended functions post-secondary programs, as specified; and, passage of a written examination and a clinical or practical examination administered by the DBC or by a DBC-approved extended functions program.

3. Establishes within the jurisdiction of DBC a Dental Hygiene Committee of California (DHCC), and states legislative intent to permit the full utilization of RDAs, registered dental hygienists in alternative practice (RDHAP), and registered dental hygienists in extended functions (RDHEF) in order to meet the dental care needs of all of the state’s citizens. Requires the DHCC to perform specified functions, including making recommendations to the DBC regarding dental hygiene scope of practice issues.
   
   

4. Permits the Office of Statewide Health Planning and Development (OSHPD) to designate experimental health workforce projects as approved projects where the projects are sponsored by community hospitals or clinics, nonprofit educational institutions, or government agencies engaged in health or education activities. Permits, notwithstanding any other provision of law, a trainee in an approved project to perform health care services under the supervision of a supervisor where the general scope of the services has been approved by OSHPD.
   
   

5. Requires, no later than January 1, 2018, regulations to be promulgated related to establishing criteria for approval of courses of instruction for the procedures using the competency-based training protocols established by Health Workforce Pilot Project No. 172 (HWPP No. 172) through OSHPD. Requires, in developing regulations and any subsequent proposed amendments to promulgated regulations, the DBC to provide to the DHCC proposed regulations related to the curriculum required for protective restorations.
   
   

6. Requires OSHPD to extend HWPP No. 172 until January 1, 2016, in order to maintain the competence of the clinicians trained during the course of the project, and to authorize training of additional clinicians in the duties specified in HWPP No. 172. Sunsets this provision January 1, 2016.

This bill:

1. Establishes the VDH grant program, administered by the dentist of the Oral Health Unit of the State Department of Public Health (DPH), to expand the VDH model of community-based delivery of dental care to California residents.
   
   

2. Requires the grant program to facilitate, coordinate, and encourage development and expansion of the delivery of dental health services through the use of the VDH model by providing grants to:

1. Develop training modules and Web-based technical assistance;

2. Establish community-based learning collaboratives;

3. Fund essential VDH technology and equipment; and,

4. Develop and fund other services, as determined by the grant administrator, as required by this bill.
   
   

1. Authorizes the program administrator to seek additional private or public funds to expand access to the VDH program.
   
   

2. Requires the VDH program to be focused on providing needed services in geographic areas of highest need, as determined by the program administrator.
   
   

3. Authorizes the program administrator to grant funds directly to the public and private educational institutions or nonprofit entities as required to meet the requirements of this bill.
   
   

4. Appropriates $4 million from the General Fund (GF) to DPH for purposes of the VDH program.

FISCAL EFFECT:

According to the Assembly Appropriations Committee:

1. $4 million GF to DPH to establish the program. DPH would scale the effort, including number of sites, individuals trained, and individuals served, to the available funding. Supporters, who are familiar with the VDH model, project the funding could be used to support training and equipment in 20 communities over a three-year grant period.

2. To the extent this model is successful in promoting access to preventive and diagnostic dental services and more children are able to receive such services through its widespread adoption, there could be commensurate cost pressure on Medi-Cal dental services to reimburse for additional services (GF/federal funds). However, any increased costs would likely be offset to some extent by reductions in emergency dental procedures or complications from untreated dental disease. The magnitude and likelihood of such costs or savings is unknown.

PRIOR VOTES:

COMMENTS:

1. Author’s statement. According to the author, in 2014, the VDH pilot project was made permanent as a sustainable and scalable model for delivering dental care in California. The project demonstrated that early dental disease prevention can be provided safely and effectively in community-based sites by allied dental team members who are connected to a dentist at an off-site location via “teledentisty.” Patients served by VDH systems have access to comprehensive dental care, including diagnosis, treatment planning and restorative care, as well as other complex care as needed. Through the project, nearly 3,000 patients have been seen at more than 50 sites around California with overwhelmingly positive results and approximately two-thirds of the patients seen were able to receive the care they needed at the community site. Good dental health is critical to a child’s ability to grow up healthy. Yet, tooth decay is the most common chronic disease and unmet health care need of children in California. California has identified 341 Dental Health Professional Shortage Areas (DHPSA), areas so designated because the dentist-to-population ratio is below the threshold set by the federal government. By their very nature, DHPSA’s identify areas throughout the state where patients frequently experience barriers to comprehensive dental care. This bill is an innovative and cost-effective model for providing dental services to the residents of this state who are in need of receiving dental care.

2. HWPP No. 172 and VDH. The HWPP No. 172 was approved by OSHPD in December 2010, and patient care with the new HWPP No. 172 duties began in January of 2011. The purpose of the pilot was to test two new duties to be performed by allied dental personnel to demonstrate that these duties could be performed safely and effectively and contribute to the development of a community-based oral health delivery system using telehealth-connected teams in a system called the VDH. The system was designed to reach and improve the oral health of underserved and vulnerable populations not fully participating in the current dental care delivery system. HWPP No. 172 was funded by public and private grants and was sponsored by the Pacific Center for Special Care at the University of the Pacific (UOP) School of Dentistry.
   
   The HWPP No. 172 provided dental services to approximately 3,000 patients in 13 California communities, operating at more than 50 sites, including in elementary school-based facilities, Head Start Preschools, a nursing home, residential care facilities and a community center. Ninety percent of patients seen were eligible for Denti-Cal. There were a total of 12 trainees licensed and experienced as RDAs, RDHs, or RDHAPs. In addition to the allied dental personnel, there were 23 dentists that participated, serving as “collaborating dentists” in the various community sites.
   
   Under the VDH and HWPP 172, RDA, RDH or RDHAPs use portable imaging equipment and an internet-based dental record system to collect electronic dental records such as X-rays, photographs, charts of dental findings, and dental and medical histories, and upload the information to a secure website, where they are reviewed by a collaborating dentist. The dentist reviews the patient’s information and creates a tentative dental treatment plan. The RDHAP, RDH or RDA then carries out the aspects of the treatment plan that can be conducted in the community setting. After the dentist reviews the electronic dental records, the RDHAP, RDH or RDA refers patients to dental offices for procedures that require the skills of a dentist. When these visits occur, the patient arrives with health history and consent arrangements completed, a diagnosis and treatment plan already determined, preventive practices in place and preventive procedures having been performed. As of 4/30/15 there were 2,858 patients seen, 2,083 radiographs taken, and 994 interim therapeutic restorations placed. All procedures were rated as acceptable and there were no reports of adverse outcomes. With regard to patient satisfaction 86% who responded to the survey were very satisfied with the overall dental care received.
   
   

3. Dental Access. According to OSHPD’s Health Care Atlas, approximately five percent of Californians live in a DHPSA; DHPSAs are Medical Service Study Areas that meet federally mandated criteria to qualify facilities for benefit programs, such as loan repayment programs. The designation is based on the availability of dentists and dental auxiliaries.  A July 2010 article published in Health Affairs, indicates, children in Medicaid, especially Latinos and African Americans, experience high rates of tooth decay, yet they visit dentists less often than privately insured children. Even Latino and African American children with private insurance are less likely than white children to visit dentists and have longer intervals between dental visits. Furthermore, Latino and African American children in Medicaid are more likely than white children in Medicaid to have longer intervals between visits. According to a 2008 publication from the California HealthCare Foundation, the burden of oral disease continues to fall more heavily on children from poor, minority households. And despite growing awareness of the lifelong effects of poor oral care, nearly one quarter of California children have never been to a dentist, including half of all children under the age of five.

4. State Audit. The California State Auditor published audit results in December 2014 of an audit conducted on the Department of Health Care Services (DHCS) administration of dental services for children on Medi-Cal which raises issues with access to services. According to the audit, although the proportion of children who had at least one dental procedure performed during the year increased by as much as 1.2 percentage points each year from 2011 to 2013, annual utilization rates are still lower than those of many other states. Data from the federal Centers for Medicare and Medicaid Services (CMS) indicate that nearly 56% of the 5.1 million children enrolled in Medi-Cal in federal fiscal year 2013 (October 1, 2012, through September 30, 2013) did not receive dental care through the program. The CMS data indicate that the national average utilization rate was 47.6% and ranged from a low of 23.7% in Ohio to a high of 63.4% in Texas for that same federal fiscal year. CMS's data also indicate that California's utilization rate of 43.9% was the 12th worst among the states that submitted data. The auditor’s review of DHCS’ data for 2011 through 2013 found similar results. Studies reviewed suggested several reasons for low utilization rates, including an uneven distribution of dentists nationwide and a relatively small number of dentists who participate in Medicaid.
   
   

5. State Budget. SB 75 (Committee on Budget and Fiscal Review) eliminates the 10% Medi-Cal payment reductions pursuant to AB 97 (Committee on Budget, Chapter 3, Statutes of 2011) for dental providers effective July 1, 2015. SB 75 is awaiting action by the Governor.

6. VDH Grant Program. According to a representative of UOP, the grant funds anticipated in this bill might include funding to cover the following start-up costs:  The equipment and instrument cost is about $35,000 - $40,000 as a one-time expense; there are supported salaries, decreasing over time, during the ramp up to a fully billable and sustainable model at a total of around $70,000 - $80,000, spread over 3 years; and, the costs for site selection and enrollment, program planning, system training, procedure training, monitoring, technical assistance and evaluation could be expected to be around a total of $80,000 - $90,000 spread over 3 years.

7. Related legislation. AB 502 (Chau) would require insurance companies to reimburse registered RDHAPs for dental hygiene care legally provided and covered by insurance, and clarifies that RDHAPs are authorized to establish corporations.
   
   

8. Prior legislation. AB 1174 (Bocanegra, Chapter 662, Statutes of 2014), expands the scope of practice for a RDAEF, RDH, and RDHAP to better enable the practice of teledentistry in accordance with the findings of a HWPP 172, and authorizes Medi-Cal payments for teledentistry services provided to individuals participating in the Medi-Cal program.
   
   

9. Support. Proponents support this bill because it would provide upfront investment necessary for the VDH to become a sustainable and scalable model for dental care delivery. Without an upfront investment in training, equipment, technical assistance, and other support that providers need to get started, the system will not be able to develop a critical mass needed to spread statewide and truly be integrated into California’s dental delivery system. The Children’s Partnership cosponsors this bill to ensure the VDH – an innovative and cost-effective system for providing dental care to California’s most vulnerable children and adults in community settings- can spread across the state. The California Dental Association also cosponsors this bill, because the VDH model of dental care uses technology to connect allied dental team members located at community sites with dentists in offices or clinics, facilitating the provision of comprehensive dental care to underserved children and adults.
   
   

10. Suggested Amendment. The committee may wish to require an evaluation of the grant program in order to measure the extent to which it meets the stated objectives. Evaluation provisions could include the following:
    
    

(g) The program administrator shall develop a method for evaluating each grantee’s progress toward meeting the objective to expand the virtual dental home model of community-based delivery of dental care to residents in geographic areas of highest need.  Upon completion of the grantee evaluations, the program administrator shall post a grant program evaluation summary associated with expenditure of the General Fund appropriation contained in this bill.

SUPPORT AND OPPOSITION:

Support: California Dental Association (co-sponsor)

Children’s Partnership (co-sponsor)

Alameda County Board of Supervisors

Alameda County Developmental Disabilities Council

California Chronic Care Coalition

California Dental Hygienists’ Association

California Society of Pediatric Dentistry

Children Now

Community Clinic Association of Los Angeles County

Community Health Systems, Inc.

Delta Dental

Dental Hygiene Committee of California

East Bay Developmental Disabilities Legislative Coalition

First 5 Sonoma County

Liberty Dental Plan of California, Inc.

Maternal and Child Health Access

Mendocino Community Health Clinic, Inc.

Neighborhood Mobile Dental Van Prevention Program

Shasta Community Health Center

State Council on Developmental Disabilities

United Ways of California

Venice Family Clinic

2 individuals

Oppose: None received

-- END --

ASSEMBLY THIRD READING

ATR Bill Id:AB 648

Author:(Low)

As Introduced Ver:February 24, 2015

2/3 vote

SUMMARY: Appropriates $4 million to the Department of Public Health (DPH) to establish the Virtual Dental Home (VDH) program.

FISCAL EFFECT: According to the Assembly Appropriations Committee:

1. $4 million General Fund (GF) to DPH to establish the program. DPH would scale the effort, including number of sites, individuals trained, and individuals served, to the available funding. Supporters, who are familiar with the VDH model, project the funding could be used to support training and equipment in 20 communities over a three-year grant period.

2. To the extent this model is successful in promoting access to preventive and diagnostic dental services and more children are able to receive such services through its widespread adoption, there could be commensurate cost pressure on Medi-Cal dental services to reimburse for additional services (GF/federal funds). However, any increased costs would likely be offset to some extent by reductions in emergency dental procedures or complications from untreated dental disease. The magnitude and likelihood of such costs or savings is unknown.

COMMENTS: According to the author, good dental health is critical to a child's ability to grow up healthy. Yet, tooth decay is the most common chronic disease and unmet health care need of children in California. According to the Journal of the California Dental Association, California's oral health disparities are more severe than the national average, particularly among low-income and disabled populations. One-quarter of children in California have never seen a dentist and approximately 65% of elementary school children are in need of dental care.

The author also state that California has identified 341 Dental Health Professional Shortage Areas (DHPSA), areas so designated because the dentist-to-population ratio is below the threshold set by the federal government. By their very nature, DHPSAs identify areas throughout the state where patients frequently experience barriers to comprehensive dental care. The author concludes that this bill supports the expansion of an innovative and cost-effective model for providing dental care to the residents of this state who are in greatest need by establishing the VDH grant program.

1. Virtual Dental Home. According to an article published in July 2012 in the Journal of the California Dental Association, "The Virtual Dental Home: Bringing Oral Health to Vulnerable and Underserved Populations," the traditional office and clinic-based oral health delivery system is failing to reach a large and increasing segment of the population. From 2009 to 2011, the number of Medi-Cal beneficiaries who received any dental service declined by 8%. A decrease was expected for adults since most adult dental benefits were eliminated in 2009, however there was also a decrease for children. Approximately 6.3 million children, or two-thirds of all children in the state, have not had any dental care by the time they reach the third grade, resulting in missed school time. Approximately 7% of California children missed school due to a dental problem in 2007, excluding time for cleaning or routine check-up.

2. State Auditor's Report. On December 11, 2014, the California State Auditor issued a report titled "California Department of Health Care Services: Weaknesses in Its Medi-Cal Dental Program Limit Children's Access to Dental Care." The report stated that insufficient number of dental providers willing to participate in Medi-Cal, low reimbursement rates and a failure to adequately monitor the program, led to limited access to care and low utilization rates for Medi-Cal beneficiaries across the state. The Audit found that 16 counties either have no active providers or do not have providers willing to accept new Medi-Cal patients, and 16 other counties have an insufficient number of providers. Recent changes in federal and state laws that have expanded Medi-Cal coverage could increase the number of children and adults who can receive additional covered dental services from 2.7 million to as many as 6.4 million, bringing into question the State's ability to provide timely and adequate care to beneficiaries.

The sponsors of the bill, the California Dental Association (CDA), state that VDH has the potential to become a sustainable and scalable model for dental care delivery, but needs an upfront investment in training, equipment, technical assistance, and other support to develop the critical mass needed to spread statewide and truly be integrated into California's dental deliver system. CDA notes that tooth decay is the number one chronic disease among children; it accounts for persistent pain, trouble eating and sleeping, missed school days, and expensive emergency room visits for preventable dental problems. The sponsor argues that children, low-income families and other vulnerable populations experience disproportionate levels of dental disease in large part due to difficulties accessing early preventive and routine dental care.

The Children's Partnership states in support that VDH uses technology to connect allied dental team members, located at community sites – such as schools and Head Start sites – with dentists in offices or clinics, to facilitate the provision of comprehensive dental care for children and adults who face barriers to accessing that care in traditional dental offices.

This bill has no known opposition.

Analysis Prepared by: Paula Villescaz / HEALTH / (916) 319-2097 FN: 0000660

Date of Hearing: April 15, 2015

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Jimmy Gomez, Chair

ABPCA Bill Id:AB 648

Author:(Low) – As Introduced Ver:February 24, 2015

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill appropriates $4 million to the Department of Public Health (DPH) to establish the Virtual Dental Home (VDH) program, and specifies administrative requirements and program goals.

FISCAL EFFECT:

1. $4 million GF to DPH to establish the program. DPH would scale the effort, including number of sites, individuals trained, and individuals served, to the available funding. The bill's supporters, who are familiar with the VDH model, project the funding could be used to support training and equipment in 20 communities over a three-year grant period.

2. To the extent this model is successful in promoting access to preventive and diagnostic dental services and more children are able to receive such services through its widespread adoption, there could be commensurate cost pressure on Medi-Cal dental services to reimburse for additional services (GF/federal funds). However, any increased costs would likely be offset to some extent by reductions in emergency dental procedures or complications from untreated dental disease. The magnitude and likelihood of such costs or savings is unknown.

COMMENTS:

1. Purpose. The author states VDH has the potential to become a sustainable and scalable model for dental care delivery, but needs an upfront investment in training, equipment, technical assistance, and other support to develop the critical mass needed to spread statewide and truly be integrated into California's dental delivery system. The bill is co-sponsored by the California Dental Association and The Children's Partnership.

2. Background. VDH is a community-based oral health delivery system in which people receive preventive and simple therapeutic services in community settings. It uses telehealth technology to link dental hygienists and dental assistants in the community with dentists in dental offices and clinics, enabling care in places like Head Start sites and schools. VDH was developed and evaluated through the state Office of Statewide Health Planning and Development's Health Workforce Pilot Program (HWPP#172). AB 1174 (Bocanegra), Chapter 662, Statutes of 2014, provided a statutory framework for VDH and authorized scope of practice changes, as well as Medi-Cal reimbursement for VDH-provided services.

Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081

Date of Hearing: April 7, 2015

ASSEMBLY COMMITTEE ON HEALTH

Rob Bonta, Chair

ABPCA Bill Id:AB 648

Author:(Low) – As Introduced Ver:February 24, 2015

SUBJECT: Community-based services: Virtual Dental Home program.

SUMMARY: Appropriates $4 million to the Department of Public Health (DPH) to establish the Virtual Dental Home (VDH) program. Specifically, this bill:

1. Appropriates $4 million to DPH to establish a VDH program to expand the VDH model of community-based delivery of dental care to the residents of this state who are in greatest need.

2. Requires the VDH program to be administered by the Director of the State Oral Health Program.

3. Requires the VDH program to facilitate and encourage development and expansion of the delivery of dental health services in schools, head start and preschool programs, and community clinics.

4. Encourages the use of teledentistry in VDH programs.

5. Requires the development of related training modules and the establishment of community-based learning collaboratives.

6. Provides grants to fund essential VDH technology and equipment.

7. Requires the program administrator to secure funds that can be used along with other private and public funding opportunities.

8. Requires the VDH program to focus on providing needed services in geographic areas of highest need.

EXISTING LAW:

1. Establishes the Medi-Cal program under which qualified low-income persons receive health care benefits.

2. Requires DPH to maintain a dental program that develops a comprehensive dental health plan to maximize utilization of all resources.

3. Establishes a community dental disease prevention program offered to school children in preschool through sixth grade, and in classes for individuals with exceptional needs, when sponsored by a city or county health department, county office of education, superintendent of schools office, school district, or other public or private nonprofit agency approved by DPH.

4. Requires the DPH Director to appoint a licensed dentist to administer the dental program.

5. Provides, to the extent federal financial participation is available, face-to-face contact between a health care provider and a patient is not required under the Medi-Cal program for teleophthalmology and teledermatology by store and forward. Indicates that services appropriately provided through the store and forward processes are subject to billing and reimbursement policies developed by DHCS.
   
   

FISCAL EFFECT: This bill has not yet been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, good dental health is critical to a child's ability to grow up healthy. Yet, tooth decay is the most common chronic disease and unmet health care need of children in California. According to the Journal of the California Dental Association, California's oral health disparities are more severe than the national average, particularly among low-income and disabled populations. One-quarter of children in California have never seen a dentist and approximately 65% of elementary school children are in need of dental care.

The author also state that California has identified 341 Dental Health Professional Shortage Areas (DHPSA), areas so designated because the dentist-to-population ratio is below the threshold set by the federal government. By their very nature, DHPSAs identify areas throughout the state where patients frequently experience barriers to comprehensive dental care. The author concludes that this bill supports the expansion of an innovative and cost-effective model for providing dental care to the residents of this state who are in greatest need by establishing the Virtual Dental Home grant program.

2. BACKGROUND.

1. Virtual Dental Home. According to an article published in July 2012 in the Journal of the California Dental Association (CDA Journal), “The Virtual Dental Home: Bringing Oral Health to Vulnerable and Underserved Populations,” the traditional office and clinic-based oral health delivery system is failing to reach a large and increasing segment of the population. The CDA Journal article states that in California, oral health disparities are more severe than the national average, particularly among low-income and disabled populations. Children in particular do not have regular access to dental services, with over half of minority elementary school children needing dental care.

From 2009 to 2011, the number of Medi-Cal beneficiaries who received any dental service declined by 8%. A decrease was expected for adults since most adult dental benefits were eliminated in 2009, however there was also a decrease for children. Approximately 6.3 million children, or two-thirds of all children in the state, have not had any dental care by the time they reach the third grade, resulting in missed school time. Approximately 7% of California children missed school due to a dental problem in 2007, excluding time for cleaning or routine check-up.

2. State Auditor's Report. On December 11, 2014, the California State Auditor issued a report titled “California Department of Health Care Services: Weaknesses in Its Medi-Cal Dental Program Limit Children's Access to Dental Care”. The report stated that insufficient number of dental providers willing to participate in Medi-Cal, low reimbursement rates and a failure to adequately monitor the program, led to limited access to care and low utilization rates for Medi-Cal beneficiaries across the state. The Audit found that 16 counties either have no active providers or do not have providers willing to accept new Medi-Cal patients, and 16 other counties have an insufficient number of providers.

Recent changes in federal and state laws that have expanded Medi-Cal coverage could increase the number of children and adults who can receive additional covered dental services from 2.7 million to as many as 6.4 million, bringing into question the State's ability to provide timely and adequate care to beneficiaries.

3. SUPPORT. The sponsors of the bill, CDA, state that VDH has the potential to become a sustainable and scalable model for dental care delivery, but needs an upfront investment in training, equipment, technical assistance, and other support to develop the critical mass needed to spread statewide and truly be integrated into California's dental deliver system. CDA notes that tooth decay is the number one chronic disease among children; it accounts for persistent pain, trouble eating and sleeping, missed school days, and expensive emergency room visits for preventable dental problems. The sponsor argues that children, low-income families and other vulnerable populations experience disproportionate levels of dental disease in large part due to difficulties accessing early preventive and routine dental care.

The Children's Partnership states that VDH uses technology to connect allied dental team members, located at community sites – such as schools and Head Start sites – with dentists in offices or clinics, to facilitate the provision of comprehensive dental care for children and adults who face barriers to accessing that care in traditional dental offices.

4. RELATED LEGISLATION.

1. AB 1357 (Bloom) establishes the Children and Family Health Promotion Program in DPH that would provide competitive grants to appropriate agencies and non-profits that seek to invest in childhood obesity and diabetes prevention activities and oral health programs. AB 1357 is in the Assembly Health Committee.

2. AB 1018 (Cooper) requires the Department of Health Care Services (DHCS) to permit county mental health plans to contract with local educational agencies, as defined, to provide services for Medi-Cal eligible pupils under Early and Periodic Screening, Diagnosis, and Treatment (EPSDT). EPSDT services include screening services, vision services, dental services, hearing services, and other necessary services to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services. AB 1018 is in the Assembly Health Committee.
   
   

1. PREVIOUS LEGISLATION.

1. AB 1174 (Bocanegra), Chapter 662, Statutes of 2014, authorizes certain allied dental professionals to perform additional activities using telehealth; extends the duration of the Health Workforce Pilot Project No. 172 until January 1, 2016; and prohibits Medi-Cal from requiring a face-to-face visit between a patient and provider before allowing for teledentistry services.

2. AB 1733 (Logue), Chapter 782, Statutes of 2012, updates several code sections to replace the term “telemedicine” with “telehealth” and expands the potential for the use of telehealth in additional health care programs administered by DHCS such as the Program of All-Inclusive Care for the Elderly.
   
   

3. AB 415 (Logue), Chapter 547, Statutes of 2011, establishes the Telehealth Advancement Act of 2011 to revise and update existing law to facilitate the advancement of telehealth as a service delivery mode in managed care and the Medi-Cal program.
   
   

4. AB 2120 (Galgiani), Chapter 260, Statutes of 2008, extends the Medi-Cal telemedicine reimbursement authorization until January 1, 2013.
   
   

5. AB 329 (Nakanishi), Chapter 386, Statutes of 2007, authorizes the Medical Board of California (MBC) to establish a pilot program to expand the practice of telemedicine and to convene a working group. AB 329 specifies that the purpose of the pilot program is to develop methods, using a telemedicine model, of delivering health care to those with chronic diseases and delivering other health information, and requires MBC to make recommendations regarding its findings to the Legislature within one calendar year of the commencement date of the pilot program.
   
   

6. AB 1224 (Hernandez), Chapter 507, Statutes of 2007, adds optometrists to the list of health care providers covered under laws governing telemedicine services.
   
   

7. AB 354 (Cogdill), Chapter 449, Statutes of 2005, expands telemedicine provisions by providing that, from July 1, 2006 through December 31, 2008, face-to-face contact between a health care provider and a patient is not required for the Medi-Cal program for “store and forward” teleophthalmology and teledermatology services.

REGISTERED SUPPORT / OPPOSITION:

Support

California Dental Association (sponsor)

The Children's Partnership (cosponsor)

CA Dental Hygienists' Association

California Primary Care Association

Children's Defense Fund – California

LIBERTY Dental Plan of California, Inc.

Maternal and Child Health Access

North County Health Services

Opposition

None on file.

Analysis Prepared by: Paula Villescaz / HEALTH / (916) 319-2097