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AB-15 Denti-Cal program: reimbursement rates.(2017-2018)

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Date Published: 12/05/2016 08:52 PM


Assembly Bill No. 15

Introduced by Assembly Member Maienschein
(Principal coauthors: Assembly Members Patterson and Waldron)
(Principal coauthors: Senators Cannella and Nielsen)
(Coauthors: Assembly Members Baker, Bigelow, Brough, Chávez, Choi, Dahle, Gallagher, Lackey, Mayes, Steinorth, and Voepel)
(Coauthors: Senators Atkins, Bates, Gaines, Nguyen, and Wilk)

December 05, 2016

An act relating to Medi-Cal.


AB 15, as introduced, Maienschein. Denti-Cal program: reimbursement rates.
Existing law provides for 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.
This bill would require the State Department of Health Care Services to increase Denti-Cal provider reimbursement rates for the 15 most common prevention, treatment, and oral evaluation services to the regional average commercial rates, effective January 1, 2018.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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


 The Legislature finds and declares all of the following:
(a) California’s Medicaid dental program, Denti-Cal, is charged with providing an adequate level of dental coverage to 13 million low-income Californians, including five million children.
(b) Dental care, particularly preventative care, can have significant long-term impacts. Tooth decay and disease are associated with pregnancy risks, diabetes, and respiratory and heart disease. Additionally, a lack of access to dental care among children can result in missed school days, and ultimately poorer academic performance.
(c) Denti-Cal, as currently implemented and funded, is a failure. Just 37.8 percent of California’s five million Denti-Cal-eligible children saw a dentist in the 2014 calendar year.
(d) The Milton Marks “Little Hoover” Commission on California State Government Organization and Efficiency and the California State Auditor both note these low utilization rates, which stem from a lack of providers and an uneven distribution of those providers that do participate in the Denti-Cal program. Five counties have no providers, and 14 counties only have providers that are not accepting new patients.
(e) The lack of providers is partly a result of low reimbursement rates, which are typically one-third to one-half of the national average for common procedures.

SEC. 2.

 (a) It is the intent of the Legislature to attract and retain more Denti-Cal providers, with an emphasis on underserved areas, and to increase utilization of the program.
(b) Effective January 1, 2018, the State Department of Health Care Services shall increase Denti-Cal provider reimbursement rates for the 15 most common prevention, treatment, and oral evaluation services to the regional average commercial rates.