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SB-1464 Medi-Cal: benefits: enrollees with special dental service needs.(2017-2018)

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Date Published: 03/23/2018 04:00 AM
SB1464:v98#DOCUMENT

Amended  IN  Senate  March 22, 2018

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Senate Bill No. 1464


Introduced by Senator Wiener
(Coauthor: Senator Pan)

February 16, 2018


An act to add Section 14132.235 to the Welfare and Institutions Code, relating to health care.


LEGISLATIVE COUNSEL'S DIGEST


SB 1464, as amended, Wiener. Oral health: elder and dependent adults. Medi-Cal: benefits: enrollees with special dental service needs.
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 under the Medi-Cal program, including certain dental services that are referred to as Denti-Cal.

Existing law expresses the declaration of the Legislature that this state shall foster and promote community services for the economic, social, and personal well-being of its citizens in order to protect elder and dependent adults.

This bill would express the intent of the Legislature to enact legislation that would improve access to oral health for all elder and dependent adults.

This bill would require the department to develop a mechanism to identify and designate individuals with chronic medical, physical, mental, behavioral, or developmental conditions or other disabilities that complicate their dental care or require the dental provider to provide additional expertise, actions, and resources. The bill would require the department to establish Medi-Cal aid codes that identify individuals meeting these criteria as enrollees with special dental service needs. The bill would include services described in specified codes from the American Dental Association’s Current Dental Terminology dental procedure codes as covered benefits in the Denti-Cal schedule of maximum allowances, and would require the department to establish payment procedures and reimbursement rates for those codes, as specified.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: NOYES   Local Program: NO  

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


SECTION 1.

 (a) Denti-Cal is the Medi-Cal dental health care component program that was established soon after the 1966 creation of the Medi-Cal program.
(b) According to an audit conducted by the California State Auditor in 2014, only 43.9 percent of children enrolled in the Denti-Cal program had seen a dentist in the previous year—a utilization rate that was the 12th-worst among states that submitted data to the federal Centers for Medicare and Medicaid Services. Eleven California counties either did not have any Denti-Cal providers or did not have any providers willing to accept new child patients covered by Denti-Cal. Additionally, the Little Hoover Commission found that only 26 percent of eligible California adults with fee-for-service Denti-Cal coverage saw a dentist in 2014, according to February 2016 State Department of Health Care Services data.
(c) It is widely recognized that people with significant and chronic medical, physical, mental, behavioral, or developmental conditions or disabilities have greater challenges obtaining dental services and maintaining good oral health than other individuals. Providing care for these individuals very often requires treating providers spend additional time and furnish other resources to deliver dental services.
(d) It is the intent of the Legislature to establish eligibility and payment to address access to dental services for Denti-Cal enrollees with special dental service needs.

SEC. 2.

 Section 14132.235 is added to the Welfare and Institutions Code, immediately following Section 14132.23, to read:

14132.235.
 (a) The department shall develop a mechanism to identify and designate individuals with chronic medical, physical, mental, behavioral, or developmental conditions or other disabilities that complicate their dental care or require the dental provider to provide additional expertise, actions, and resources. The department shall establish Medi-Cal aid codes that identify individuals meeting these criteria as enrollees with special dental service needs.
(b) For enrollees with special dental service needs, the department shall include the services described in the following codes from the American Dental Association’s Current Dental Terminology (ADA CDT) dental procedure codes, or any updated ADA CDT codes that identify those services, as covered benefits in the Denti-Cal schedule of maximum allowances, and establish payment procedures for the service codes when enrollees receive those services:
(1) D9920: Behavior management, by report.
(2) D9991: Dental case management—addressing appointment compliance barriers.
(3) D9992: Dental case management—care coordination.
(c) The department shall establish reimbursement rates for the services identified in subdivision (b) when billed in conjunction with the provision of other dental services for an enrollee with special dental service needs, to compensate for the additional time and resources required to arrange for, provide for, and follow up on dental treatment for, these individuals.

SECTION 1.

It is the intent of the Legislature to enact legislation that would improve access to oral health for all elder and dependent adults.