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

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Date Published: 03/24/2017 04:00 AM
AB15:v98#DOCUMENT

Revised  June 20, 2017
Amended  IN  Assembly  March 23, 2017

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

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 Voepel, Acosta, Travis Allen, Bonta, Cristina Garcia, Harper, Mathis, Thurmond, and Gloria)
(Coauthors: Senators Atkins, Bates, Gaines, Nguyen, and Wilk Wilk, Anderson, Fuller, and Vidak)

December 05, 2016


An act to add Section 14149.9 to the Welfare and Institutions Code, relating to Medi-Cal. Medi-Cal, and making an appropriation therefor.


LEGISLATIVE COUNSEL'S DIGEST


AB 15, as amended, 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.
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 department to increase funding for existing health care programs under the Medi-Cal program. Existing law establishes the Healthcare Treatment Fund for this purpose.
This bill would require the State Department of Health Care Services to increase department, for the 2017–18 fiscal year, to double 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. based on the average rates per service established in the 2015–16 fiscal year. The bill would appropriate for the 2017–18 fiscal year such an amount as may be necessary to double the reimbursement rates from the Healthcare Treatment Fund to the department, as specified.
Vote: MAJORITY   Appropriation: NOYES   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) 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 Economy 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.

SEC. 2.

 Section 14149.9 is added to the Welfare and Institutions Code, immediately following Section 14149.8, to read:

14149.9.
 (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) For the 2017–18 fiscal year, the State Department of Health Care Services shall double Denti-Cal provider reimbursement rates for the 15 most common prevention, treatment, and oral evaluation services based on the average rates per service established in the 2015–16 fiscal year.
(c) The Legislature shall appropriate for the 2017–18 fiscal year such an amount as may be necessary to implement subdivision (b) 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, in combination with the maximum federal financial participation that can be obtained.

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REVISIONS:
Heading—Line 7.
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