BILL ANALYSIS
SB 1403
Page 1
Date of Hearing: June 20, 2006
ASSEMBLY COMMITTEE ON HEALTH
Wilma Chan, Chair
SB 1403 (Scott) - As Amended: April 24, 2006
SENATE VOTE : 33-0
SUBJECT : Medi-Cal: dental restoration documentation
requirements.
SUMMARY : Eliminates the Medi-Cal pretreatment dental x-ray
requirement for beneficiaries who are under four years of age or
developmentally disabled. States that x-rays or photographs
that indicate tooth decay in these beneficiaries are sufficient
documentation to establish the medical necessity for treatment
provided.
EXISTING LAW :
1)Establishes the Medi-Cal program, administered by the
Department of Health Services (DHS), which provides
comprehensive health benefits to low-income children, their
parents or caretaker relatives, pregnant women, elderly, blind
or disabled persons, nursing home residents, and refugees who
meet specified eligibility criteria.
2)Establishes the Denti-Cal program as a part of Medi-Cal and
specifies covered services and limits for services. Requires
the submission of an x-ray taken prior to dental restoration
treatments in order for a dental provider to be paid.
FISCAL EFFECT : Unknown. (Note: This bill is keyed non-fiscal
but it appears to have a potential fiscal impact of unknown
amount.)
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, this bill was
introduced in response to concerns raised by a constituent
dentist who treats children with disabilities. According to
the author, the current statutory requirement of a clear x-ray
cannot be met for many special-needs patients, including those
with autism, cerebral palsy and Down's syndrome. The author
agrees with the need for Denti-Cal fraud prevention but
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believes that it must not be done at the expense of the most
medically-needy and fragile children.
2)BACKGROUND . In 2000, the U.S. Surgeon General issued a report
which called the state of dental health in this country a
silent epidemic. The report indicated that many, especially
poor children, the elderly and minorities, are silently
suffering from oral diseases which are progressive and
cumulative and become more complex over time. Such diseases
can affect an individual's physical appearance, ability to
eat, ability to communicate and economic productivity. In
California, dental disease is the number one health problem
among children. School children with infected and painful
teeth miss more school days than children with healthy teeth.
3)DENTAL X-RAY GUIDELINES . Federal Food and Drug Administration
(FDA) Dental Radiograph Guidelines make it clear that x-rays
are desirable and are recommended generally. However, the
guidelines specifically address the possibility that x-rays
cannot be obtained: "The guidelines assume that diagnostically
adequate radiographs can be obtained; if not, appropriate
management techniques should be used after consideration of
the relative risks and benefits for the patient. . .
Recommendations are subject to clinical judgment and may not
apply to every patient. . . Radiographs should be taken only
when there is an expectation by dentists that the diagnostic
yield will affect patient care." An excerpt from the American
Dental Association (ADA) and FDA Guide to Patient Selection
for Dental Radiographs states that: "The dentist must weigh
the benefits of taking dental x-rays against the risk of
exposing a patient to x-rays, the effects of which accumulate
from multiple sources over time."
4)SUPPORT . The California Dental Association (CDA) argues that
the existing Denti-Cal x-ray requirement poses an unnecessary
barrier to oral health care for individuals who are often the
most difficult to treat and frequently experience limited
access to care. CDA states that it continues to hear from
pediatric and general dentists who are frustrated with the
impact this x-ray requirement has on being able to treat these
patients. According to CDA, Denti-Cal dentists struggle to be
reimbursed for the care they provide and their claims are
often denied because the x-ray documentation fails to meet
Denti-Cal standards of clearly defining dental disease. CDA
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claims that it is well recognized in dentistry that an x-ray
is always preferable when it can be obtained, but when there
is an expectation that the effort will not produce an x-ray of
diagnostic quality, dentists believe it is inappropriate to
expose a patient to unnecessary radiation. Finally, CDA
argues that when it comes to very young children and patients
with developmental disabilities, this bill will improve access
to care and improve the health outcomes of this unique and
underserved population.
REGISTERED SUPPORT / OPPOSITION :
Support
American Federation of State, County and Municipal Employees
California Dental Association
California Primary Care Association
San Diego County Dental Society
Opposition
None on file.
Analysis Prepared by : John Gilman / HEALTH / (916) 319-2097