Major Legislative Issues - 2003

Last Updated: October 13, 2003

Following are brief summaries of bills and issues supported and opposed by CDA in 2003.

Instructions for using this page:

Click on a bill number to find out more; this will take you to the California Legislative Counsels Legislative Information Page. Once youre there:

Select either "Assembly" or "Senate" in the "HOUSE" box;
Type the number of the bill in the "BILL NUMBER" box; and
Hit the "SEARCH" button.

Once youre there, you can read the most recent version in either browser (HTML) or Adobe Acrobat Reader (*.pdf) format. You may also check the measure's status and history. To learn more about the author, click on the surname after the bill number. Youll be taken to the member's official legislative web site, where the choices are self-explanatory.

(NOTE: Every bill that imposes a fiscal cost on the state is referred from policy committee to the Appropriations Committee in each house to assess that impact. If the committee concludes that it is $150,000 or greater, the bill is placed on a "Suspense File," where committee members evaluate the impact and decide whether it will move to the floor and under what circumstancessuch as amending the bill to reduce or minimize its cost. Once bills have passed both houses of the Legislature, they are sent to enrollment for preparation and presentation to the Governor for his disposition. In almost all cases, he has until midnight October 12 to sign or veto bills.

Only bills that were active this session are included. Click here to research past legislation if you know the bill's number, author, or subject. The content and status of legislation changes constantly. Please call the Public Policy Division at 1-800-736-7071, Ext. 5200, for more information.)

Access to Care

Denti-Cal: Another close call!

Abstract: Since last falls success in preserving hard-won provider rate increases in fiscal years 2000-01 and 2001-02 and adult Denti-Cal services (see Major Issues Facing Dentistry in 2002), the states budget woes continued to worsen. In both his original January budget proposal for the current and next budget years and its May revision released May 14, Gov. Davis proposed elimination of adult Denti-Cal benefits and cuts in provider reimbursement rates. Budget writers in both houses resisted. The stalemate persisted through several budget vote drills, past the July 1 constitutional deadline. Anticipating the inevitable hard choices demanded by a structural deficit approaching a third of the states spending plan, CDA continued to work with the Department of Health Services (DHS) to identify incremental savings to save the program until economic times are better.

Legislators sought to save the Denti-Cal program, and CDA agreed to support moves, both in an extraordinary (SB 1X 5) and the regular (SB 108) legislative session to impose a nickel-a-drink fee on alcohol sales because it is dedicated to fund emergency and trauma services (see below).

Publicly, Republican legislators dug in, resisting tax increases of any kind but especially a majority-vote restoration or administrative trigger of a VLF reinstatement. They also embraced almost all of the Governors proposed spending reductions, including elimination of adult dental services and rolling back Medi-Cal/Denti-Cal provider rate increases. Stalemate continued into Spring as CDA worked diligently with both Budget Committee and health subcommittee members and staff to identify potential savings to keep adult dental services alive.

In late April, signs of a softening Assembly impasse appeared. Speaker Herb Wesson broached the subject of spending reductions in health and social service programs in his own caucus and lower-house Republicans released a detailed, multi-year deficit reduction plan that backed away from some of the cuts proposed by the Governor, including adult dental services. Legislative leaders negotiated and the Legislature passed six bills producing net combined-year savings of $3.6 billion. Gov. Davis signed those bills on May 5; among those was SB 1X 26, which produced an estimated $50 million in adult dental savings.

There have been some changes to the adult optional dental program within Denti-Cal. For example, SB 26 which took effect July 1, contained modifications to the adult optional program in Denti-Cal and providers should be aware of these changes. The changes that have now gone into effect are for adults age 21 and older:

Crowns on posterior teeth are limited to prefabricated ADA approved materials except when a posterior tooth is used as an abutment for any fixed or removable prosthesis with cast clasps and rests. Prefabricated crowns will be the only option reimbursed under the program;

Procedure 452 - Subgingival curettage and root planning is now reimbursed at $118.00.

Submission of X -rays for any patient exceeding four restorations in a calendar year are now required. Electronic filers need not submit their x-rays with the billing, but providers should be ready to submit them upon request of the department.

Emergency Services: Nickel-a-Drink Fee proposed.

Abstract: Public concern over the deterioration of Californias emergency and trauma care system travels both with and outside the states budget woes. CDA was called upon to support three bills to assess a nickel-a-drink fee on alcohol sales to shore up that system.

SB 1X 5 and SB 108, both authored by Sen. Gloria Romero and supported by CDA, would have enacted the Alcohol-Related Emergency Services Reimbursement Act of 2003, requiring the State Board of Equalization to collect a $0.05 per drink fee from every wholesaler in the state who distributes alcoholic beverages to retailers for consumption here. Revenue would have gone to the Alcohol-Related Emergency Services Reimbursement Trust Fund, administered by the Department of Health Services to be continuously appropriated for allocation to qualified local emergency medical services providers for reimbursement of expenses incurred in treating alcohol-related trauma. These identical bills, introduced into both the First Extraordinary (special budget) and Regular Sessions of the Legislature, were supported by a broad array of health, labor, law enforcement, and local government interests and opposed by distributors and retailers and their business and labor (i.e., Teamsters and Retail Clerks) allies. Either measure would have produced an estimated $700 million per year. (There were other bills that would impose or raise taxes on alcohol on which CDA took no position because the revenue realized was not earmarked for the direct provision of health care services.

SB 1X 5 was referred after introduction to four separate policy committees, while SB 108 was referred to only two. Both bills passed out of the Health and Human Services Committee on March 26 on a party-line vote, 8-2, but did not move forward by the end of this legislative session.

Related Legislation: None.

Tax Credits: Break for Denti-Cal providers in rural counties victim of bad budget times.

Abstract: A Republican freshmans proposal to give medical and dental professionals a direct tax credit for Medicaid services in underserved areas gets held in committee.

AB 988 (Bill Maze), supported by CDA, authorizes an election of one of two different nonrefundable credits for qualified medical care professionals (including dentists and auxiliaries) who treat Medi-Cal beneficiaries in qualified countieseither a credit equal to 20% of the amount received for treating Medi-Cal beneficiaries in a qualified underserved county, or a credit equal to 10% of the salary received as an employee in a qualified health center. The bill was held on the Assembly Revenue and Taxation Committees Suspense File, 5-2, on May 19.

Related Legislation: None.

Universal Coverage: Business & LaborBattle of the Heavyweights

Abstract: Organized labor makes universal health coverage a priority and wants employers to pay or play; the California Chamber of Commerce has anointed the effort a major job killer. The notion of a single-payer system is revived, with Senate leadership succession overtones. Swept up in the confrontation are CDA and other stakeholders.

CDA and every interest with a stake in health care were following this sessions universal coverage debate. Sen. Sheila Kuehl, an announced candidate to succeed Senate President Pro Tempore John Burton when his final term expires next year, set the debate in motion last fall by surveying interested parties about a single-payer system. Burton himself weighed in earlier this year, introducing a labor-backed, pay or play measure. (In most cases, the subsidy would come from a payroll tax, either in the 7% range or as yet unspecified.) A number of other legislators filed variations on the theme. With that in mind, CDAs Joint Policy Council met on April 19 and reviewed the half-dozen major proposals summarized below. Out of that discussion was born a working group charged with the responsibility of recommending to the Board of Trustees a set of core principles based on existing and possible new CDA policy against which any universal coverage proposal would have to be measured to earn the organizations endorsement.

Following is a sampler of mandatory or universal health coverage bills from this year, by bill number. (An asterisk--*--indicates that dental benefits were included.)

AB 30 (Keith Richman)*Requires expansion of the Health Families Programresulting in a 50% federal match for program coststo provide coverage to uninsured, childless employed adults with a family income under 250% of the Federal Poverty Level (FPL). Eligible adults would pay 25% of premium costs.

AB 857 (Dario Frommer)One of the Health Committee Chairmans offering builds on a new federal lawTitle II of the Federal Trade Act of 2002, which offers money to offset health care costs for workers who lost their jobs from increased imports and funding grants for states to create coverage pools for eligible workersto create a benchmark for a high-risk purchasing pool for eligible workers.

AB 1524 (Keith Richman)--Creates the County Health Initiative Matching Fund to expand health insurance coverage to adults. Expands scope of existing childrens-only fund's health insurance coverage to include adults as specified. Conditions new coverage on full federal funding from existing programs and no negative impact on childrens coverage.

AB 1527 (Dario Frommer)-- Expands access to employer-based health using a "pay or play" approachthat is, either provide specified coverage or pay a fee or tax into a pool to subsidize mandatory coverageapplicable to employers with 51 or more employees and establishes a premium assistance program to enable Medi-Cal or Healthy Families Program eligible employees (or their dependents) of any size employer to keep employment-based coverage when available.

AB 1528 (Rebecca Cohn)-- Enacts the Healthy California Act of 2003. Creates the California Essential Health Benefits Program (CEHBP), administered by the Managed Risk Medical Board (MRMIB), to ensure all Californians have health care coverage with a minimum set of benefits. Requires coverage through an individual mandate, an employer pay-or-play system, and public programs.

SB 2 (John Burton, Jackie Speier)--Requires employers to provide specified minimum health coverage benefits to employees and dependents by purchasing coverage from any health plan, providing coverage through a self-funded, employer-sponsored plan, or by paying a fee to the State Health Purchasing Program (SHPP), which would use a purchasing pool to provide coverage.

SB 927 (Sheila Kuehl)-- Establishes the California Health Care System to provide universal and affordable health care coverage for all California residents using a single payer system, to be administered by the newly created Health Care Agency under the control of an elected Health Care Commissioner. Provides that the HCA shall be comprised of a Health Policy Board, the Office of Consumer Advocacy, and the Office of Medical Practice Standards. Coverage benefits would be set and reviewed periodically by the Agency.

Although all bills moved out of their respective houses, they were sent to a joint conference committee for review and report. SB 2, supported by labor, was the bill that moved forward and was signed by Governor Davis in the final days before his recall. It requires medium (20-199 employees; employee is 100+ hours per month) and large (200+) employers, on January 1, 2007 and January 1, 2006, respectively, to begin paying a state-assessed fee to provide defined minimum health care benefits to eligible employees (and dependents of large employer workers), with specified exceptions. Employers who offer required coverage are eligible for a credit against the fee. (As defined, minimum mandated coverage does not include dental benefits.) (Chapter 673, Statutes 2003)

Related Legislation: AB 293; AB 1130; AB 1163; AB 1524.

CDA Affairs

Insurer Dividends: CDA joined coalition to reverse court decision disallowing state tax deduction for dividends from affiliated insurer.

Abstract: CDA-HCI is one of a number of state taxpayers that were issued deficiencies by the Franchise Tax Board as a result of a court case that struck down the deductibility of dividends received from affiliated insurers. Legislative relief is being sought by CDA and representatives of similarly-situated taxpayers.

Last year, CDA-HCI was notified by the Franchise Tax BoardCalifornias tax collectorthat it owed a little more than $806,000 in back taxes, plus interest. This was because the holding company had taken a deduction on its returns over the years for dividends received from The Dentists' Insurance Company (TDIC), an affiliated insurer. This "dividend received deduction" (DRD) is permitted under federal law and has been allowed to California domestic corporations under Section 24410 of California's Revenue & Taxation Code since the mid-1960s, largely to avoid double taxation on insurers. (The California Constitution requires insurers to pay a gross premiums tax in lieu of corporate income tax.) On December 21, 2000, the Fourth District Court of Appeal ruled in Ceridian v. Franchise Tax Board, 86 Cal App 4^th 483, that the deduction applicable only to corporations domiciled in California violated the Commerce Clause of the U.S. Constitution. Prior legislative attempts to cure the problem have failed.

This session, CDA joined a coalition of entities with affiliated insurers in supporting AB 263 (Jenny Oropeza), a bill that would reclaim the deduction for open tax years (1997-2002) at a fixed percentage, subject to taxpayers' elections regarding treatment of related nonbusiness income, and restore it prospectively for all eligible corporations from 2003 forward.

California's dire budget straits work against full restoration of the DRD but the coalition demonstrated to many that it would be preferable for the state to act to stabilize the situation and collect immediate revenue at some percentage of assessed deficiencies, rather than leave resolution of the controversy to litigation which may yield nothing in the way of short-term revenue.

AB 263 moved through the process until the final weeks of this legislative year and was shelved pending the outcome of the recall election and additional wrangling over structural budget deficits.

Related Legislation: None.

Childrens Oral Health

Childrens Oral Health Carbonated Beverages: Soda tax author shifts attention to school sales.

Abstract: After her attempt to tax sugared beverages to support child and oral health failed last year, a Sacramento Senator focused on the problem at a significant point of saleschools.

Last year, Sen. Deborah Ortiz, Chairwoman of the Senate Health and Human Services Committee, authored a bill supported by CDA that aimed to attack the problems of childhood obesity and poor oral health by taxing sugared beverages and dedicating the proceeds to combating those problems (15% of revenues were to be dedicated to oral health needs). The bill died due to fierce opposition from the soft-drink industry and threatened loss of revenues to schools from beverage sales and related vending incentives. This session, Sen. Ortiz carried SB 677, also supported by CDA, which as introduced would have limited the sale of beverages on all public school campuses to defined nutritional beveragesspecified fruit-based drinks, drinking waters, specified sports drink, and milk. The final bill was limited to banning the sale of unhealthy beverages in elementary, middle, and junior high schools during school hours. CDA had a unique opportunity during these debates to raise the oral health consequences of drinking soda, and the effect poor oral health has on school attendance.

The Governor signed SB 677 on September 16. (Chapter 415, Statutes 2003)

Related Legislation: None.

Childrens Oral Health Resolution: Oral Health Month and GKAS recognized.

Abstract: CDA sponsored resolution underscoring importance of oral health in children and pro bono dentistry.

HR 15 (John Laird), a legislative resolution sponsored by CDA, recites a panoply of salient facts on the state of California childrens oral health and resolves that:

February 2003 is recognized as Childrens Dental Health Month;

February 21, 2003, is recognized as Give Kids a Smile Day; and

The Assembly of the State of California recognizes the severity of the problem of children's oral health and the importance of the dental community providing pro bono services throughout the year.

The resolution was adopted by the Assembly on February 20.

Related Legislation: SB 167, SB 875.

"Junk" Science

Amalgam: CDA takes over Denti-Cal choice issue.

Abstract: Still unsatisfied with the Dental Materials Fact Sheet, Consumers for Dental Choice chose a different tacticrestorative material choice for both privately insured and Denti-Cal patientsto try to get their opinions on amalgam elevated into statute as findings of fact. CDA persuaded their author to respect both science and patients.

Assemblyman Jerome Horton agreed to author AB 999 at the request of Consumers for Dental Choice. As introduced, the bill would have:

Required the Insurance Commissioner to request, in writing, that dental care plans allow a covered individual to elect to receive alternatives to mercury-based fillings;

Authorized Denti-Cal recipients to elect to receive alternatives to mercury-based dental fillings;

Required participating dentists to post a notice regarding exposure to mercury in dental fillings; and

Enacted as legislative findings and declarations a series of carefully chosen facts designed to discredit amalgam as a safe and effective restorative material.

CDA opposed the bill as introduced and scheduled meetings with the author and his staff to brief them on both the true state of science on the use of dental amalgam and restorative material coverage policies in the Denti-Cal program. CDA pointed out that because many private dental plans and Denti-Cal do not cover composite restorations, a dentist cannot provide them as an alternative without violating conditions of participation orin a Denti-Cal casecommitting criminal fraud. Persuaded by these arguments, Assemblyman Horton amended his bill to:

Find and declare that existing law provides sufficient information about restorative materials permit patients to make an informed choice and that the Dental Board has encouraged those types of discussions;

Find and declare that if a dentist, in consultation with the patient, determines that a restorative treatment option not included in the benefits of the Denti-Cal program is within the standard of care, the dentist should have the choice of providing that treatment;

Amend Denti-Cal law to permit a provider to recommend, after consultation with the beneficiary, a dental restorative material other than the covered benefit of amalgam; and

Amend Denti-Cal law to allow that provider to claim and receive the reimbursement rate for an amalgam restoration when using a different dental restorative material.

With CDA changing its position to support, AB 999 moved through the legislative process and was signed by the Governor on October 10. (Chapter 747, Statutes 2003)

Related Legislation: AB 611; see Practice-Related Issues: Amalgam Separators, below.

"Junk Science" Lawsuits: Plaintiffs lawyers smother reform again; demand for real action increases.

Abstract: Joint hearings early in the year on Unfair Competition Law shakedown lawsuitssuch as that filed against CDA and ADA by Kids Against Pollutioncompelled by media attention produced uncharacteristically swift disciplinary action against one law firm. Nonetheless, real legislative reform ran aground once again in both policy committees under fire from the Consumer Attorneys of California. Instead, the reforms that emerged would have made matters worse.

After three sessions success in stopping meaningful legislative reform to Californias overly broad Unfair Competition Law (UCL - Business and Professions Code 17200 et seq.), the Consumer Attorneys of California (CAOC) are facing new challenges. (The lawsuits filed by the Khorrami Law Firm accusing ADA and CDA of "deceiving" consumers about mercury in amalgam fillings are grounded entirely in the UCL.) Over the fall and winter, the Trevor Law Group, a Beverly Hills firm, drew notoriety for filing thousands of UCL complaints against small businesses, principally against auto repair shops and ethnic goods and service providers, allegedly in hopes of extracting quick settlements. The controversy attracted the interest of the Attorney General and the State Bar, and the Judiciary Committees in both houses were constrained to conduct joint investigative hearings in January. These proceedings compelled the committees chairwomen, Assemblywoman Ellen Corbett and Sen. Martha Escutia, to urge the State Bar and the Judicial Council to jump-start their own assessments. Democrat members of the Assembly Panel introduced a spot bill on the subject, AB 95.

Nine other reform measures were introduced this session. The most comprehensive of these, CDA-supported AB 102 (Robert Pacheco), would have amended existing law to:

Require the person bringing the action to have suffered harm or have relied on a representation of the defendant;

Bar an action when there is no evidence of present harm and the defendant has terminated the activity;

Limit suits to no more than one action against one defendant for the same conduct; and

Provide a mechanism so that no UCL claim is added to another lawsuit for tactical advantage.

CDA believes that these reforms are necessary, at a minimum, to provide relief for its members and other organizations like CDA that may be sued for public statements on controversial issues.

Both Judiciary Committeesdays before their deadlines and with minimal public noticemet, defeated on party-line votes all bills not sponsored or supported by COAC, and reported out respective reform bills sponsored by the plaintiffs bar. These two billsAB 95 (now authored only by Corbett) and SB 122 (Escutia), both opposed by CDA unless amended to achieve real reformwere double-joined, meaning that one cannot become law without the other. Together, they:

Required that UCL plaintiffs provide defendants a statutorily prescribed notice that theyre being sued;

Required court review and approval of attorneys fees;

Permitted joinder of defendants at the election of the plaintiff; and

Gave plaintiffs lawyers a new monetary remedy, disgorgement of profits or other ill-gotten gains, that now is available only to the Attorney General and district attorneys.

SB 122 passed the Senate June 4, 22-15, and AB 95 passed the Assembly with a bare majority at the first-house deadline, 41-35. The linked measures cleared second-house policy committeesby 5-1 and 9-4 votes, respectively, but did not reach the Governors desk because moderate Democrats refused to pass them out of the Assembly.

CDA continues to participate as a member of a coalition sponsored by the Civil Justice Association of California that is evaluating whether the issue of UCL reform should be taken directly to the voters.

Related Legislation: AB 599; AB 754; SB 889; SB 890; SB 912.

Anti-"SLAPP" Motions: Sen. Kuehl tries again, and is successful.

Abstract: Fresh off an October2002 veto, the Consumer Attorneys of California again try to prohibit certain defendants from filing an anti-Strategic Lawsuit Against Public Participation (SLAPP). This measure will prevent CDA and others from filing this special motion to strike as we did in 2002 in the Kids Against Pollution anti-amalgam action in which we won.

Ten years ago, the Legislature enacted a law allowing a defendant a special motion to strike a civil complaint against theman anti-SLAPP motionon the grounds that his or her actions were in furtherance of the right of petition or free speech under the United States or California Constitution in connection with a public issue. As passed and amended in 1997, this law was intended to protect "little guys" against "big guys" with superior litigative resources; in subsequent practice, business defendants have used the motion successfully to blunt what they believe to be nuisance lawsuits, invoking constitutionally recognized and protected "commercial speech." CDA filed such a motion in the "Kids Against Pollution," anti-amalgam action, and prevailed in its appeal to the First Appellate District of the trial courts denial. As a result, all four causes of action are expected to be dismissed.

Had SB 515 (Sheila James Kuehl) been on the books at the time, CDA would have never had the chance to file its anti-SLAPP motion. A slight variation on the theme that got vetoed last October, the bill narrows the applicability of the procedure to specially defined noncommercial speech situations, carves out some business, insurance, and securities causes of action, and forbids appeals of denials of motions to strike.

SB 515 came out of the Senate Judiciary Committee on May 6, 5-1, and passed the Senate May 29, 22-15. The bill moved through the process and was signed by the Governor on September 8. (Chapter 338, Statutes 2003)

Related Legislation: None.

Licensure

Dental Assistants Scope of Practice. CDA and DAA discuss reform with public health input.

Abstract: On the table: for CDA, Career Pathways; for DAA, mandatory training and permit to practice.

After many months of exchanges and sometimes-contentious debate about the scope of practice for dental assistants among CDA, the Dental Assisting Alliance (DAA), and the California Primary Care Association, final negotiations stalled at the end of this legislative year.

Out of a desire to take positive steps to address the shortage of qualified dental auxiliaries, CDAs Council on Education and Professional Relations built CDAs Career Pathways: Proposal for Allied Dental Health Personnel, which was unveiled on May 9, 2001. Since then, disputes inside and outside the Dental Board's Committee on Dental Auxiliaries over mandating external CPR and infection-control training for and licensing of dental assistants have threatened to obscure the goals of reform: Create a statutory and regulatory scheme adequate to protect patients but agile enough to attract new professionals into a career with potential for growth and fulfillment. CDA's position has remained that care must be taken not to shift the supervising dentist's supervisory authority too far away from real accountability.

Issues that were discussed included:

Defining the "basic supportive dental duties" of dental assistants; how they should be trained in CPR, infection control, and jurisprudence; and whether they should be required to obtain state permits.

Categories and defining duties of "specialty"i.e., orthodontic, surgery, and restorativeRegistered Dental Assistants, and what to do about existing RDAs.

Whether RDAs in Extended Functions should be replaced by an RDA with comprehensive specialty training.

Whether general and specialty restorative duties should be defined by class or device, or some combination of the two.

Whether new examinations should be conducted on live patients or using typodonts.

The number of auxiliaries a single dentist may supervise.

Guided by a member "working group," CDA leaders and staff met with DAA, CPCA, dental school faculty, and public-health dentists to continue discussion.

Although much work was done, and consensus was reached on many issues, final negotiations bogged down when a conflict between proposed regulations and legislative negotiations could not be resolved, specifically regarding the placement of composite restorations. CDA continues to oppose some of the regulatory language and has testified publicly before the Dental Board.

SB 362, authored by Senate Business & Professions Committee Chairwoman Liz Figueroa and co-authored by Sen. Sam Aanestad and Assembly Business & Professions Committee Chairman Lou Correa, was the likely vehicle for the agreement. (Another potential vehicle, SB 844 (Ed Vincent), which at present contains a only a statement of legislative intent concerning utilization of dental auxiliaries, remained in the Senate Rules Committee and is now a two-year bill. Under normal rules, this means that it may be considered actively again next January and must pass the Senate by January 31 to remain alive.)

Related Legislation: None.

Dental Board Composition. CDA proposed statutory apportionment of general and specialty dentist representation on the board.

Abstract: CDA sponsored a bill requiring that at least three of six unallocated practice slots on Californias Dental Board be filled with general practitioners; ADA-accredited specialists could be appointed to the other three slots.

Under current law, the only statutory qualification beyond licensure in good standing imposed on any of the eight dentist members of the 14-member Dental Board of California is that one be a California dental school faculty member and that one practice in a nonprofit community clinic. CDA decided to sponsor AB 1007 (Nakano). General dentists still constitute the overwhelming majority of all active licensees within the profession (approximately 80%) and CDA believes that representation on the board would provide the best perspective and the best protection for consumers.

AB 1007 provided that, of the remaining six practicing dentists, three shall be in the full-time practice of general dentistry, and a maximum of three may be dentists who practice in any specialty accredited by the American Dental Association. In this form the bill passed the Business & Professions Committee, 13-0, on May 7 and the Assembly, 77-0, on May 12. AB 1007 remains in the Senate Business & Professions Committee as a two-year bill.

Related Legislation: None.

Dental Hygiene 3^rd & 4^th Dental Students Taking Exam. CDA sponsored bill to implement House policy; CDHA bitterly opposed.

Abstract: Last November, CDA's House of Delegates approved the notion that the law should allow qualified third and fourth-year dental students to sit for the dental hygienists' exam. In legislative testimony, CDHA has gone ballistic.

In 2002, CDA's House of Delegates adopted a resolution sponsored by dental students, asking for legislation to allow third- and fourth-year dental students to sit for the dental hygiene examination.

This year, CDA is sponsoring AB 539 by Assemblyman John Laird to carry out the Delegates' will. The bill permits third- and fourth-year dentistry students to sit for the dental hygienists qualifying exam. It also incorporates, within the requirements for registration as a dental hygienist, a provision allowing students who have successfully completed two full years of dental school to substitute that coursework for completion of a CODA-accredited dental hygiene educational program. CDA has graphically demonstrated to legislators, using a side-by-side comparison of curricula and coursework, that completion of two years of dental school equals or exceeds hygiene training. CDA has argued that it's likely that up to 25% of dental students may take advantage of such a law both as a hedge against higher postgraduate debt and to acquire real-world experience. In addition to helping ease the current shortage of dental hygienists, it is also more likely that they will be exposed to underserved patients, given the urban locations of most California schools.

The California Dental Hygienists' Association (CDHA) has vociferously opposed AB 539, arguing that the bill would have a negative impact on access to care and constitutes an attempt by dentistry to keep hygienists from finding full-time employment and accompanying benefits.

AB 539 passed the Assembly Business & Professions Committee, 12-1 (the single negative vote was cast in error), on April 30, the Appropriations Committee May 14, 18-0, and the full house 76-0 on June 5. It was reported with minor amendments from the Senate Business & Professions Committee on July 14, 6-0. Senate Appropriations Committee voted it out 9-2 after it was amended to allow COMDA to charge students the actual cost of giving the examination. CDA held the bill on the last day of session due to an anticipated veto in the Governors office.

Related Legislation: None.

Hygienists Separate Regulation. Discussions in limbo.

Abstract: Last year, language expressing the Legislature's intent to "pursue" the issue of a separate regulatory board for hygienists in the next session was enacted into law. No progress was made this year in any regard.

One of the negotiating points between CDA and the California Dental Hygiene Association (CDHA) on scope-of-practice reform last session was the recommendation to the Joint Legislative Sunset Review Committee by the Committee on Dental Auxiliaries that hygienists have their own regulatory board. CDHA took the position that scope-of-practice recodification legislation should include that provision, while CDA insisted that one would more naturally follow the other, given the realities of the Dental Boards status in the already-mandated, truncated review process. One of the omnibus bills of 2002 provided a statement of legislative intent to pursue the issue in future joint review. SB 1955 (Figueroa) was signed last September 30. (Chapter 1150, Statutes 2002)

In February, CDHA submitted draft legislation establishing a separate California Hygiene Board to CDA staff that revived several contentious scope-reform points that were resolved through negotiation last year. At the same time, COMDA staff circulated possible "clarifying" amendments that also revised statutes in effect for a month that are the product of careful compromise. CDA staff has asked CDHA's advocates whether it was their intention to reopen these issues before presenting the separate-board proposal to CDA leaders and experts for internal review. Though CDHA leaders have indicated informally to their CDA counterparts that there is flexibility, CDHA's advocates have yet to provide an answer. The lack of response may or may not be related to the organization's bitter opposition to CDA's measure to allow third- and fourth-year dental students to take the hygiene exam (see AB 539 above).

No further discussions occurred on this subject.

Related Legislation: SB 844.

RT Exam Deadline & Backlog. CDA focuses on existing applications at expiration.

Abstract: The statutory deadline for foreign-trained professionals to apply for and take their written and restorative techniques exam is January 1, 2004. While CDA opposes another extension, it is willing to grant grace to applicants-in-being at sunset.

Under the statutory scheme first enacted by AB 1116 in 1997 and once extended since then, foreign dental school graduates:

Have until January 1, 2004, to furnish adequate evidence of having received a diploma to become eligible to take a progressive and written restorative techniques examination that will qualify them for the balance of the regular licensure exam.

Until next January 1, any applicant who fails to pass the licensure examination after four attempts is not eligible for further reexamination until he or she has successfully completed at least two academic years of education at an approved dental school.

As introduced, AB 1467 (Gloria Negrete McLeod), sponsored by Western Dental Services, would have moved those dates forward another two years to January 1, 2006. CDA opposed the simple extension on the grounds that there was no compelling case to be made to alter the Legislatures will after six years, including one extension. CDA encouraged the Dental Board to actively lobby their position on the bill (oppose unless amended). CDA stepped away from the bill once it was amended to:

Postpone repealing existing licensure qualification requirements one additional year, to January 1, 2005; and

Allow the restorative techniques (RT) examination to be administered to foreign-trained applicants after December 31, 2004, only if they have completed existing eligibility requirements and have passed Parts I and II of the National Dental Board Examiners written examination.

When the bill was heard in the Senate Business and Professions Committee on July 14, the Dental Board registered an Oppose Unless Amended position, on the grounds that as drafted it would seriously strain the Boards examination resources through a period as late as fiscal 2010. The Board requested amendments to restore the Parts I and II completion requirement and to leave the existing cutoff date in place, with provisions to assure that eligible applicants will be examined fairly after the deadline passes. After vigorous debate, the Committee elected to put the bill over until August 18. Because this bill contained an urgency clause, it required a two-thirds vote. Due to partisan politics, this bill and approximately 30 others were not voted on during the last hours of this legislative year.

Related Legislation: None.

Practice-Related Issues

Amalgam Separators CDA's effort to produce local workable compromise stalled by environmental groups.

Abstract: This year, legislation was introduced that would have mandated amalgam separators in all California operatories. CDA worked with legislators, staff, and state and local regulators to fashion a "local choice" solution that was derailed by environmental groups.

As introduced, AB 611 (Gloria Negrete McLeod) required that:

By January 1, 2004, all dentists have a state-of-the-art amalgam separator installed in his or her office and be (or have office staff) trained in its use;

Imposed administrative fines of $100 per day for noncompliance to be assessed and collected by the Dental Board; and

By March 1, 2004, and annually thereafter, dentists file reports to the Department of Toxic Substances and Control on the quantity of mercury discharged into wastewater and the quantity of mercury recycled during the previous calendar year.

CDA opposed the measure, sponsored by Consumers for Dental Choice. As with AB 999, CDA took the opportunity to attempt to educate the author on the environmental impact of amalgam in wastewater and sought to involve state and local regulators in identifying and codifying a practical and economically feasible way to minimize harmful discharge. On May 6, significant amendments supported by CDA were presented to the Assembly Environmental Safety & Toxic Materials Committee to require the State Water Resources Control Board to work with CDA in taking specific actions to evaluate and promote effective solutions and technologies for the reduction of dental amalgam waste and the recovery of mercury and dental amalgam wastes, including:

Identifying potential sources of dental amalgam and mercury discharges to local publicly owned treatment works (POTWs);

Developing outreach and educational programs;

Assessing the efficacy of dental amalgam reduction programs and recovery systems; and

Establishing and implementing specific dental amalgam recovery projects through the use of various methodologies.

The bill requires each licensed dentist to comply with specified best management practices (BMPs) regarding amalgam-containing traps, filters, or containers and the discharge of dental amalgam into the sewer system, and would also require each dentist to take specified actions with regard to non-contact and contact amalgam, and amalgam-containing waste. Finally, the proposed changes authorized POTWs or regional boards that determine that additional methods are required for dentists to meet local discharge limits, to work cooperatively with them to determine whether other technologies, based on scientific information, may be required.

Committee members agreed to the amendments, 7-0, and sent the bill to the Assembly Appropriations Committee, where it was placed on the Suspense File on May 21. On May 28, the Appropriations Committee voted to hold AB 611 in committee, based on concerns expressed by environmental interests. CDAs Council on Legislation believes it is in the best interest of dentistry and the public to continue to try to find a legislative solution to this issue. Staff is meeting with Senate Environmental Quality Committee staff to determine if there are other options.

Related Legislation: None.

Cultural Competency CMA wants to establish voluntary, practitioner directed improvement effort. CDA expressed an interest in joining in.

Abstract: For the past two sessions, the Legislature has entertained a variety of notions for improving health practitioners' ability to manage the care of patients who speak different languages and possess diverse cultural characteristics and beliefsincluding time-specific mandates. This year, CMA is sponsoring legislation adopting a voluntary continuing education program. CDA has had discussion with the author about being included.

AB 801 (Manny Diaz), sponsored by the California Medical Association (CMA), creates the "Cultural and Linguistic Competency of Physicians Act of 2003." Under its terms, CMA's component medical societies would operate a voluntary continuing education program for physicians monitored by the state. The program would develop educational classes to teach foreign languages to interested physicians and would offer classes designed to teach physician participants about cultural practices and beliefs that affect health care. A work group would recommend whether successful participating physicians receive credit for the program and establish standards for courses and training. The program would be funded by fees paid by physicians taking the classes and other funds secured by the component societies. Early on, CDA expressed support for the bill if it was amended to include CDA and its component societies. Subsequent amendments, however, placed a significant burden on the Dental Board, causing CDA to temporarily withdraw their request for inclusion.

AB 801 was signed by the Governor on September 25 (Chapter 510, Statutes 2003)

Related Legislation: None.

Medical Corporations CDA seeks to add dentists to practitioners who may participate.

Abstract: Under current law, dentists cannot participate as minority officers, directors, or shareholders in medical corporationsunlike many other categories of licensed allied health professionals. CDA wants to correct that anomaly.

CDA is the sponsor of AB 123 (Rebecca Cohn), which would add to the Moscone-Knox Act a professional dental corporation in which licensed physicians and surgeons and allied dental health professionals could participate as minority shareholders (up to 49%), officers, directors, and professional employees.

An idea that was suggested and endorsed by the Health Committee of the State Bar's Business Law Section, the bill is designed to remove existing impediments to licensed dentists entering into legal arrangements for integrated care, where an initial medical diagnosis may be required and a dentist is prohibited from advertising on his or her own a treatment for a condition in which the jaw and dentition are implicated, such as facial, head and neck pain.

AB 123 was reported to the Assembly by the Business & Professions Committee unanimously on April 2 and passed, 72-0, on its April 10 Consent Calendar. The bill came out of the Senate Business & Professions Committee without debate and was passed by the Senate on Special Consent on July 17. The Governor signed the bill on September 28. (Chapter 549, Statute 2003)

Related Legislation: None.

"Spam" Senator who banned "junk faxes" takes aim at overstuffed e-mailboxes.

Abstract: Spam" has been regulated in the state for five years. Have legislated successfully against unsolicited faxes, the same author wanted to ban junk e-mail.

Sen. Debra Bowen took aim at unsolicited e-mailspamearly in her legislative career by authoring a law requiring senders of unrequested e-mail to include a legend in the messages subject line that it is advertising and giving the recipient a convenient method to unsubscribe. Last year, she jockeyed a CDA-supported bill (AB 2944) toughening state law by prohibiting sending unsolicited facsimiles and applying federal fines to violators. This session, she authored another CDA-supported measure, SB 12, which modifies existing law to prohibit outright the sending of unsolicited e-mail ads from California or to a California e-mail address.

The bill passed the Business & Professions Committee, 5-1, on March 26 and the full Senate, 21-12, on May 22. It ran into trouble in the Assembly Business & Professions Committee where it was opposed by Microsoft, Yahoo, and representatives of other large Internet service providers. SB 12 failed passage on July 1 in deference to SB 186 by Senator Kevin Murray, which was supported by those ISPs and which passed the Committee 13-0 on July 8. SB 186 was signed by the Governor, while SB 12 could be revived next year.

Related Legislation: AB 567; SB 342.

Worker's Compensation Expanded benefits and crashing market force the issue.

Abstract: After three straight vetoes, last year organized labor finally got a signature on a bill increasing benefits for injured workers. Meanwhile, employers are facing workers' comp insurance premiums that have as much as tripled since "reform" was last enacted. The state's "insurer of last resort" is now virtually the first resort. Add a new Insurance Commissioner. Stir.

Facing re-election last fall, Gov. Davis signed AB 749, a bill touted as "comprehensive reform" whose centerpiece was a significant bump in benefits for eligible employees hurt on the job. Enactment was a victory for labor interests, who had sent four straight bills to his desk to be disposed of by veto. Though the bill contained almost four-dozen other provisions produced by year-long negotiations among the players, the surrounding climate had already soured. Not unlike much-touted energy market legislation, the last significant statutory policy shift on the issue occurred last decade when the partieschiefly, employers demanding premium relief and comp attorneys and doctors protecting the middlepushed through "reform." A key feature of that package was repeal of the state's minimum-rate law, a decades-old provision that kept insurers' rates from undercutting costs. While it produced immediate reductions in premiums, that action fulfilled other predictions made at the time: Short-term rate wars would indeed undercut claims costs, leading to market consolidation, retrenchment, andabsent other cost controlsinsolvencies, leading to sharp premium increases. A key statistic: the State Compensation Insurance Fund, a legislatively created "insurer of last resort," has seen its market share nearly triple in that time, to over 50% of total premiums.

This year, the California Chamber of Commerce introduced a package of reforms, and labor, led by Cal-AFL-CIO, was determined to preserve benefits. That dynamic focuses attention on the middlemedical and legal costs of claimsmeaning that applicants attorneys and industrial health practitioners, leap to the defense. Insurance Commissioner John Garamendifirst elected in 1990 and a candidate for Governor himself during the last reform debatemade reform a top priority out of sheer market necessity.

The Chamber sponsored or supported the following Senate package of bills:

SB 176 (Ross Johnson)Requires rating organizations to notify a policyholder of a change in classification assignment.

SB 223 (Bob Margett)Requires use of generic drugs by prescribers in comp cases.

SB 228 (Richard Alarcon)Streamlines and simplifies medical billing procedures in the system to achieve cost savings.

SB 365 (Johnson)Requires that work-related injuries must be caused predominately by employment to be eligible for benefits.

SB 366 (Johnson)Requires that psychiatric injuries be proved to be job-related to sustain eligibility.

SB 414 (Tom McClintock)--Revises the comp definition of injury to mean an injury or disease certified by a physician using medical evidence based on objective medical findings. (Sponsor)

SB 714 (Jim Battin)Reforms permanent disability system; prevents over-apportionment of non-job-related injuries. (Sponsor)

SB 757 (Chuck Poochigian)Requires the state system's Administrative Director to develop a utilization schedule.

SB 758 (Poochigian)Revises the vocational rehabilitation program by making it voluntary and eliminating "cash-outs" for $10,000.

SB 759 (Poochigian)Reduces litigation costs by establishing a 90-day statute of limitations on filing certain types of claims.

SB 893 (Bill Morrow)Requires injury ratings for permanent disabilities be based upon proven medical guidelines. (Sponsor)

SB 899 (Poochigian)Prohibits comp physicians from referring a patient to an entity in which he or she has a financial interest. (Sponsor)

SB 1010 (Poochigian)Repeals five key labor-backed laws enacted in the last two years: increased comp benefits; the eight-hour-day overtime rule; the prevailing wage requirement for private construction; enhanced local authority to punish employment violations; and attributing the experience modification ("X-mod") rate of clients to temporary employment agencies.

SB 1011 (Battin)Repeals two more recent labor reforms expanding state agency benefits in personal service contracts for janitorial, housekeeping, and security guard services, and requiring bodies awarding public contracts funded by the School Bond Acts to initiate labor compliance programs.

The Senate Labor & Industrial Relations Committee heard all those bills on April 23; Senate Bills 176, 223, 228; 757; and 899all addressing procedural reforms to reduce costs by taking them out of the middle without touching benefitspassed. Faced with resolute labor opposition, the rest were defeated on party-line votes.

On the Assembly side, the major players were Insurance Committee Chairman Juan Vargas and Assemblyman Keith Richman, the only physician in the Legislature. They introduced a series of bills proposing a number of systemic reforms.

AB 1480 (Richman)Requires use of established medical guidelines and limits injury apportionment in permanent disability ratings to a cumulative 100%.

AB 1481 (Richman)Bases Medical Fee Schedule on Medicare RBRVS with allowances, requires adoption of an outpatient facility fee schedule, and requires balanced billing.

AB 1482 (Richman)Requires adoption of an official, standardized Outpatient Facility Fee Schedule applicable to injury cases.

AB 1483 (Richman)Requires establishment of revised procedures to certify physicians, educate DEU raters and claims adjusters, and track utilization and quality of care patterns.

AB 1578 (Vargas)Increases the fine for committing workers' comp insurance fraud from $50,000 to $150,000.

AB 1579 (Vargas)Prohibits a physician from referring a workers' comp claimant for outpatient surgery services if the physician or his or her immediate family has a financial interest; and extends the applicability of the existing criminal provisions to these referrals.

After many of these bills were referred to a joint conference committee, proponents say the final package claim will rescue employersat least temporarilyfrom an anticipated 12% increase in workers compensation insurance premiums next year (the most optimistic estimate of savings to be $5.9 billion.)