LEGISLATIVE VICTORY:
DENTAL PLAN
®
Reprinted with permission from the California Dental Association
CDA’s sponsored legislation calling for
more value and transparency from
dental plans passed the California
Legislature with bipartisan support and
was signed by Gov. Jerry Brown on
Sept. 29. CDA and the author of SB
1008, Sen. Nancy Skinner (D-Berkeley),
worked closely with stakeholders to
ensure the best outcome for CDA
members and consumers in California
— increased transparency,
accountability and value from dental
benefit plans.
“Signing this bill into law is an
unqualified victory for dental plan
patients in California. Patients deserve
to have clear, understandable
information about their dental plans,”
said CDA President Natasha Lee, DDS.
“As providers, we all too often see
patients in our offices struggle to
understand what procedures are and are
not covered. We aim to stop that and
ensure patients get the care they need
with SB 1008.”
Dr. Lee continued: “I want to thank Gov.
Brown for signing SB 1008 and state Sen.
Skinner for working with her colleagues
to pass this important reform.”
SB 1008 builds off CDA-sponsored
legislation that passed in 2014, AB 1962
(Skinner), which created a mandate for
dental plans to annually disclose to state
regulators and the public their “loss
ratio,” or how much of premium dollars
are spent on patient care. Three years of
reporting shows a wide variation in
dental loss ratios (DLR) by product type
and market, with some plans falling as
low as 4 percent. This variation raises
significant questions about the
consistency and value of many dental
plans. The plan-reported data validates
the concern that too much of dental
plan premiums are spent on
administrative overhead costs and not
enough are spent on patient care.
The lack of standardization among
dental plans and a regulatory “Wild
West” lead to questionable plan value
and consumer frustration when needed
services are not covered. To help
combat this, SB 1008 will require all
dental plans to use a uniform matrix to
disclose their benefits, similar to the
matrix used by medical plans. The
matrix will provide plan beneficiaries
with a uniform summary of benefits and
coverage template to include plan
details, including: deductible; annual
benefit limit; coverage of the following
categories: preventive and diagnostic
services, basic and major services, and
orthodontia; reimbursement levels and
estimated enrollee cost share; waiting
periods; and examples to illustrate
coverage of commonly used benefits.
The uniform matrix will be designed
through a stakeholder process to be
available starting in 2021 or 12 months
after regulations are adopted.
Sen. Skinner said, “No one should have
to drill into 80 pages of legalese to
understand their dental plan. SB 1008
requires dental insurers to provide
details on what their plans cover in a
simple, easy to understand format, so
consumers understand what services are
covered and what services they may
have to pay for out of pocket.”
SB 1008 will help level the playing field
for consumers and providers by holding
plans accountable to comparable
disclosure standards as medical plans.
While amendments were taken along
the way, CDA is pleased that the new
law continues the association’s efforts to
increase dental plan transparency and
accountability.
SB 501 PASSES, ADDS TRAINING,
MONITORING REQUIREMENTS FOR
PEDIATRIC DENTAL SEDATION
Orinda), which updates the regulatory
structure for pediatric dental sedation
and ensures that children have access to
safe, effective pediatric sedation services
when needed.
SB 501 reflects three years of work,
starting with a 2016 report from the
Dental Board of California that studied
recent pediatric deaths and made
recommendations to improve safety. SB
501 updates definitions for levels of
sedation to reflect those recognized by
the American Dental Association,
acknowledging that level of sedation is
independent from route of
administration.
Developed through substantial
stakeholder involvement, SB 501
provides for additional training and
monitoring requirements targeted to
ensure that during the provision of
pediatric dental sedation, the right people
are in the room with the training and
ability to respond quickly and expertly to
emergencies should they arise.
GOV. BROWN VETOES SDF
LEGISLATION
Lastly, another CDA-sponsored bill, SB
1148 authored by Sen. Richard Pan,
MD, (D-Sacramento) was vetoed. This
bill would have made silver diamine
fluoride a covered benefit in the Medi-
Cal dental program for young children,
the developmentally delayed, and adults
residing in living facilities. Gov. Brown
issued a message on this bill saying that
because it would have required new
ongoing state funding, he believes it
should be considered as part of the
budget.
CDA will update members about the
provisions of SB 1008, including the
new uniform matrix to be used by dental
plans, once they are developed. 䡲
Gov. Brown also signed into law SB
501, authored by Sen. Steve Glazer (D-
Los Angeles Dental Society Explorer