Direct-to-Consumer Orthodontic Consumer Protections
The movement of teeth without appropriate diagnostics can have significant harmful and irreversible effects on patients including loss of teeth, a misaligned bite, shortened roots, and receded gums. For this reason, an in-person exam and current radiographs are needed before beginning treatment to understand more fully what is going on beneath the gums, to avoid complications, and to determine if patients are suitable candidates for orthodontic treatment. With the emergence of new direct-to-consumer (DTC) business models offering various dental services that are ordered without an in-person clinical examination, it is imperative that orthodontic treatment continues to meet a uniform standard of care regardless of whether the treatment occurs through telehealth or in person. CAO continues to advocate for consumer protections that ensure that DTC orthodontic business models have the same level of oversight and patient safety as traditional in-person care.
Bills Supported in 2023 Legislative Session
AB 236—Holden | Health care coverage: provider directories
Summary: This bill would require health care service plans and health insurers to have accurate provider directories and subject them to administrative penalties if they don’t meet the specified accuracy benchmarks each year. It also requires plans or insurers to delete providers from the directory if they haven’t been financially compensated in the past year. Additionally, plans and insurers must provide information about in-network providers on request and must limit cost-sharing amounts for services from those providers. Violations of the bill’s requirements would be considered a crime and, therefore, impose a state-mandated local program. However, the California Constitution states that no reimbursement is required for this act.
AB 481—Carrillo | Dentistry: dental assistants
Summary: The Dental Practice Act sets up the Dental Board of California to issue and regulate licensing for dentists and dental assistants. The Dental Assisting Council is part of the Dental Board and must make recommendations about dental assistants in the state. This bill updates the requirements for members of the council, including having one employed as a faculty member of a registered dental assisting educational program and one employed clinically in a private dental practice or health care clinic. It also updates the requirements for licensure as a registered dental assistant and sets forth duties and functions a dental assistant may perform. In addition, for an orthodontic assistant permit or dental sedation assistant permit, the bill makes changes to the requirements for obtaining the permit, and updates the duties and functions of those with the permit.
AB 936—Wood | Dentistry: exemptions
Summary: The Dental Practice Act is a law that regulates dentists and dental assistants in California and requires a valid license to practice dentistry. Currently, a final year student in a dental school who attends a sponsored event and practices dentistry without expectation of compensation and under the supervision of a licensed dentist may do so, as long as certain conditions are met. This bill proposed would allow dental students who have begun clinical training at an approved dental school to do the same.
AB 952—Wood | Dental coverage disclosures
Summary: This bill would require certain health care service plans or health insurers that cover dental services to disclose and include on identification cards whether or not the dental coverage is regulated by the Department of Managed Health Care or the Department of Insurance. If a health care service plan willingly violates this law, it would be considered a crime. There is no reimbursement required for this act.
AB 1048—Wicks | Dental benefits and rate review
Summary: The Knox-Keene Health Care Service Plan Act of 1975 requires health care service plans and health insurers to provide certain coverage and disclosure requirements for any plan contracts and policies that cover dental services. Starting January 1, 2024, health care service plans and health insurers will be prohibited from placing dental waiting period provisions or preexisting condition provisions on any enrollees. Additionally, the Department of Managed Health Care and Department of Insurance will be mandated to review certain rate changes for any plan contracts and policies concerning dental services. Finally, this bill provides that the state will not require reimbursement for any expenses incurred due to this act.
SB 70—Wiener | Prescription drug coverage
Summary: This bill would expand existing law so that health care service plans or health insurers cannot limit or exclude coverage of a drug dose or dosage form of a drug prescribed for off-label use if the drug has been previously covered for a chronic condition or cancer. It also prohibits additional costs from being imposed for a drug that was already previously approved for coverage. Violation of these provisions by a health care service plan would be a crime. Local agencies and school districts are not required to provide reimbursement for costs related to this bill.