March 2019 Volume LIV Number 2

 
 
 
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Federal News

March 2012 Volume XLVIII Number 2

FY 2012 Appropriations Update: Pediatric Dentistry Funding Secured

Congressional efforts at developing the final FY 2012 Labor-HHS appropriations bill were completed in late December 2011 after much political wrangling. The entire conference report is H. Rpt. 112-331 and the final law is P.L. 112-74. Multiple agencies are funded in this "omnibus" package, including the Dept. of Health and Human Services. Overall, level funding was obtained in the FY 2012 conference bill for HRSA title VII primary care dental programs, with $7,563,000 each directed toward pediatric and general dentistry. This is just under the AAPD’s advocacy goal of $8 million goal and represents an important victory considering the significant reductions made in other areas of the federal budget. The AAPD also assisted ADA in their successful efforts to obtain language in the FY 2012 bill to prevent HRSA from funding the alternative dental provider demonstration project authorized under ACA.

Essential Health Benefits Update

AAPD and ADA Continue Ad vocacy Efforts; Federal Guidance Released on Dec . 16, 2011

On Nov. 9, 2011, the AAPD and ADA met for a second time with staff of the Center for Consumer Information and Insurance Oversight (CCIIO), which is a new agency under CMS (the Center for Medicare and Medicaid Services) that was created under the Affordable Care Act (ACA). CCIIO is responsible for writing the federal regulations that will provide further guidance to states concerning "essential health benefits" that are required to be covered by all qualified health plans (QHPs). Effective Jan. 1, 2014, QHPs are those plans in the small group and individual market offered inside or outside of state insurance exchanges. Pediatric oral health is one of the essential benefits under the ACA, with the statutory guidance being that it should follow a "typical employer" plan. The AAPD and ADA have provided extensive analysis and recommendations to CCIIO staff, based on the AAPD policy on model dental benefits. A comprehensive analysis of the current dental insurance market-place was also provided, with both associations arguing for robust consumer choice among dental plans that have comprehensive coverage and adequate provider networks. For example, the following information was submitted concerning FEHBP:

"A model to examine closely in relation to appropriately establishing dental benefits in a payment and administrative structure that ensures access to care is the Federal Employee Health Benefits Program (FEHBP), which provides health benefits for federal and postal employees, retirees and their dependents. The consumer purchasing experience in this model is very telling. When dental benefits were originally included as part of the FEHBP, they were only made available through medical plans that offered limited dental benefits. There were multiple complaints from beneficiaries about the inadequacy of the dental network and the limitation on coverage. In response, the Federal Employees Dental and Vision Benefits Enhancement Act of 2004 was passed which gave the Office of Personnel Management the authority to establish a separate dental and vision program called the Federal Employees Dental and Vision Insurance Program (FEDVIP). The FEDVIP is described by OPM as the program for federal and postal workers who want "comprehensive dental and vision benefits." The 2012 rate information and benefit descriptions available from OPM may be helpful to HHS in thinking about the costs and scope of benefits that could be offered through state exchanges."

CCII O subsequently released "essential health benefits" guidance to state in the form of a bulletin, rather than a proposed regulation, on Dec. 16, 2011. The AAPD and ADA prepared joint comments on this guidance, which were due Jan. 31, 2012. Some preliminary analysis of the guidance is as follows:

  • The guidance is clearly geared towards state flexibility, meaning that there will be many specific decisions about benefits made at the state level along with the overall implementation of state health insurance exchanges.

  • For considering adequate stand-alone pediatric oral health plans, states are pointed towards the FEDVIP dental plan or state CHIP dental plan, which is consistent with recommendations from the AAPD and ADA.

  • It is unclear what parameters for pediatric oral health must be followed when such coverage is offered under a medical plan.

  • The treatment of state insurance mandates like general anesthesia appears to be favorable, for those states that already have such laws in place.

Below are links to the guidance along with other background materials from the federal government:

For the essential health benefits bulletin, visit: http://cciio.cms.gov/resources/regulations/index.html#hie.

For a fact sheet on the essential health benefits bulletin, visit: http://www.healthcare.gov/news/factsheets/2011/12/essential-health-benefits12162011a.html.

For a summary of individual market coverage as it relates to essential health benefits, visit: http://aspe.hhs.gov/health/reports/2011/IndividualMarket/ib.shtml.

For information comparing benefits in small group products and state and Federal employee plans, visit: http://aspe.hhs.gov/health/reports/2011/MarketComparison/rb.shtml.

Additional information will be provided in upcoming issues of PDT and AAPD E-News including a summary of AAPD and ADA comments on the CCIIO bulletin.