May 2019 Volume LIV Number 3

 
 
 
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Legislative and Regulatory Update - May 2012

May 2012 Volume XLVIII Number 3

Unless otherwise noted, for further information on any of these issues please contact Chief Operating Officer and General Counsel C. Scott Litch at (312) 337-2169 or slitch@aapd.org.


Federal


Organized Dentistry Coalition Comments on Essential Health Benefits Guidance


The AAPD, the American Dental Association and other members of the Organized Dentistry Coalition (ODC) commented to the federal Center for Consumer Information and Insurance Oversight (CCIIO) on Jan. 31, 2012, in response to draft guidance from this agency on essential health benefits (EHB). ODC commented that the benchmark plans identified in the guidance fall short of finding the proper balance between affordability and ensuring a comprehensive set of pediatric oral health benefits for the EHB package. ODC urged HHS to address the pediatric oral health benefit in a separate guidance, and suggested this additional guidance include more specific criteria for determining if the benchmark plan chosen by the state is in line with the typical employer-sponsored plan currently offered in the dental benefits market. ODC also recommended that benchmark plans include state requirements for general anesthesia for dental services in 2016 and beyond.
 

Background

The Affordable Care Act (ACA) requires that all insurance issuers in the individual or small group markets – inside or outside of state insurance exchanges – must cover "essential health benefits", including
pediatric oral care. This must be "equal to the scope of benefits provided under a typical employer plan, as determined by the Secretary."

Under the ACA’s directive, the Secretary of Labor conducted survey of employer-sponsored coverage to determine the benefits typically covered.

The Deptartment of Labor report of April 15, 2011, included the following discussion of pediatric oral health coverage:

" . . . Plans typically grouped dental services into categories, such as preventive services (typically exams and cleanings), basic services (typically fillings, dental surgery, periodontal care, and endodontic care), major services (typically crowns and prosthetics), and orthodontia. Cost sharing for dental services typically involved an annual deductible—the median was $50 per person. After meeting the deductible, dental plans often paid a percent of covered services up to a maximum annual benefit. The median percent paid by the plan was 100 percent for preventive services, 80 percent for basic services, and 50 percent for major services and orthodontia. The median annual maximum was $1,500; a separate maximum applicable to orthodontic services also had a median value of $1,500."

On Dec. 16, 2011, CCIIO issued an Essential Health Bulletin indicating that states will be permitted to selected benchmark plans, defined as: the largest plan by enrollment in any of the three largest small group insurance products in the state’s small group market; any of the largest three state employee health benefit plans by enrollment; any of the largest three national Federal Employee Health Benefit Plan (FEHBP) options by enrollment; or the largest insured commercial
non-Medicaid Health Maintenance Organization (HMO) operating in the state. If the pediatric oral health benefit is missing from the chosen benchmark plan, a state must supplement the benchmark to cover the EHB category with one of the following options: the Federal Employees Dental and Vision Insurance Program (FEDVIP) dental plan with the largest
national enrollment; or the state’s separate Children’s Health Insurance Program (CHIP). This was confirmed in a FAQ document issued by the CMS Center for Medicaid and CHIP Services on Feb. 17, 2012.

During the transitional years of 2014-2015, if a state chooses a benchmark plan that is subject to existing state benefit mandates, those mandates would be included in the EHB package, obviating the requirement that the state defray the cost of the mandates. If the state selects a benchmark that does not include some or all of the mandates, the state would have to pay for those mandates not covered by the benchmark. For 2016 and beyond, the agency will develop an approach that might exclude some state benefit mandates from the EHB package.

For the CCIIO essential health benefits bulletin of Dec. 16, 2011, see: http://cciio.cms.gov/resources/regulations/index.html#hie.
 

AAPD Submits Written Testimony to Senate HELP Subcommittee on Access to Children’s Oral Health Care


On March 5, 2012, the AAPD filed a written statement for the record with the U.S. Senate Subcommittee on Primary Health and Aging of the Health, Education, Labor, and Pensions Committee. This was in response to the subcommittee’s Feb. 29, 2012, hearing on Dental Crisis in America: The Need to Expand Access. While the subcommittee’s focus on this important issue was welcomed, the AAPD expressed concern that the hearing fixated on dental therapists as being a purported solution to access, rather than carefully analyzing barriers to care and highlighting strategies far more likely to obtain successful results. The AAPD testimony is an encapsulation of the Academy’s wide-ranging efforts to improve access to oral health care for children and promote effective policy solutions, including reforms of Medicaid dental programs that have been enacted to date in only a handful of states. For a copy of the testimony see: http://aapd-oldsite.ae-admin.com/upload/news/2012/4757.pdf.

For further information, contact AAPD Pediatric Oral Health Research and Policy Center Assistant Director Jan Silverman at jsilverman@aapd.org.


New CMS Chief Dental Officer Appointed

mouden
In February 2012, the Centers for Medicare and Medicaid Services (CMS) announced the appointment of its new chief dental officer, Dr. Lynn Mouden, D.D.S. Mouden will work in the Center for Medicaid and Chip Services (CMCS). Mouden previously served as director of Arkansas’
Office of Oral Health. He also holds faculty appointments at the University of Missouri-Kansas City School of Dentistry, the University of Tennessee College of Dentistry, and three faculty appointments at the University of Arkansas for Medical Sciences (UAMS). He also spent 16 years in private practice dentistry and eight years with the Missouri Department of Health before taking
the position in Arkansas.

Mouden is a Fellow of both the International and American College of Dentists, and has served in numerous dental leadership roles at the local, state and national level. He is a past president of the Association of State and Territorial Dental Directors (ASTDD) and serves as the American Dental Association’s national spokesperson on family violence prevention. Mouden earned his undergraduate degree from the University of Kansas; his D.D.S., with distinction, from the University of Missouri at Kansas City; his Masters in Public Health from the University of North Carolina; and completed the U.S. Department of Health and Human Services Primary Care Policy Fellowship in 1998. He has received the Outstanding Service Award from ASTDD and most recently was awarded the Chief Dental Officer’s
Exemplary Service Award from the U.S. Public Health Service.

The AAPD was pleased to personally welcome Mouden to his new position during the March 7-8, 2012, AAPD Lobby Days conference in Washington, D.C.
 

State


California – Update on SB 694


californiaIn early January, SB 694 (carried over from 2011) was amended to reflect an agreement between the California Dental Association and the Children’s Partnership (a coalition to enact workforce change spearheaded by Pew). The first part of the measure would establish a statewide Office of Oral Health within the Department of Public Health, considerably raising the profile of oral health issues within the Department. The state is authorized to accept funding for the new office from both public and private sources. Should those funds not be collected, the provisions establishing the office will not go into effect. Additionally, the office will sunset in 2016 if not reauthorized. The director of the office would be a dentist and the new entity would be charged with the development of a statewide comprehensive oral health plan and further be charged with developing and implementing a "scientifically rigorous study to assess the safety, quality, cost effectiveness and patient satisfaction of expanded [surgical] dental procedures for the purpose of informing future decisions about how to meet the state’s unmet oral health need for the state’s children." The measure passed the Senate and was awaiting action by the House as of press time.

The California Society of Pediatric Dentistry (CSPD) endorsed this bill by a unanimous vote of their board of Jan. 21, 2012, albeit "in principle" and with a number of caveats. As CSPD Public Policy Advocate Dr. Paul Reggiardo writes:
"CSPD has made no decision as to what alternative workforce model or expanded functions for existing workforce categories it might support (if any) once the information from the workforce study is available. If the study indicated that certain procedures for pediatric patients could be provided by an individual with less education and training than a dentist and produced comparable quality, safety and cost-effectiveness, and patient satisfaction, CSPD would then be in a position to make an evidence-supported scope of practice recommendations.
 
With this information, CSPD could then look at the practice settings, supervision levels, payer sources, and payment schemes under which these certain specified procedures might be provided in a model in which the dentist remains the head of a single delivery system. Armed with this knowledge, we would also have the evidence base to refute any midlevel provider or scope of practice proposals which we do not believe would optimally serve the public, protect the patient, and increase access for a targeted population."

The CSPD support letter for SB 694 is available at: http://www.cspd.org/advocacy/pdf/2012/CSPD_SB%20694_Support_SEN_Floor_012412.pdf.

For further information contact Reggiardo at reggiardo@prodigy.net.
 

Connecticut – Competing Workforce Proposals under Consideration


Recently, the Joint Public Health Committee of the State Legislature signaled that there will be a dental scope of practice bill as a result of the newly instituted scope review process initiated in 2011. As a result of that, the dental hygienists submitted a proposal to the Department of Public Health to create an advanced dental hygienist practitioner (ADHP). The Connecticut State Dental Association (CSDA) submitted a proposal to permit dental hygienists to perform interim restorative therapy (IRT), a temporary restoration. Finally, the dental assistants submitted a proposal to create EFDAs in Connecticut. The AAPD assisted the CSDA and the dental assistants in preparing the EFDA proposal. The Public Health Committee, in creating a bill, has signaled that something will be addressed.
This is still pending as of press time.
 

Maine – Preventive Services Bill Supported by Dental Association


The Maine Dental Association supports LD 1666 "An Act to Guarantee Basic Preventive Dental Health Services for Children in Maine." The bill would require dental insurance companies to pay for at least two fluoride
treatments under dental insurance policies sold in Maine. Maine Dental Association executive director Frances Miliano indicated in a press release that:

"We are seeing a very negative trend in dental benefit insurance plans. Most insurance companies were covering two fluoride treatments a year – many are now cutting back to only one. The companies may save money by reducing treatments to one, but the cost to the children in potential dental pain is enormous. Children at high risk for dental disease should actually receive more than two treatments a year. MaineCare eligible children get a second application under the MaineCare program because it is seen as therapeutic and worth the cost. Common sense would say insurance plans should also cover the second treatment."


Missouri – Governor Not Thrilled by Dental Board Workforce Proposal


The Missouri governor has declined the opportunity to support either the dental therapist or ADHP model previously endorsed by the state dental board. To date, no workforce legislation has been introduced to either chamber of the legislature.


New Hampshire


A measure supported by the Pew Foundation, SB 284, would create a dental therapist pilot program in addition to creating a Public Health Hygienist with the potential ability to have a similar diagnosis and treatment scope as a therapist and EFDAs. Hearings have been held in the Senate Health and Human Services Committee, but no votes have been taken to date. The New Hampshire Dental Association has prepared detailed analysis showing that geographic access to dentists is not an issue in this very small state.


Pennylvania – Pediatric Dentists Attend PDA Lobby Day


martinhannaPediatric dentists Drs. Brian Martin (Pittsburgh, Pa.) and Michael J. Hanna (McKees Rock, Pa.) attended the Pennsylvania Dental Association’s (PDA) Lobby Day in the state capital of Harrisburg in June 2011. They met representatives and senators to discuss issues affecting dental care for the children of Pennsylvania. Martin also spoke at the press conference as Director of Children’s Hospital of Pittsburgh’s
Pediatric Dental Services.
Martin (l) and Hanna (r) are pictured on the steps of the PDA headquarters.
 
 

Washington State – Workforce Proposal Update


The Washington State Dental Association is dealing with bills in both the House (HB 2226) and Senate (SB 6126) that would create both a Dental Practitioner (someone who has completed a DHAT program) and Dental Hygiene Practitioner
(someone completing a post-bachelor’s dental hygiene therapy program – i.e. ADHP or the MN Master’s therapy programs). This Senate bill was approved in committee on Feb. 3, 2012. Like most alternative workforce bills, SB 6126 has no on-site supervision by a dentist after an initial calibration period with supervision. Both models have the usual host of invasive procedures within the scope of practice. Prior to the committee vote, two unusual provisions were added to the bill via substitution. The first requires a dentist who enters into a "practice plan" (the term used in the legislation for an off-site relationship with a dentist) with either version of a practitioner to "ensure that he or she or another dentist is available to the dental practitioner or dental hygiene practitioner for instant communication via video conferencing during treatment if needed." The second change was the addition of language calling for "the American dental association and the Washington state dental association [sic]" to "consult with stakeholders, including dentists, dental hygienists, and patient advocates, to study programs in the state that use volunteer dentists and oral surgeons to provide specialty care dental services, including tooth extractions and root canals, to low-income adults and children. This study should include an investigation into expansion of volunteer methods to finance these programs." It asks that the results of this be reported to the legislature by Jan. 1, 2013.