May 2020 Volume LV Number 3


Legislative and Regulatory Update

March 2013 Volume XLVIX Number 2

 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



The Council on Government Affairs (CGA) has developed priorities for 2013, which were approved by the board of  trustees at its meeting on Jan. 11, 2013, and are available on the AAPD website at


Essential Health Benefits (EHB) Resources

The AAPD has created a website page that collects important materials concerning implementation of essential health benefits stateby-state under the Affordable Care Act (ACA). Pediatric oral health is defined under the ACA as an essential health benefit, and federal guidance indicates states can use the Federal Employees Dental and Vision Plan or the state CHIP plan as a benchmark for a stand-alone pediatric oral health plan. This website page contains an overview of  state health insurance exchange progress, key federal documents, AAPD documents and resources, and analysis from states concerning their pediatric oral health benchmark plan for state health insurance exchanges. Go to: percent2fadvocacy percent2fessential_health_benefits percent2f then log in with your member ID and password. This page will be frequently updated, so we encourage members to bookmark and check periodically.



The AAPD has compiled a website resource page for those interested in pursuing state legislation requiring an oral health examination prior to school entrance. This includes information on states that currently have such laws, as well as model legislation. See: login/?Redir=  percent2fadvocacy  percent2fschool_oral_health_entrance_exam_toolkit  percent2f.

AAPD and ADA Comment on EHB Regulation

On Nov. 20, 2012, the U.S. Department of Health and Human Services released proposed regulations on Essential Health Benefits, Actuarial Value, and Accreditation Standards: Ensuring Meaningful, Affordable Coverage. The proposed regulations repeat much of the same material from earlier federal guidance. Comments were specifically requested on the "reasonable" annual limit on cost sharing for stand-alone dental plans. One bit of good news is that the proposal would include as EHB all state health insurance mandates enacted prior to Dec. 31, 2011. This means that general anesthesia coverage for dental services will be an EHB in those states that have passed such laws  (see: The only general anesthesia mandate that misses this deadline is in Pennsylvania, where the law was enacted in 2012. The complete federal proposed regulations are now posted on the AAPDs EHB website resource page.

Joint regulatory comments were filed on Dec. 19, 2012, by the AAPD and the American Dental Association (ADA), and were also endorsed by the Organized Dentistry Coalition. The main points in this comment letter were:

          The federal and state officials involved in establishing exchanges must ensure that consumers know the full value of  what they will be paying for.

          Stand-alone dental plans and medical plans with dental benefits must be able to compete on an equal footing both inside and outside the exchanges to ensure consumers have a wide selection of dental plans.

          The pediatric dental essential health benefit should be a required purchase for all families with children who buy their coverage in the individual or small group market.

          Children up to age 21 should be covered by a dental benefit and there should be adult dental coverage for emergencies as part of state essential health benefit packages.

For a copy of the complete letter see: http://www.aapd. org/assets/1/7/EHB_Comments_from_ADA-AAPD_FINAL_APPROVED_12-19-12.pdf.

ADA, AAPD, and Many Health-related Associations Support Repeal or Modification of Medical Device Excise Tax

As one of the funding mechanisms for the Affordable Care Act (ACA), starting Jan. 1, 2013, a 2.3 percent excise tax on the sale of any medical device by a manufacturer, producer, or importer will be implemented. The tax will be applied to all regulated U.S. Food and Drug Administration Class I, Class II, and Class III medical devices, with a few product exemptions. The manufacturer or importer of a taxable medical device is responsible for reporting and paying the tax.

The IRS estimates there are some 180,000 taxable devices, include dental devices which are about 130 in number. Based on analysis by the ADA of the IRS final regulation of Dec. 7, 2012, dental equipment, material and supplies purchased by dentists for use in an office will be subject to the tax. This includes restorative materials, hand instruments, surgical instruments and endodontic filling materials. It appears completed dental prosthetics will not be taxed. While a completed crown or denture may not be taxed, the material used to make the crown or denture such as the metal alloys, acrylic and porcelains will be taxed. The tax will certainly result in some increased costs for dentists and dental patients. There is an exception from the tax for retail or "over the counter" (OTC) products.

The ADA, AAPD, and other members  of the Organized Dentistry Coalition are on record supporting the successful action of  the House of  Representatives to repeal this tax last year: ganized_dentistry_coalition_urge_repeal_of_medical_device_tax/

This effort is supported by many healthrelated associations and the medical device industry, and has gained bi-partisan support because of the potential negative impact on jobs in many states with such industry. However, the U.S. Senate has not taken action to date. For more details see: http://www., which also has a link to a list of  covered devices. Unfortunately, as the ADA has noted, the FDA list may appear downright illogical and arbitrary, as it was compiled originally for reasons not related to taxation.

State news


In 2012, the AAPD, through the Council on Government Affairs instituted a state Public Policy Advocate initiative in order to strengthen and coordinate advocacy efforts by our state chapters. The Public Policy Advocate (PPA) position is designed to serve as the state pediatric dentistry associations advocate for the oral health issues of infants, children, adolescents and patients with special health care and developmental needs. The PPA will help represent the state pediatric dentistry association in promoting childrens oral health issues with the state legislature and other elected bodies, state regulatory agencies (including Medicaid and health departments), licensing bureaus, professional health and child welfare organizations, oral health coalitions, foundations, institutions of dental education, publicly-funded safety net programs, and the private sector benefits industry. The PPA will also closely coordinate their activities with those of the state dental association. PPAs will serve as an advocacy liaison between the state pediatric dentistry association and the state dental association.

The  PPA  program  is  modeled  on  the  successful  efforts  bDrPaul  Reggiardo (past AAPD president and chair of  the Council on Dental Benefit Programs) in serving as PPA for the California Society of   Pediatric Dentistry over the past decade. Each state unit organization was asked to submit two nominees, with the final selection made by the Council on Government Affairs. The AAPD is hosting a full-day orientation session for the initial group of PPAs, to be held on March 11, 2013, in Washington, D.C., immediately prior to the AAPDs lobbying/public policy conference. The initial list of state PPAs is included below. The AAPD thanks all those for agreeing to serve, and hopes to add additional state PPAs in the coming year as more states see the benefits of this program.