November 2018 Volume LIII Number 6

 
 
 
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Legislative and Regulatory Update

March 2016 Volume LI 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 slitch@aapd.org.

 

Federal News

Final FY 2016 Appropriations Legislation Includes $10 Million for Title VII Pediatric Dentistry Training and $875,000 for Dental Faculty Loan Repayment Program

As Congressional negotiations on the FY 2016 federal budget continued throughout the fall of 2015, the AAPD, ADA, ADEA, and AADR send a joint letter to Labor-HHS-Education Appropriations Subcommittee chairs and ranking minority members reminding them of the dental community’s funding requests, including $10 million for Title VII pediatric dentistry. Once again budget negotiations went down to the wire towards the end of the year, after passage of short term continuing resolutions to fund the federal government (since the new fiscal year 2016 started on Oct. 1, 2016). In mid-December 2015 Congress finally approved an Omnibus appropriations bill. The $1.15 trillion spending package was approved by a margin of 316-113 in the House (150 Republicans joined with 166 Democrats to vote yes, while 95 Republicans and 18 Democrats voted no) and 65-33 in the Senate. The President signed the bill on Dec. 18, 2015, making it Public Law No. 114-113.

The AAPD was delighted to see the following report language which supports the AAPD’s top federal appropriations priority, Title VII pediatric dentistry training:  

HEALTH RESOURCES AND SERVICES ADMINISTRATION
HEALTH WORKFORCE

"Oral Health Training.-The agreement includes not less than $10,000,000 for General Dentistry programs and not less than $10,000,000 for Pediatric Dentistry programs. The agreement provides $875,000 for section 748 authority for the Dental Faculty Loan Repayment Program. The Health Resources and Services Administration (HRSA) is directed to publish a new funding opportunity and then award grants in fiscal year 2016 from
the funding provided."

The AAPD thanks all of those advocates who attended the Public Policy Advocacy Conference in Washington, D.C., in March 2015, which included advocacy for this program. The AAPD especially thanks Congressional Liaison Heber Simmons Jr. and Mike Gilliland and Kate McAuliffe at Hogan Lovells in Washington, D.C., for all of their efforts through-out the long budgetary process. The AAPD also acknowledges our joint efforts with ADA, ADEA, and AADR.

 

AAPD Successful in Push for New Dental Faculty Loan Repayment Grant Cycle 

The AAPD met with HRSA Acting Administrator Jim Macrae and his staff in early November 2015 to push for a re-start of the dental faculty loan repayment program under Section 748 (the primary dental section of Title VII). In correspondence with HRSA earlier in 2015 (from AAPD, ADA, and ADEA), HRSA had expressed little interest in issuing new grants in this area. However, as a result of this face-to-face meeting and the language included in the omnibus FY 2016 appropriations law (as described above), HRSA is preparing to announce a new grant program in FY 2016. The AAPD will work with postdoctoral and predoctoral pediatric dentistry program directors to assist them in applying for this funding opportunity. 

 

Health Care Reform: Recent ACA Regulatory Comment Letters

On Sept. 30, 2015, the AAPD and ADA sent a joint letter to the Center for Consumer Information and Insurance Oversight (CCIIO) on proposed Affordable Care Act (ACA) essential health benefit benchmark plans regulations. The AAPD and ADA asked CCIIO to require states to make the 2017 benchmark plans more transparent in regards to pediatric dental benefits. ADA President Maxine Feinberg and AAPD President Robert L. Delarosa expressed the need for more details in places where the plans called for "Dental Check-ups for Children" and "Basic Dental, Children." 

"With limited information on the specifics of each plan’s benefit design, we can only hope that the pediatric oral health services offered by these plans are comparable to those offered in plan years 2014-2016 through either CHIP or FEDVIP supplementation." 

The ACA requires non-grandfathered health plans in the individual and small group markets to cover essential health benefits, including pediatric oral health services. For plan years 2014-16, most states selected to supplement using a benefit package modeled from either a separate Children’s Health Insurance Program (CHIP) or from a benefit package offered through the Federal Employee Dental and Vision Program (FEDVIP). 

The letter also recommended that CCIIO include the AAPD periodicity schedule in the definition of preventive oral health services provided in a dental plan without cost-sharing implications. The AAPD Guideline on Periodicity of Examination, Preventive Dental Services, Anticipatory Guidance/Counseling, and Oral Treatment for Infants, Children, and Adolescents recommends: 

  • Clinical oral examination and adjunctive diagnostic tools;
  • Oral hygiene and dietary counseling for parents;
  • Removal of supragingival and subgingival stains or deposits as indicated;
  • Systemic fluoride supplements, if indicated;
  • Caries risk assessment;
  • Topical fluoride treatments every six months or as indicated by the individual patient’s needs (ages 12 months and above);
  • Scale and clean the teeth every six months or as indicated by the individual patient’s needs (ages 2 years and above);
  • Pit and fissure sealants for caries-susceptible primary and permanent molars, premolars, and anterior teeth (ages 2 and above);
  • Substance abuse counseling (e.g. smoking, smokeless tobacco) (ages 12 years and above).

A copy of the letter is available at: http://www.aapd.org/aapd_and_ada_urge_transparency_for_aca_pediatric_dental_benefits/.

On Dec. 18, 2015, the AAPD and ADA filed a joint comment letter with CMS regarding proposed regulations on ACA benefit and payment parameters for 2017. Again greater clarity of dental coverage provisions for both SADPs and embedded plans was urged, plus an exemption for co-payments or other cost-sharing for preventive services as described in AAPD’s periodicity schedule. One positive is that CMS is codifying that EHBs must include state-mandated benefits passed on or before Dec. 31, 2011, which means all state general anesthesia laws will have a positive impact on ACA plans (expect for Pennsylvania which passed their law after this date). 

 

State News

New State-by-State Dental Analysis from ADA HPI

The AAPD has informed our state Public Policy Advocates about the availability of new state-by-state oral health data analysis from the ADA’s Health Policy Institute (HPI). The report, entitled "The Oral Health Care System: A State-by-State Analysis," includes data on all 50 states and the District of Columbia, as well as the nation as a whole.

This report should prove useful on a number of issues, especially workforce. Contrary to assertions by the Pew Charitable Trust and the Kellogg Foundation, the supply of dentists has been increasing and the dentist workforce has the capacity to accommodate additional demand. Also, dental insurance coverage for children and utilization of dental care by Medicaid-insured children has been increasing. In 39 of 50 states the gap between dental utilization of children covered by Medicaid as compared to children covered by private dental insurance has narrowed. This finding is consistent with CDC data released earlier this year showing a slight decline in ECC among preschool children. At that time the AAPD’s Pediatric Oral Health Research and Policy Center pointed out that the increase in the number of pediatric dentists over past 15 years is likely a contributing factor to such improvements. 

Among the key findings:  

  • The percentage of Medicaid-enrolled children who visited a dentist within the past year increased from 29 percent in 2000 to 48 percent in 2013. As a result, the gap in dental care use between Medicaid enrolled children and children with private dental benefits narrowed significantly over this same timeframe in the vast majority of states.
  • The trend for adults differs dramatically from that for children. Dental visits by adults with private dental benefits are declining in most states. (A separate HPI analysis shows that the gap in dental care use between Medicaid and privately insured adults is much wider than it is for children.)
  • Ninety-five percent of adults say they value keeping their mouth healthy. Routine dental care is seen as a key part of overall wellness, with 93 percent of adults agreeing that regular visits to the dentist "help keep me healthy."   
  • Fifty percent of adults responded correctly to a set of general-knowledge questions about oral health.
  • The supply of dentists per capita increased from 57.3 dentists per 100,000 people in 2001 to 60.5/100,000 in 2013. Other HPI research suggests this trend is likely to continue through 2033.
  • Each state report includes the most current available information on:
  • Trends in dental care utilization (dental visits) for Medicaid-enrolled children, as well as for children and adults with private dental benefits;
  • Trends in the supply of dentists, including the percentage who participate in Medicaid;
  • Trends in reimbursement rates for dental care services in Medicaid and private dental benefit plans; and
  • Percentage of the population with access to optimally fluoridated drinking water (among people on community water systems).

Each state report also includes results from an innovative survey of nearly 15,000 U.S. adults, measuring their "dental IQ," self-reported oral health status, and attitudes toward the importance and value of good oral health.

The entire report is available at www.ada.org/statefacts.

 

 

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