September 2017 Volume LII Number 5

 
 
 
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Legislative and Regulatory Update

July 2017 Volume LII Number 4

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

AAPD Pleased with Pediatric Dentistry Training and Faculty Loan Repayment Funds in Final FY 2017 Omnibus Federal Budget Bill

On May 5, 2017, President Trump signed the final FY 2017 om- nibus budget bill (HR 244 https://www.congress.gov/bill/115th-congress/ house-bill/244, P.L. 115-31) to fund federal programs through the remainder of the fiscal year. Since Oct. 1, 2016, the federal govern- ment has been funded via several Continuing Resolutions at the FY 2016 level.

The AAPD’s top appropriations priority is Title VII funding for pediatric dentistry training. While many health programs are contin- ued at the FY 2016 levels, and overall Title VII and VIII medicine and nursing programs will receive a 0.6 percent decrease in fund- ing, overall Title VII oral health training will receive a $1.2 million increase. This includes $10 million directed to pediatric dentistry training, along with an additional amount for faculty loan repayment.

The AAPD also obtained the following favorable report language:

"Oral Health Training—The agreement includes an additional $800,000 for the Dental Faculty Loan Repayment Program under section 748 of the Public Health Service Act. The agreement directs HRSA to publish a new funding opportunity announcement and to give preference in grant awards to pe- diatric dentistry faculty supervising residents and to applicants providing clinical services in dental clinics located in dental schools, hospitals, or community-based affiliated sites."

The AAPD acknowledges the efforts of Congressional Liaison Dr. Heber Simmons Jr. and the firm of Hogan Lovells in obtaining this outcome. The AAPD also thanks all members who advocated for this funding during the 2017 AAPD Public Policy Advocacy Conference in Washington, D.C.

The full subcommittee report is available at: https://www.congress. gov/114/crpt/srpt274/CRPT-114srpt274.pdf.

Background: The authority to fund pediatric dentistry residency training under Title VII was first enacted under the health Profes- sions Education Partnership of 1998. This expanded the existing General Dentistry training authority by providing "start-up funds" to increase Pediatric Dentistry positions at existing programs or initiate new programs. Under the 2010 Affordable Care Act, Title VII was expanded to create a primary care dental funding cluster under Sec- tion 748 of the Public Health Service Act. Authority was broadened to allow use of funds for faculty development, predoctoral training, and faculty loan repayment. The AAPD has long advocated for this latter initiative due to the significant difficulties in recruiting qualified individuals to fill faculty positions.

New Dental Faculty Loan Repayment Grant Issued Thanks to AAPD Advocacy Efforts

Due to the funding and report language that was obtained by the AAPD, in early June HRSA announced a new FY 2017 grant cycle as indicated below:

Dental Faculty Loan Repayment Program

NOTICE OF FUNDING OPPORTUNITY
Fiscal Year 2017

APPLY FOR THIS OPPORTUNITY ON GRANTS.GOV

The Health Resources and Services Administration (HRSA), Bureau of Health Workforce (BHW), Division of Medicine and Dentistry is accepting applications for the fiscal year (FY) 2017 Dental Faculty Loan Repayment Program.

The purpose of this program is to increase the number of dental and dental hygiene faculty in the workforce by assisting dental and dental hygiene training programs to attract and retain dental and dental hygiene faculty through loan repayment.

Preference in making grant awards will be given to ap- plicants providing loan repayment to pediatric dentistry faculty supervising residents at dental training institutions providing clinical services in dental clinics located in den- tal schools, hospitals, or community-based affiliated sites.

Applications due July 17, 2017.

AAPD has alerted pediatric dentistry postdoctoral and predoctoral programs and strongly encouraged applica- tions.

STATE NEWS

Brief Updates from Public Policy Advocates (PPAs)

Oklahoma Congressional Visit to Pediatric Dental Practice

Oklahoma PPA Dr. Ashley Orynich reports host- ing a visit in early May at a Tulsa pediatric dental practice for Congressman Jim Bridenstine (R-Okla 1st). Orynich and the congressman discussed current issues pending in Congress related to Medicaid and ACA repeal and replace legislation.

Dr Ashley Orynich:

"I chose to work in Tulsa to make a difference, yet following a recent trip to my Harvard Kennedy School of Government reunion, an honored professor shed light on this very motive. My perspective on how to make a difference was always encompassed with a sense of grandiosity and scale. The more lives I could touch, the more impact I had, the big- ger the difference. This mindset was challenged. How can you measure the difference made when love is immeasurable? How can you compare the value of one child’s relief from pain and disease versus that of a policy proposal adopted to improve the lives of many?

It’s impossible to quantify the impact of the lives we touch. Yet we are still called to treat our children with love, and this is the driving force in our great profession. Every single moment we are faced with decisions that can create a positive change, no matter the scale. Our office at On the Cusp Pediatric Dentistry recently hosted Representative Jim Briden- stine to advocate for our patients. The state of Oklahoma has more than half a million children enrolled in Medicaid with only 75 registered pediatric dentists, and even fewer of those providers accept Medicaid patients. One phone call to a policymaker can have a greater impact than ever realized, just as one patient’s visit to your office can affect a lifetime of well-being. I am privileged to work with my team in Tulsa while also remaining rooted with Texas A&M Baylor, a path across state lines deliberately filled with the constant reigniting of a passion for learning and advocacy. No matter the setting, no matter the individual, treat one another with love no matter the measure of difference."

Minnesota Medicaid Dental Program Payment Boost Pending

Minnesota PPA Dr. Elise Sarvas reports that the Minnesota state legislature is close to finalizing the biannual budget bill in both the House and Senate. Thanks to strong advocacy efforts by the Minnesota Dental Association, the bill includes language that provides for a significant increase in pediatric dental reimbursement. While it still needs a signature from Governor Dayton, this will likely be in the final bill or a very close version of it. Governor Dayton has been a strong advocate for increasing dental reimbursement rates and proposed a 54 percent increase.

As background, on May 1, 2017, the Centers for Medicare and Medicaid Services (CMS) sent a letter to Minnesota warning that the state did not adequately cover dental care for children on Medicaid. Only 37 percent of Minnesota children on Medicaid had any type of preventive dental care in 2015, far below the national average of 46 percent. An improvement plan from the state was requested within 90 days.

In the current bill, reimbursement changes include a 23.8 percent increase for pediatric FFS patients, effective July 1, 2017. While not 54 percent, Sarvas indicates it’s a step in the right direction that begins to dig Minnesota out of the inglo- rious last-place position in terms of Medicaid dental reimbursement. Other notable pediatric-related dental changes include:

• Authorization for the use of handheld dental X-ray equipment.
• Limits on the quantity of opiate prescriptions in dentistry and optometry.
• Exemption of rural dentists from Rule 101 (the law that requires any health care provider to accept a certain percentage of patients on Medicaid or MNCare if they wish to be eligible to be reimbursed for services to public employees or work- ers compensations patients).

Nebraska

Nebraska PPA Dr. Holly Portwood reports that in late March the state legislature unanimously passed an expanded duties bill (LB 18) for dental assistants and hygien- ists. This was a 10 year effort with support of the Nebraska Academy of Pediatric Dentistry, the Nebraska Dental Association, the state board of dentistry, and the AAPD. She indicates this bill improve the efficiency of dental care while keeping the dentist the head of the dental team. Among the bill’s highlights:

• A licensed dental hygienist may provide the following services to children in a public health setting or in a health care or related facility:
• Oral prophylaxis to healthy children who do not require antibiotic premedi- cation;
• Pulp vitality testing;
• Application of fluorides, sealants, and other recognized topical agents for the prevention of oral disease;
• Upon completion of education and testing approved by the board, interim therapeutic restoration technique; and
• Upon completion of education and testing approved by the board, written prescriptions for mouth rinses and fluoride products that help decrease risk for tooth decay.
• A dental assistant may under indirect supervision of a licensed dentist monitor nitrous oxide if the dental assistant has current and valid certification for cardio- pulmonary resuscitation approved by the board and place topical local anesthesia.
• Upon completion of education and testing approved by the board, a dental as- sistant may take X-rays under the general supervision of a licensed dentist and perform coronal polishing under the indirect supervision of a licensed dentist.
• Upon completion of education and testing approved by the board and with a permit from the department for the respective competency, a licensed dental assistant may, under the indirect supervi- sion of a licensed dentist:
• Take dental impressions for fixed prostheses;
• Take dental impressions and make minor adjustments for removable prostheses;
• Cement prefabricated fixed pros- theses on primary teeth; and
• Monitor and administer nitrous oxide analgesia.
• Upon completion of education and testing approved by the board and with a permit from the department for the respective competency, an expanded function dental assistant may place, under the indirect supervision of a licensed dentist:
• Restorative level one simple resto- rations (one surface); and
• Restorative level two complex restorations (multiple surfaces). The licensed dentist supervising a dental assistant, a licensed dental assistant, or an expanded function dental assistant shall be responsible for patient care for each patient regardless of whether the patient care is rendered personally by the dentist or by a dental assistant, a licensed dental assistant, or an expanded function dental assistant.

Washington

Washington State PPA Dr. John Gibbons reports that in April the state legislature approved a Medicaid audit reform bill (Substitute House Bill 1314). Modeled after many provisions in a 2015 Nebraska law, the bill would require the following:

• Thirty days’ notice before scheduling any on-site audit, unless there is evidence of danger to public health and safety or fraudulent activities.
• Reasonable effort to avoid reviewing claims that are currently or have already been au- dited by the state Medicaid program.
• Providers must be allowed to submit electronic records.
• A finding of overpayment may not be based on extrapolation unless there is a determina- tion of sustained high level of payment error involving the provider or when documented education intervention has failed to correct the level of payment error.
• Any finding based upon extrapolation and related sampling must be estab- lished to be statistically fair and reasonable.
• Overpayments may not be recouped until all informal and formal appeals processes have been completed.
• A provider with an adverse determination must be offered the option of repaying accord- ing to a negotiated plan of up to 12 months.
• Auditors must produce a preliminary report or draft audit findings within 120 days from receipt of all requested information.
• In any appeal, the auditor must employee or contract with a medical or den- tal professional who practices within the same specialty, is board certified, and experienced in the treatment, billing and coding procedures used by the provider being audited.
• The state must compile an annual report and publish on their website data on:
• Number and types of claims;
• Number of records requested;
• Number of overpayments and underpayments, and dollar amounts:
• Number of adverse determinations and the overturn rates;
• Number of informal and formal appeals; and
• Contractor’s compensation structure and dollar amount.
• The state shall provide education and training programs annually for providers, including a summary of audit results, a description of common issues, problems and mistakes identi- fied through audit and review, and opportunities for improvement.

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