May 2019 Volume LIV Number 3


AAPD 2017 Legislative and Regulatory Priorities

March 2017 Volume LII Number 2

Developed by the Council on Government Affairs and Approved by the Board of Trustees

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

Target: Federal Health Care Reform
1. Support corrections to Affordable Care Act (ACA) or successor legislation to:
(a) Make pediatric oral health cover- age mandatory–assuming there is a mandatory benefits package for children in successor legislation.
(b) Exempt preventive dental services from deductibles in embedded plans and SADPs.
(c) Reauthorize the Children’s Health Insurance Program (CHIP).
(d) Retain dental health professions training reauthorization (Section 748 of HPTA) as contained in Section 5303 of the ACA.
2. Assist ADA in promotion of ERISA reform bill from Congressman Gosar (H.R. 1677 from previous Congress), that would require all health plans offer- ing dental benefits to provide uniform coordination of benefits and permit consumers to designate payment of dental benefits to providers who do not participate in the network.
3. Work with ADA and other dental and medical organizations to support suc- cessor bill to H.R. 3323, the Dental and Optometric Care Access Act, which would apply non-covered services provisions to ERISA plans.

Target: Federal Regulations
1. As the Affordable Care Act (ACA) provi- sion defines pediatric oral health as an essential health benefit (EHB), ensure that implementing regulations re- quire robust coverage consistent with the AAPD Policy on a Model Dental Benefits for Infants, Children, Adolescents, and Individuals with Special Health Care Needs. Coordinate joint response/com- ments on proposed regulations with ADA and keep key members of Congress informed.

Support mandatory purchase (vs. offer) of an appropriately structured embedded or stand-alone dental plan for children inside exchanges, and encourage states to adopt such a requirement as several have already done (Kentucky, Nevada, Washington state).

Sustain regulatory inclusion of general anesthesia coverage state mandates as EHB in 2017 and beyond (for states that approved such mandates prior to 12/31/2011). Monitor types of pediatric oral health insurance offered in state health insurance exchanges as compared with AAPD model benefits.

Evaluate and respond to key ACA insurance plan issues such as network adequacy, provider fees, family out-of- pocket costs, and the impact of pediatric dental coverage embedded in medical plans. Communicate recommendations to Center for Consumer Information and Insurance Oversight.


2. Work closely with ADA, state dental associations, and state pediatric dentistry chapters to ensure that state health insurance exchanges appropriately adhere to federal guidelines and regula- tions concerning insurance plans offering pediatric oral health coverage. Fully engage state Public Policy Advocates in this effort


Target: State Legislation and Regulations
1. Continue to provide technical assistance to states for General Anesthesia coverage via legislation or state in- surance marketplace regulations, highlighting ongoing cost analysis and using TRICARE coverage and success in 33 states to spur momentum. Utiliz- ing research and policy center technical brief and working closely with CDBP, educate insurers and insurance regula- tors on necessity of this benefit and role of pediatric dentists in treating high risk children.



Target: Federal Health Care Reform
1. Explore possibility of targeted pe- diatric oral health bill to address Medicaid dental reform by increas- ing Medicaid matching payments for states that pursue specific Medicaid dental reforms including reimbursement at competitive market-based rates (per previous proposals such as S. 1522/H.R. 3120). Protect Medicaid EPSDT guarantee in Medicaid block grant and other cost-savings proposals.

Target: Federal Regulations
1. Ensure that Medicaid EPSDT regula- tions continue to promote the dental home and a required examination by a dentist.
2. Encourage CMS to include pediat- ric oral health quality measures developed by the Dental Quality Alliance1 as part of the Medicaid dental program.

Target: State Legislation and Regulations
1. Provide continued technical assistance to state pediatric dentistry chapters for Medicaid dental reform for their ef- forts with both state legislatures and state dental associations.

Continue to promote states’ adoption of appropriate dental periodicity schedules consistent with AAPD guidelines, and update research and policy center dental periodicity schedule adoption map on website as appropriate.

Promote state Medicaid programs’ adoption of pediatric oral health quality measures developed by the Dental Qual- ity Alliance (DQA).

Continue to inform and educate key constituencies about reforms that work, including MSDA (Medicaid/CHIP State Dental Association), NCSL, NGA etc.

Work with research and policy center and CDBP to respond to Medicaid medical movement to managed care by:
(a) promoting dental managed care hybrid payment models that leave the risk with the plan contractor (or at least share it between the plan and the provider); and
(b) maintaining accountable dental fee-for-service plans.

2. Ensure that state Medicaid programs conducting provider audits do so in an appropriate and fair manner, adhering to AAPD clinical guidelines and utilizing peer review by pediatric dentists. Secure appropriate guidance to states from CMS Center for Medicaid and State Operations.



Target: Federal Regulations
1. Secure HRSA review and update of dental health professions short- age area (HPSA) criteria, building from unimplemented 2005 UNC/Sheps Center report along with other recom- mendations. An improved dental HPSA will provide a more accurate federal as- sessment of oral health workforce needs.


Target: State Legislation and Regulations
1. Promote states’ adoption of expanded duties for dental assistants as recommended in the AAPD’s Policy on Workforce Issues and Delivery of Oral Health Care Services in a Dental Home, and assist state chapters dealing with dental therapist and other mid-level proposals.2 Provide technical assistance, via research and policy center, to state Public Policy Advocates working in collaboration with state dental associations on this issue.


Target: Federal Appropriations for FY 2018
1. Seek appropriations for sec. 748 Title VII dental primary care cluster of $35.873 million3, with directed funding of not less than $10 million going to pediatric dentistry in recognition of the demand for training grants and the in- creased need for pediatric dentists to treat newly insured children under the ACA4. Obtain continued support for dental faculty loan repayment, and strongly encourage HRSA to issue a new grant announcement with broader clinical site eligibility than FY 2016 grants.
2. Support efforts of Children’s Hospital Association to obtain full funding of $300 million for Children’s Hospitals GME, and oppose any HRSA efforts to restructure the program and eliminate dental positions from residency count in funding formula.
3. Seek HRSA support for establishing a Chief Dental Officer position, work- ing from Congressional report language obtained in FY 2017 committee bills.



Target: Federal Health Care Reform
1. Work with ADA and other dental and medical organizations to support a simplified process across appropriate governmental agencies to designate in- dividuals with intellectual disabili- ties as a medically underserved population.

Target: Federal Regulations
1. Monitor implementation of Head Start Performance Standards proposed in 2015, to ensure appropriate require- ments for dental periodicity schedule and establishment of a dental home.

Target: State Legislation and Regulations
1. Provide technical assistance to states seeking legislation for mandatory oral health examinations prior to school matriculation. Seek support of state dental associations and other in- terested organizations via efforts of state Public Policy Advocates.5
2. Work with ADA, state dental associa- tions, and state pediatric dental units to promote community water fluori- dation, and prevent efforts to remove fluoride from currently fluoridated com- munities.

1The initial DQA pediatric oral health quality measures tested and adopted in 2013 are as follows:
Evaluating Utilization
Use of Services
Preventive Services
Treatment Services

Evaluating Quality of Care
Oral Evaluation
Topical Fluoride Intensity
Sealant use in 6-9 years
Sealant use in 10-14 years
Care Continuity
Usual Source of Services

Evaluating Cost

Per-Month Cost

The DQA was formed by the ADA at the request of CMS. The AAPD was a founding member and has a representa- tive on the DQA’s Executive Committee.
2 The AAPD Pediatric Oral Health Research and Policy Center maintains an EFDA "tool kit" on its web page.

3Congressional appropriators have included the Feingold- Collins State Oral Health grants under this total amount. The AAPD, ADA, and ADEA supported $10 million each for pediatric dentistry and general dentistry in FY 2017.

4 As Congress considers tax reform legislation explore pos- sible inclusion of tax exemption of faculty loan repayment amount, or via Title VII reauthorization explore authority for school or residency program to provide additional amounts to cover tax liability as done in NIH loan repay- ment programs.

5Note that a tool kit is available on the AAPD research and policy center Web page.

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