November 2019 Volume LIV Number 6

 
 
 
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Legislative, Regulatory and Legal Update

September 2019 Volume LIV Number 5

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
MEDICAID DENTAL AUDIT LANGUAGE IN U.S. HOUSE REPORT
The FY 2020 House Appropriations Committee Report for Labor-HHS-Education programs was released in early May and approved by the committee. Among other provisions, it includes the following language recommended by the AAPD:
"Medicaid Dental Audits.—The Committee is concerned that failure to use professional guidelines or established state Medic- aid manual parameters in the auditing process can result in inac- curate and unreasonable Medicaid dental audits. These practices deter providers from participation in the program and negatively affect care to patients. The Committee therefore directs CMS to instruct contracted auditors to utilize dental profession clinical guidelines, best practices, and policies of the American Academy of Pediatric Dentistry and American Dental Association when conducting dental audits, and require independent peer-to-peer review. The Committee directs CMS to report back to the Com- mittee within 90 days of enactment of this Act on steps taken to address these auditing concerns."
 
The AAPD thanks Congressman Henry Cuellar (D-Texas 28th) for submitting this report language. The AAPD is also working to add similar language in the Senate bill. Final approval of Labor-HHS-Ed- ucation appropriations bills are still pending per negotiations between the Senate, House, and White House over budget caps and the debt ceiling limit.
 
AAPD, ADA, AND CDHP EXPRESS CONCERN ABOUT CMS ACA WAIVERS
In response to the Centers for Medicare and Medicaid Services’ (CMS) Request for Information on state relief empowerment waiv- ers, the AAPD, ADA, and Children’s Dental Health Project (CDHP) expressed concern that the agency’s waiver guidance could adversely impact children’s access to oral health care and urged the agency not to implement the guidance.
 
In October 2018, CMS announced four Affordable Care Act (ACA) section 1332 waiver concepts designed to empower states to come up with better health care solutions for their residents. At that time the three organizations expressed support in a December letter for the concept of providing states with more flexibility, but also raised concern that the guidance may weaken the ACA’s Essential Health Benefits — also known as EHBs. Pediatric oral health is an EHB under the ACA.
 
The June 28, 2019, letter shared those concerns again, pointing out that "under the ACA guardrails in Section 1332, a state’s plan waiver must provide comprehensive health coverage to at least as many residents as would have coverage without the waiver," and not- ing that the 2018 guidance doesn’t include that protection. "Addition- ally, we think that allowing states to align Section 1332 waivers with 1115 Medicaid waivers could threaten children’s coverage under the Medicaid and Children’s Health Insurance Programs." Citing ADA Health Policy Institute research, the letter noted that since 2015, the percentage of children with dental coverage has reached an all-time high. The letter also shared studies from the American Journal of Public Health and Journal of Dental Research providing evidence that oral health impacts school performance and employability.
 
 
STATE NEWS
CALIFORNIA’S NEW LOAN REPAYMENT PROGRAM
(from California Public Policy Advocate Dr. Natalie Mansour)
California recently announced paying off $10.5 million in student loan debt for 40 dentists who agreed to ensure that 30 percent of their patient caseload is made up of Medi-Cal patients. The CalHealthCares repayment program is funded from an allocation in the revised 2019-20 budget and a $2 increase in tobacco taxes that went into effect July 1, 2017. Proposition 56, approved by California voters in November 2016. Altogether, $340 million will be provided under this loan repayment program for health professionals, via at least five rounds of funding. The program is run by Physicians for a Healthy California, the charitable arm of the California Medical Association. They will start accepting applications for the next round of awards in January.
 
Almost 240 dentists applied for CalHealthCares. The 40 awardees – nine pediatric dentists and 31 general dentists – will serve Medi-Cal patients in Sacramento County and 19 other counties in community clinics, federally qualified health centers, academic settings, group practices and private practices. The debt relief program will cover up to $300,000 of the cost of dental school, a dental or physician residency program, and any fellowship completed within the last five years. Those who accept the awards agree to ensure that Medi-Cal patients represent 30 per- cent of their caseload for five years.
 
The American Dental Education Association estimates that 2018 dental school students have average student loan debt of $285,184 if they graduated from public schools and $326,133 if they graduated from private schools. Only about one-third of California’s licensed dentists take some Medi-Cal dental patients in their practice, accord- ing to DHCS statistics. Roughly 13.4 million Californians are eligible for dental care under Medi-Cal, a program known as Denti-Cal. Denti-Cal came under fire from the Little Hoover Commission, an independent state oversight agency, which indicated that the admin- istering agency was ignoring the Legislature’s direction that it meet a goal of 60 percent utilization for children covered by Medi-Cal. Cre- ation of such a loan repayment program was one of the Commission’s recommendations. As reported in the Sacramento Bee:
 
"Expanding access to care will ensure California’s most vulner- able residents receive oral health care, which is essential to overall health," said Dr. Del Brunner, president of the California Dental Association, in a prepared news release. "We know student loan debt is one of the biggest financial hurdles a dentist may face and this program will allow practitioners to follow their passion of providing care for the underserved." Increasingly, studies have pointed out that poor dental hygiene can increase the risk of serious health problems such as poorly controlled diabetes, heart attacks, stroke and other problems. The American Academy of Pediatric Dentistry has noted that, among children from disad- vantaged backgrounds, a rapid form of tooth decay has reached epidemic proportions."
 
OREGON LEGISLATURE APPROVES DENTAL SPECIALTY ADVERTISING BILL
(from Oregon Public Policy Advocate Dr. Natasha Bramley)
In early June, the Oregon legislature approved SB 835, legislation supported by the state chapters of AAOMS, AAPD, and other dental specialties that would specify the requirements necessary to advertise as a dental specialist. The bill was signed into law by the Governor on June 13, 2019. The key provision of SB 835 is as follows:
 
"SECTION 2. (1) A dentist licensed by the Oregon Board of Dentistry may advertise that the dentist is a specialist in one or more areas of dentistry if the dentist:
(a) Has completed a post-doctoral residency program that is at least two years in length and is accredited by the Commission on Dental Accreditation, or its successor organization, and ap- proved by the board by rule;
(b) Is a specialist as defined by the National Commission on Recognition of Dental Specialties and Certifying Boards, or its successor organization, and adopted by the board by rule; or
(c) Has completed an advanced dental education program that is at least two years in length and is recognized by the United States Department of Education, and approved by the board by rule."
 
FLORIDA APPROVES NEW LOAN REPAYMENT PROGRAM
(from Florida Public Policy Advocate Dr. Irwine Sanvil)
In late June, Florida Governor Ron DeSantis signed into law HB 843 which, among other things, revives a defunct loan repayment program for dentists who see low-income patients. Florida Dental Association President Jolene Paramore said, "This is a way that we can provide care in those communities that are underserved, be able to reach Floridians who don’t have access to a dentist, and be able to have them be a Medicaid provider." Ten participating dentists may receive up to $50,000 a year to help repay their loans and can serve in the program for up to five years. Dr. Paramore indicated this program could be implemented within six months with appropriate funding from the state.
 
Updated State Loan Repayment Programs Chart Now Available
The AAPD is pleased to announce that the updated State Loan Repayment Programs Chart is now available! Student debt is rising in nearly every field, but can be especially prohibitive within the field of dentistry. One especially unfortunate effect of rising debt is that many dentists are unable to work in the places or serve the people who may need them the most. Luckily, today, nearly every state offers some program to forgive student dental loan debt for dentists practicing in Health Care Shortage Areas (HPSAs) and Medically Underserved Areas (MUAs), with some plans forgiving up to $200,000 worth of qualifying debt! Complete with brand new plans with funding approved just this year, the AAPD has compiled this updated chart as a resource for residents and recent graduates looking to make a difference in our most underserved communities. It is located in the Members- only Resources section of the AAPD website, under Residency Director Resources.

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