March 2021 Volume LVI Number 2

 
 
 
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A Message from Your CEO

March 2021 Volume LVI Number 2

 Pediatric Dentistry and the 2020 ADA Virtual Annual Session House of Delegates
 
During the virtual American Dental Association (ADA) 2020 Annual Session this past October, the AAPD re- viewed resolutions of interest to pediatric dentistry being considered by the ADA House of Delegates. We com- municated the AAPD’s positions to AAPD member delegates and alternates and submitted written testimony to ADA Reference Committees on select resolutions (including the key ones described below).
 
Resolution 15H – Use of SDF
Resolved, that the ADA policy, Statement on the Use of Silver Diamine Fluoride to Arrest Carious Lesions, be adopted:
 
ADA Statement on the Use of Silver Diamine Fluoride to Arrest Carious Lesions
38% Silver Diamine Fluoride (SDF) is a topical antimicrobial and remineralizing agent which was cleared by the FDA as a Class II medical device to treat tooth sensitivity. In certain circumstances, SDF may be used as a non- restorative treatment to arrest carious lesions on primary and permanent teeth. The use of SDF to arrest carious lesions requires appropriate diagnosis and monitoring by a dentist.
 
When using SDF for caries management, the following protocols should be followed:
  1. Development of a patient-specific treatment plan by the dentist.
  2. Patients or their lawful guardians should be informed of all available treatment options, possible side effects, and the need for follow-up monitoring when giving informed consent.
  3. The application of SDF may be delegated to qualified allied dental personnel with the appropriate training and supervision in accordance with state laws and in conjunction with the above protocols.
and be it further
 
Resolved, that the ADA supports SDF as a covered benefit by third-party payers, and be it further
Resolved, that if the tooth treated with SDF requires further treatment, that this restorative treatment or ex- traction of the tooth also remain a covered benefit.
 
The AAPD supported this resolution, which was adopted by the ADA House of Delegates.
 
Resolution 16H – Amendment of Teledentistry Policy Statement
Resolved, that the Comprehensive ADA Policy Statement on Teledentistry (Trans.2015:244), be amended . . . [to read as follows:]
 
Comprehensive ADA Policy Statement on Teledentistry
Teledentistry refers to the use of telehealth systems and meth- odologies in dentistry. Telehealth refers to a broad variety of technologies and tactics to deliver virtual medical, health, and education services. Telehealth is not a specific service, but a collection of means to enhance care and education delivery.
  • Teledentistry can include patient care and education delivery using, but not limited to, the following modalities:
  • Synchronous (live video): Live, two-way interaction be- tween a person (patient, caregiver, or provider) and a pro- vider using audiovisual telecommunications technology.
  • Asynchronous (store and forward): Transmission of recorded health information (for example, radiographs, photographs, video, digital impressions and photomicro- graphs of patients) through a secure electronic communi- cations system to a practitioner, who uses the information to evaluate a patient’s condition or render a service outside of a real-time or live interaction.
  • Remote patient monitoring (RPM): Personal health and medical data collection from an individual in one loca- tion via electronic communication technologies, which is transmitted to a provider (sometimes via a data processing service) in a different location for use in care and related support of care.
  • Mobile health (mHealth): Health care and public health practice and education supported by mobile communica- tion devices such as cell phones, tablet computers, and personal digital assistants (PDA).
General Considerations: While in-person (face to face) direct examination has been historically the most direct way to pro- vide care, advances in technology have expanded the options for dentists to communicate with patients and with remotely located licensed dental team members. The ADA believes that examinations performed using teledentisty can be an effective way to extend the reach of dental professionals, increasing ac- cess to care by reducing the effect of distance barriers to care. Teledentistry has the capability to expand the reach of a dental home to provide needed dental care to a population within reasonable geographic distances and varied locations where the services are rendered.
 
In order to achieve this goal, services delivered via teleden- tistry must be consistent with how they would be delivered in-person. Examinations and subsequent interventions per- formed using teledentistry must be based on the same level of information that would be available in an in-person en- vironment, and it is the legal responsibility of the dentist to ensure that all records collected are sufficient for the dentist to make a diagnosis and treatment plan. The treatment of pa- tients who receive services via teledentistry must be properly documented and should include providing the patient with a summary of services. A dentist who uses teledentistry shall
have adequate knowledge of the nature and availability of lo- cal dental resources to provide appropriate follow-up care to a patient following a teledentistry encounter. A dentist shall refer a patient to an acute care facility or an emergency department when referral is necessary for the safety of the patient or in case of emergency.
 
As the care provided is equivalent to in person care, insurer reimbursement of services provided must be made at the same rate that it would be made for the services when provided in person, including reimbursement for the teledentistry codes as appropriate.
 
Patients’ Rights: Dental patients whose care is rendered or coordinated using teledentistry modalities have the right to expect:
  1. That any dentist delivering, directing or supervising ser- vices using teledentistry technologies will be licensed in the state where the patient receives services, or be provid- ing these services as otherwise authorized by that state’s dental board.
  2. Access to the licensure and board certification qualifica- tions of the oral health care practitioner who is providing the care in advance of the visit.
  3. Access to the licensure and board certification qualifica- tions of the oral health care practitioner who is providing the care in advance of the visit.
  4. That they will be informed about the identity of the provid- ers collecting or evaluating their information or providing treatment, and of any costs they will be responsible for in advance of the delivery of services.
  5. That relevant patient information will be collected prior to performing services using teledentistry technologies and methods including medical, dental, and social history, and other relevant demographic and personal information.
  6. That the provision of services using teledentistry technolo- gies will be properly documented and the records and documentation collected will be provided to the patient upon request.
  7. That services provided using teledentistry technologies and methods include care coordination as a part of a den- tal home and that the patient’s records be made available to any entity that is serving as the patient’s dental home.
  8. That the patient will be actively involved in treatment deci- sions, will be able to choose how they receive a covered service, including considerations for urgency, convenience and satisfaction and without such penalties as higher deductibles, co-payments or coinsurance relative to that of in-person services.
  9. That the dentist shall determine the delivery of services using teledentistry technologies and all services are per- formed in accordance with applicable laws and regulations addressing the privacy and security of patients’ private health information.
Quality of Care: The dentist is responsible for, and retains the authority for ensuring, the safety and quality of services provid- ed to patients using teledentistry technologies and methods. Services delivered via teledentistry should be consistent with in-person services, and the delivery of services utilizing these modalities must abide by laws addressing privacy and security of a patient’s dental/medical information.
 
Licensure: Dentists and allied dental personnel who deliver services through teledentistry modalities must be licensed or credentialed in accordance with the laws of the state in which the patient receives service. The delivery of services via tele- dentistry must comply with the state’s scope of practice laws, regulations or rules. Teledentistry cannot be used to expand the scope of practice or change permissible duties of dental auxiliaries. The American Dental Association opposes a single national federalized system of dental licensure for the purposes of teledentistry.
 
Reimbursement: Dental benefit plans and all other third-party payers, in both public (e.g. Medicaid) and private programs, shall provide coverage for services using teledentistry tech- nologies and methods (synchronous or asynchronous) deliv- ered to a covered person to the same extent that the services would be covered if they were provided through in-person encounters. Coverage for services delivered via teledentistry modalities will be at the same levels as those provided for services provided through in-person encounters and not be limited or restricted based on the technology used or the loca- tion of either the patient or the provider as long as the health care provider is licensed in the state where the patient receives service.
 
Technical Considerations: Dentists are encouraged to con- sider conformance with applicable data exchange standards to facilitate delivery of services via teledentistry modalities. These include, but are not limited to, Digital Imaging and Commu- nications in Medicine (DICOM) standards when selecting and using imaging systems, X12/HL7 for the exchange of informa- tion and ICD-9/10-CM/SNOMED/SNODENT for documentation consistency.
 
The AAPD supported the intent of this resolution, which was ad- opted by the ADA House of Delegates.
 
Resolution 21H – Optimizing Dental Health Prior to Surgical/Medical Procedures
Resolved, that the following ADA policy statement on Opti- mizing Dental Health Prior to Surgical/Medical Procedures and Treatment be adopted:
 
The ADA believes that optimizing dental health prior to the performance of complex medical and surgical procedures can be an important component of clinical care. Inter- professional communication and collaboration are crucial to identifying pre-existing or underlying oral health concerns that may impact post-medical/surgical complications or healing time, particularly for patients who are immunocom- promised or otherwise at greater risk of adverse medical outcomes because of underlying health problems. Direct communication with patients and their medical teams regarding the need for, and ability to obtain, a dental exami- nation, and consultation and treatment, when appropriate, prior to initiation of complex surgical and medical treat- ments is especially recommended.
The AAPD supported this resolution, which was adopted by the ADA House of Delegates.
 
Resolution 25H – Guidelines for Medicaid Dental Audits
Resolved, that the American Dental Association encourages state dental associations to work with their respective state Medicaid agency to adopt such guidelines for Medicaid Dental Reviews and/or in States that use a managed care model to in- corporate such guidelines into their request for proposal (RFP) to third-party payers interested in managing the dental benefit:
 
Guidelines for Medicaid Dental Reviews
The Auditor/Reviewer shall demonstrate adherence, not only to individual State Board regulations and requirements, but also an understanding, acceptance and adherence to Medicaid State guidelines and specific specialty guidelines as applicable. In addition, the Auditor/Reviewer shall demonstrate experience in treatment planning specific patient demographic groups and/or unique care delivery sites that influence treatment plan- ning being reviewed. It is recommended that entities, which conduct Medicaid Dental reviews and audits, utilize auditors and reviewers who:
  1. Have a current active license to practice dentistry in the State where audited treatment has been rendered and be available to present their findings.
  2. Are of the same specialty (or equivalent education) as the dentist being audited.
  3. Document and reference the guidelines of an appropri- ate dental or specialty organization as the basis for their findings, including the definition of Medical Necessity being used within the review.
  4. Have a history of treating Medicaid recipients in the state in which the audited dentist practices.
  5. Have experience treating patients in a similar care delivery setting as the dentist being audited, such as a hospital, surgery center or school-based setting, especially if a sig- nificant portion of the audit targets such venues.
In addition, these entities shall be expected to conduct the re- view and audit in an efficient and expeditious manner, includng:
  1. Stating a reasonable period of time in which an audit can proceed before dismissal can be sought.
  2. Defining the reasonable use of extrapolation in the initial audit request.
The AAPD supported this resolution, which was adopted by the ADA House of Delegates.
 
Resolution 51H – Support of CHIP
Resolved, that the following policy titled Support for the Chil- dren’s Health Insurance Program be adopted:
 
Support for the Children’s Health Insurance Program
 
Resolved, that that the American Dental Association sup- ports the Children’s Health Insurance Program (CHIP), and be it further
 
Resolved, that funds dedicated to the program should be used to provide medical and dental care to children with family income less than or equal to 200 percent of the federal poverty level before any expansion to children in families above that level, and be it further
 
Resolved, that decisions to cover children beyond 200 percent of the federal poverty level continue to be made on a state-by- state basis, and be it further
 
Resolved, that the policy titled Reauthorization of the State Children’s Health Insurance Program (Trans.2007:451) be rescinded.
The AAPD supported this resolution, which was adopted by the ADA House of Delegates.
 
Resolution 65 – General Anesthesia Coverage under Health Plans
Resolved, that the following policy titled Anesthesia Coverage Under Health Plans be adopted:
 
Anesthesia Coverage Under Health Plans
Resolved, the ADA supports the position that all health plans, including those governed by the Employee Retirement Income Security Act, should be required to cover general anesthesia and/or hospital or outpatient surgical facility charges incurred by covered persons who receive dental treatment under anesthesia, due to a documented physical, mental or medical reason as determined by the treating dentist(s) and/or physi- cian, and be it further
 
Resolved, that the policy titled ERISA Reform (Trans.1998:738) be rescinded.
The AAPD supported this resolution, but it was referred to the appropriate ADA agency to be presented at the 2021 ADA House of Delegates.
 
Resolution 83B – Elimination of Wait Periods
Resolved, that the American Dental Association supports the elimination of wait periods for treatment for children from dental benefit plans.
 
The AAPD supported this resolution, but it was referred to the ap- propriate ADA agency to be presented at the 2021 ADA House of Delegates.
 
Resolution 84H – Dentistry is Essential Healthcare
Resolved, that the ADA Interim Policy, "Dentistry is Essential Healthcare" be adopted.
 
Dentistry is Essential Healthcare
The American Dental Association supports the following policy:
  1. Oral health is an integral component of systemic health.
  2. Dentistry is essential healthcare because of its role in evaluating, diagnosing, preventing or treating oral diseas- es, which can affect systemic health.
  3. The term "Essential Dental Care" be defined as any care that prevents or eliminates infection, preserves the structure and function of teeth as well as the orofacial hard and soft tissues, and that this term be used in lieu of the terms "Emergency Dental Care" and "Elective Dental Care" when communicating with legislators, regulators, policy makers and the media in defining care that should continue to be delivered during global pandemics or other disaster situa- tions, if any limitations are proposed.
  4. Government agencies such as the Department of Home- land Security and the Federal Emergency Management Agency have acknowledged dentistry as an essential service needed to maintain the health of Americans. State agencies or officials should recognize the oral health workforce when designating its essential workforce dur- ing public health emergencies, in order to assist them in protecting the health of their constituents.
The AAPD supported this resolution, which was adopted by the ADA House of Delegates.
 
Resolution 100H – Advanced Education in Special Care Dentistry
Resolved, that the ADA Council on Dental Education and Licensure (CDEL) explore, with other appropriate communities of interest, the feasibility of requesting the development of an accreditation process and accreditation standards for advanced education programs in special care dentistry by the Commis- sion on Dental Accreditation (CODA), and be it further
 
Resolved, that CDEL address actionable strategies to:
  1. enhance and expand pre-doctoral training;
  2. develop and promote continuing education programs for existing practitioners; and
  3. investigate advanced educational opportunities, and be it further
Resolved, that the feasibility study with any recommendations be provided to the 2021 ADA House of Delegates.
 
The AAPD opposed this resolution as adopted by the ADA House of Delegates, instead supporting Resolution 100S from the Fifth Trustee District. Our written testimony stated that all dentists should be competent in treating patients with special health care needs, as specifically cited in CODA predoctoral stan- dards. The AAPD noted that GPRs provide this type of training, and it is an important part of pediatric dentistry residency training. The AAPD is concerned that creation of advanced training programs in this area would discourage dentists who do not receive such train- ing from treating these patients.
 
AAPD Member Delegates and Alternates
 
We thank those AAPD members who served in the 2020 ADA Virtual House of Delegates:
 
1st District (Conn., Maine, Mass., N.H., R.I., Vt.)
Delegates
Annemarie DeLessio-Matta
(Southbury, Conn.)
Jonathan D. Shenkin (Augusta, Maine)
Alternates
John Kiang (Providence, R.I.)
Maritza Morell (Andover, Mass.)
 
2nd District (N.Y.)
Delegates
Loren C. Baim (affiliate member) (Glen Falls, N.Y.)
Lois A. Jackson (New York, N.Y.)
Margaret Madonian (Liverpool, N.Y.)
Ioanna G. Mentzelopoulou (New York, N.Y.)
Jay Skolnick (Webster, N.Y.)
 
3rd District (Pa.)
Delegate
Marian S. Wolford (Erie, Pa.)
 
4th District (Air Force, Army, Del., D.C., Md., Navy, N.J., PHS, P.R., Veterans Af- fairs, Virgin Islands)
Alternates
Rachel A. Maher (Wilmington, Del.)
Jason P. Rosenfeld (Butler, N.J.)
Sonia A. Taylor-Griffith (St. Thomas, V.I.)
 
5th District (Ala., Ga., Miss.)
Delegate
James I. Lopez (Columbus, Ga.)
Alternates
Lauren B. Moore (Mobile, Ala.)
Ryan M. Vaughn (Gainesville, Ga.)
 
6th District (Ky., Mo., Tenn., W. Va.)
Delegate
K. Jean Beauchamp (Clarksville, Tenn.)
Rhonda Dawn Switzer-Nadasdi
(Nashville, Tenn.)
 
7th District (Ind., Ohio)
Delegate
Hal S. Jeter (South Point, Ohio)
Alternates
Homa Amini (Columbus, Ohio)
Sally Z. Lauterjung (Akron, Ohio)
 
8th District (Ill.)
Delegates
Susan Bordenave-Bishop (affiliate member) (Peoria, Ill.)
Cissy K. Furusho (Lincolnwood, Ill.)
Alternate
Sharon J. Perlman (affiliate member) (Chicago, Ill.)
 
9th District (Mich., Wisc.)
Delegate
Clifford R. Hartmann (New Berlin, Wisc.)
 
10th District (Iowa, Minn., Neb., N.D., S.D.)
Delegates
Valerie B. Peckosh (Dubuque, Iowa) James D. Nickman (North Oaks, Minn.) Aruna S. Rao (Minneapolis, Minn.)
Alternate
David C. Johnsen (Iowa City, Iowa)
 
11th District (Alaska, Idaho, Mont., Ore., Wash.)
Delegates
Christopher Delecki (affiliate member) (Kirkland, Wash.)
Jane Gillette (affiliate member) (Boze- man, Mont.)
Bernard J. Larson (Mount Vernon, Wash.)
 
12th District (Ark., Kan., La., Okla.)
Delegate
John T. Fales, Jr. (Olathe, Kansas)
Alternates
Christopher Paul Fagan (Enid, Okla.)
Timothy R. Fagan (Enid, Okla.)
Jill Jenkins (Shawnee, Kansas)
Nick Rogers (affiliate member) (Arkansas City, Kansas)
 
13th District (Calif.)
Delegates
John L. Blake (affiliate member) (Long Beach, Calif.)
Lindsey A. Robinson (Grass Valley, Calif.)
Alternates
Paul Ayson (affiliate member) (Visalia, Calif.)
Erin Shah (San Francisco, Calif.)
Nidhi Taneja (Cupertino, Calif.)
 
14th District (Ariz., Colo., Hawaii, Nev., N.M., Utah., Wyo.)
Delegates
Darren D. Chamberlain (Springville, Utah)
Jeffrey A. Kahl (Colorado Springs, Colo.) Kirk J. Robertson (Flagstaff, Ariz.) Alternates
Karen D. Foster (Greenwood Village,
Colo.)
Christopher C. Lee (Honolulu, Hawaii)
 
15th District (Texas)
Delegates
Paul A. Kennedy, III (Corpus Christi, Texas)
Charles W. Miller (Arlington, Texas) Rita M. Cammarata (Houston, Texas) Alternate
Georganne P. McCandless (Tomball,
Texas)
 
16th District (N.C., S.C., Va.)
Delegates
Scott W. Cashion (Greensboro, N.C.)
Roslyn M. Crisp (Burlington, N.C.)
Alternate
Shamik S. Vakil (Charlotte, N.C.)
 
17th District (Fla.)
Delegate
Stephen D. Cochran (Jacksonville, Fla.)
Alternate
Casey Lynn (Apollo Beach, Fla.)
 

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