November 2021 Volume LVI Number 6


Legislative and Regulatory Update

November 2021 Volume LVI Number 6

Dental Medicaid Rates Boosted in Three States: Minnesota, Mississippi, and Wisconsin

As reported by Minnesota Academy of Pediatric Dentistry Public Policy Advocate Dr. Elise Sarvas
The Minnesota legislature passed an om- nibus health and human services bill that was signed by the Governor on June 29, 2021.1 Among other provisions, it is fantas- tic news that Medicaid dental reimburse- ment rates will increase by 98 percent starting in January 2022. Additionally, the Critical Access Dollars (20 percent increase) was preserved (university-owned dental clinics receive these dollars).
This is a once in a generation reimbursement rate increase and will affect most practitioners in the state who are not state- operated dental clinics, federally qualified health centers, ru- ral health centers, or Indian health services which fall under a different fee schedule.
In addition to the rate increase the bill also sets establishes a process to start measuring dental utilization and create benchmarks for different geographical areas. This means that if a county is not getting a certain percentage of the people in their area on public insurance at least one dental visit a year, they will need to study the issue and fix it. There are also measures to fund telehealth services and tobacco prevention and cessation.
Many thanks go to Dr. Jim Nickman, past-president of the AAPD, current president of the Minnesota Dental Associa- tion (MDA), and adjunct University of Minnesota dental faculty member for his work with the MDA in getting this passed. Nickman indicates that key factors for this success were: a) a bold proposal from DHS to rebase the system to more contemporary rates; b) an interested House chair to drive the issue, c) and a united front of private and non-profit providers from throughout the state.
The MDA provided the following summary of the Medicaid dental provisions:
  • "The bill creates performance benchmarks to improve dental utilization for Managed Care and county-based purchasing plans. If the health plans do not meet the benchmarks established by the Minn. Department of Health, they will be required to submit a corrective action plan. If in 2024 plans in aggregate are continuing to fail to meet the performance benchmarks, the state will enter into an agreement with a single administrator to begin delivering services beginning in 2026.
  • To better understand dental utilization in the state, the commissioner of DHS will submit a report to legislators on dental utilization.
  • The legislation requires a uniform dental creden- tialing process beginning Jan. 1, 2022.
  • The legislation does eliminate the rural, children, and community clinic add-on and reinvests those dollars into an across-the-board rate increase.
  • The legislation expands Medicaid to cover nonsur- gical treatment for periodontal disease for adults including scaling and root planing once every two years for each quadrant, and routine periodontal maintenance procedures.
  • Each year the commissioner of DHS will submit a report to legislators on provider reimbursement rates, in order to improve transparency.
  • The legislation establishes a dental home advi- sory committee that will require DSAC (dental services advisory committee), in collaboration with specific stakeholders, to design a dental home demonstration project and present the recommendations by Feb. 1, 2022. The advisory committee will include a representative from the Minnesota Dental Association and two private practice dentists.
  • The commissioner of DHS shall present recom- mendations on dental rate rebasing to legisla- tors by Feb. 1, 2022. The report must include recommendations on the frequency of rebasing, whether it should incorporate an inflation factor, and other factors relevant to ensuring access to dental care.
  • The commissioner of DHS will review other states that have implemented a carve out model and switched to a single administrator and compare programs."
As reported by Mississippi Academy of Pediatric Dentistry Public Policy Advocate Dr. Neva Eklund
In 2020, the Mississippi Academy of Pediat- ric Dentistry (MAPD) engaged a state-level lobbying firm to work on Medicaid issues before the state legislature and general anesthesia issues before the state dental board. Typically, in every third Mississippi legislative session Medicaid is up for reauthorization. MAPD’s focus was on in-creased dental fees and greater accountability for managed care organizations (MCOs). In 2021 progress was made via changes the legislature made to remove the automatic five percent administrative withholding on reimbursement rates, and approve a five percent increase in preventive and diag- nostic fees for each fiscal year 2022, 2023, and 2024. MAPD also assisted the Mississippi dental board in re-vamping their anesthesia regulation to ensure safer measures are in place for Mississippi children under anesthesia during dental procedures.
MAPD President Dr. Tiffany Green sent the following message to chapter members:
"Mississippi Academy of Pediatric Dentistry owes a huge thank you to Clare Hester, Erin Nail and the entire team at Capitol Resources, LLC. I am a firm believer that NONE of the above things would have been accomplished without our partnership. They have led and directed us, fought for our interests and the safety of the children of Mississippi, connected and established valuable relationships with legislators and state agencies, and opened doors and helped us gain respect from Mr. Drew Snyder and the Department of Medicaid. They have kept your leadership informed on almost a daily basis and have advocated for our inter- ests on many late nights at the Capitol when there was no other voice present representing the dentists of Mississippi. This WIN should validate any questions we as a collective body have ever had on the value and necessity of this partnership!"
The Mississippi Dental Association provided the following details on the legislation (SB 2799) passed in April 2021 that reauthorized the Medicaid program for three years (July 1, 2021 – July 1, 2024):
"This legislation was a collective effort of a coalition of health care providers (including representatives from MDA and MS Academy of Pediatric Dentistry). Our dentist volunteer leaders and lobby team worked really hard to meet with legislators, elected officials and other pertinent leaders to help pass the bill. MDA efforts began last summer, and built up leading into the session. We all owe a special thanks to the dentists who took time to deliver advocacy messages to our leaders when it counted.
The bill does a number of things to impact reimburse- ment and program management. First, the bill elimi- nates the five percent administrative fee for dentists who participate in Medicaid. The fee was implemented in the 1990s, so this law reverses a long-time fee for dentists (and other providers too). It also provides for a five percent fee increase for three years for dentists on preventative/diagnostic care. While the increase is a start, we will continue advocating for dentists to be fairly compensated for Medicaid treatment.
The following items in the bill pertain to reimburse- ment rates:
  • Increases dental rates on diagnostic and pre- ventative services each of SFY 2022-2024 by five percent each year.
  • Deletes five percent provider withhold (includ- ing dentistry) and requirement for the medical care advisory committee to study reimbursement rates.
  • Prohibits Medicaid from increasing or decreasing reimbursement rates or limitations on services from the levels in effect on July 1, 2021, unless authorized by the Legislature.
The following provisions apply to Managed Care Organizations (MCOs) who contract with Medicaid on the program:
  • If Medicaid reduces rates to providers because projected expenditures exceed appropriation,then Medicaid must accompany any reimburse- ment reductions with reductions in the MCO profit and administrative fees to the fullest extent allowable.
  • Prohibits MCOs from implementing more strin- gent requirement than Medicaid for prior au- thorization, utilization review, medical services, transportation services and prescription drugs. Also requires the MCOs to submit a report to the Medicaid Chairmen by Dec. 2, 2021, on the status of the processes for these services. Intention is to have alignment and standardization for these processes.
  • Requires all MCOs or similar programs to adopt level of care guidelines in determining medical necessity in all utilization management practices including PA, concurrent reviews, retro reviews and payments.
  • Authorizes MCO categories of eligibility to only include categories eligible for participation in Medicaid managed care as of Jan. 1, 2021, and CHIP waiver in operation as of Jan. 1, 2021, and removes the Commission on Expanding Managed Care.
  • MCOs required to annually share administrative cost data and number of Mississippi FTEs dedicat- ed to the Mississippi contracts for Medicaid and CHIP with the Medicaid Chairmen.
  • More stringent reporting/review/audit require- ments on MCOs performed by PEER, State Auditor, Mississippi Insurance Department or an indepen- dent third party and publish the results in their entirety on the Division’s website.
  • By Dec. 1, 2021, MCOs must adopt a standardized and expedited credentialing process; if not, then DOM must do it by July 1, 2022. Provisions for temporary credentialing are provided.
  • MCOs must give detailed explanation of reasons for a denial of a procedure that was ordered or re- quested by a provider as well as provide the name and credentials of the person who denied the coverage. MCOs and Medicaid must also expedite the review and appeals process.
  • Legislative intent for DOM to study feasibility of using one vendor for dental benefits."
As reported by Wisconsin Academy of Pediatric Dentistry Public Policy Advocate Dr. Colleen Greene
The Wisconsin Academy of Pediatric Den- tistry is delighted with the first significant Medicaid dental fee increase in 20 years, overall a 40 percent increase that goes into effect on Jan. 1, 2022. The Wisconsin Dental Association has engaged in proac- tive and multi-faceted legislative solutions to improve access to care for vulnerable individuals, including taking a neutral position on dental therapy legislation, pushing for expanded function dental auxiliaries and collaborating to set the stage for teledentistry opportunities. Medicaid dental fees were last raised one per- cent in 2008 and one percent in 2002, so this is a monumen- tal achievement. It is a credit to the decades-long advocacy of dentists, organized dentistry leaders and staff members as well as collaboration among diverse stakeholders statewide and a bipartisan group of elected officials and lawmakers.
The Wisconsin Dental Association (WDA) issued the follow- ing press release on July 8, 2021:
"Advocacy at work: Gov. Evers signs monumental dental Medicaid increase into law
After months of WDA advocacy, Gov. Tony Evers this morning signed into law a 2021-23 state budget that includes a 40 percent dental Medicaid reimbursement increase. The hike is the largest increase in the state budget, and the largest in recent memory. It repre- sents an additional $46 million over the biennium.
Many thanks to the WDA members who sent over 500 emails to lawmakers in support of dental Medic- aid increases and testified at budget hearings as our Madison team continued to engage with legislators, the Department of Health Services and the Governor’s Office. Passage of the 40 percent increase is a huge victory for the WDA, its members and the patients you serve.
WDA President Dr. Paula Crum (Green Bay) issued the following statement shortly after the governor signed the budget:
"On behalf of the 3,100 members of the Wisconsin Dental Association, I would like to extend a sincere thank you to the Legislature and Gov. Evers for including dental Medicaid reimbursement increases in the 2021-23 state budget. Through bipartisan action and support, the Legislature and Governor have taken a strong step forward toward increasing access to care for our state’s most vulnerable populations.

"Today’s action represents the state’s first significant investment in oral health in two decades. Expanding access to oral health is, and should remain, a biparti- san priority. The WDA would like to thank Gov. Evers, Speaker Robin Vos, Majority Leader Devin LeMahieu and Joint Committee on Finance Co-Chairmen Mark Born and Howard Marklein for doing just that.

"I also want to extend my appreciation to WDA member dentists who sent over 500 messages to lawmakers urging them to support increased Medic- aid reimbursement.
Successful advocacy campaigns require engaged and enthusiastic grassroots partners. Today’s bill signing is a testament to this.
"We greatly appreciate the increased attention be- ing paid to oral health in Wisconsin. We all agree that getting more people quality oral healthcare will require a multipronged approach, utilizing a variety of solutions. The Wisconsin Dental Associa- tion strongly believes increasing reimbursement rates in our state is one of the prongs to do just that. Today is a momentous day, and we look for- ward to continuing to collaborate to accomplish even more this legislative session."
Pediatric Dentist Appointed CMS Chief Dental Officer
The AAPD is delighted that board certified pediatric dentist and AAPD member Dr. Natalia Chalmers has been appointed Chief Dental Officer (CDO) at the Centers for Medicare and Medicaid Services (CMS). The CMS CDO position had been vacant since 2017, and AAPD has strongly advocated for a CDO appointment. Congressional appropriations report language was obtained each fiscal year since then urging CMS to fill the CDO position. Dr. Chalmers previously served a temporary stint as CMS Dental Officer beginning in 2020, on assignment from the Food and Drug Administration. Earlier this year, the AAPD and ADA jointly wrote CMS to endorse Dr. Chalmers’ candidacy. She is the first CDO to serve in the CMS Office of the Administrator. Congratulations Dr. Chalmers!
Dental Loan Repayment Assistance Act
The AAPD spearheaded a letter from the Organized Dentistry Coalition (which includes ADA and ADEA among others) in support of legislation that would allow full-time educators participating in the HRSA Dental Faculty Loan Repayment Program to exclude from their federal income taxes the amount of the loan forgiveness received from this program. In July 30, 2021 letters to the Senate Finance and House Ways and Means Committees, the groups asked lawmakers to include S. 449/HR 1285, Dental Loan Repayment Assistance Act, in any tax legislation considered by Congress in 2021.
ACA Benefit and Payment Parameters 2022
The AAPD and ADA submitted a joint letter to the Centers for Medicare and Medicaid Services (CMS) on July 28, 2021 outlining our position on updates to the proposed notice of benefit and payment parameters for the Affordable Care Act next year. The letter supported the agency’s proposal to repeal a provision that would have allowed direct enrollment outside of exchanges. The letter also expressed support for an extension of the ACA open enrollment period and cre- ation of a special open enrollment period for lower-income consumers.
Permanent CHIP Reauthorization
The AAPD and ADA joined more than 500 organizations in sending a July 22, 2021 letter to congressional leaders urging them to pass the Comprehensive Access to Robust Insur- ance Now Guaranteed for Kids Act and the Children’s Health Insurance Program Permanency Act and make the Children’s Health Insurance Program (CHIP) permanent. The groups, led by the First Focus Campaign for Children, said CHIP has helped reduce the number of children without health insur- ance, improved health care access for pregnant women and children, and become a vital source of health care coverage for American Indian, Alaska Native, Black, Hispanic and multi- racial children.
REDI ACT Reintroduced
Congressman (and dentist) Dr. Brian Babin (R-Texas 36th) reintroduced the Resident Education Deferred Interest (REDI) Act (H.R. 4122) along with Congresswoman Chrissy Houlahan (D- PA 6th). The legislation would halt interest accrual while loans are in deferment during residency training. The full text of the accompanying press release is below; it lists a number of supporting organizations, including the AAPD:
Babin, Houlahan Ease Heavy Burden on America’s Health Care Providers
Washington, June 24, 2021
WASHINGTON, D.C. – Today, U.S. Congressman Brian Babin (TX-36) and U.S. Congresswoman Chrissy Houlahan (PA- 06) issued the following statement on the introduction of the Resident Education Deferred Interest Act (REDI Act) to address the growing doctor shortage, help make medical education more affordable, and boost health care outcomes in Southeast Texas and across the nation.
"As a dentist, I know firsthand how expensive graduate school is, as well as how burdensome hefty student loans are when you’re working to become a health care profes- sional," said Rep. Babin. "By the time many medical and dental school students finish their required training, balloon- ing interest payments too often prevent them from further specializing in practices like radiology or serving in rural areas far from large hospitals. This bill will help remove those barriers, bringing quality doctors and dentists to patients in my district and underserved areas across America."
"During this pandemic, we were painfully reminded just how vital our medical professionals are," said Rep. Houlahan. "We need to be doing everything in our power to break down barriers preventing people from entering these lifesaving fields. Most young doctors and dentists finish their residen- cies carrying crippling student debt, often preventing them from pursuing more specialized fields or providing medi cal services in rural and remote locations. Our bipartisan legislation will begin the overdue process of eliminating such economic barriers and support young medical professionals serving across the country, building a more equitable and fair health care system."
"Physicians and dentists accumulate significant student debt during post-graduate education and must then undertake several years of residency with very low pay, making it dif- ficult to begin repaying their student debt right away," said B.D. Tiner, D.D.S., M.D., F.A.C.S., of San Antonio, Texas, and president of the American Association of Oral and Maxillo- facial Surgeons. "Interest accrual relief during residency – as provided for in the REDI Act – will prevent students from being punished during their residency with higher debt bal- ances and will make the options of serving in underserved areas or faculty and research positions more attractive and affordable. The physician and dental community is grateful to Representatives Babin and Houlahan for introducing the REDI Act to address this important issue."
Supporting Organizations [of REDI Act]:
Academy of General Dentistry
American Academy of Dermatology 
Association American Academy of Neurology
American Academy of Ophthalmology
American Academy of Oral and Maxillofacial Pathology 
American Academy of Oral and Maxillofacial Radiology 
American Association of Orthopedic Surgeons
American Academy of Pediatric Dentistry
American Academy of Periodontology
American Association for Dental Research
American Association of Child and Adolescent Psychiatry 
American Association of Endodontists
American Association of Neurological Surgeons 
Congress of Neurological Surgeons
American Association of Oral and Maxillofacial Surgeons
American Association of Orthodontists 
American Association of Women Dentists
American College of Obstetricians and Gynecologists 
American College of Osteopathic Surgeons
American College of Rheumatology 
American Dental Association
American Dental Education Association 
American Society of Anesthesiologists 
American Society of Dentist Anesthesiologists 
American Student Dental Association 
American Society for Radiation Oncology
Society for Cardiovascular Angiography and Interventions 
The Society of Thoracic Surgeons
American College of Prosthodontists 
American College of Emergency Physicians

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