Bill would Fix Insurance Payment Problems for Some Dental Patients
Rep. Paul Gosar (R-Ariz.), one of two dentist members of Congress, has taken the lead in addressing insurance practices that hurt dental offices and patients by requiring plans to allow both coordination of benefits and assignment of benefits.
Rep. Gosar’s recently introduced bill, the Dental Insurance Fairness Act (H.R. 1798), would require dental plans to allow policy holders to use both their primary and secondary policies to pay for the cost of care. In some states without coordination-of-benefit laws, plan rules that prohibit this kind of coordination leave the beneficiaries on the hook for a portion of the care provided, notwithstanding the fact that they’re paying for two policies.
The assignment-of-benefits provision would allow patients to direct dental plan payments directly to their treating dentists, even non-participating providers. Permitting this would mean that patients would not have to pay out-of-pocket for covered services and then wait to be reimbursed by their dental plans.
So far the bill has five cosponsors.
Association Tells Senate to Support Antitrust Reform
The ADA asked members of the Senate Judiciary Antitrust Subcommittee last week to support legislation that would eliminate the antitrust exemption for health insurers. Specifically, the Association seeks introduction of a Senate companion to H.R. 911, the bill introduced in the House of Representatives earlier this year by Rep. Paul Gosar (R-Ariz.). The Gosar bill would remove the McCarran-Ferguson Act’s antitrust exemption for health insurers but would specifically exclude other forms of insurance.
The ADA letter to members of the Senate subcommittee is available online at ADA.org.
ADA Welcomes Surgeon General Endorsement of Community Water Fluoridation
U.S. Surgeon General Dr. Regina Benjamin today officially endorsed community water fluoridation as “one of the most effective choices communities can make to prevent health problems while actually improving the oral health of their citizens."
Dr. Benjamin made her endorsement in a letter sent to the National Oral Health Conference being held this week in Huntsville, Ala. Attendees heard the letter read aloud at the conference opening ceremony this morning.
"Fluoridation’s effectiveness in preventing tooth decay is not limited to children, but extends throughout life, resulting in fewer and less severe cavities,” Dr. Benjamin said. “In fact, each generation born since the implementation of water fluoridation has enjoyed better dental health than the generation that preceded it.”
Every surgeon general for the past 50 years has endorsed community water fluoridation of community water supplies as a safe and effective weapon in the war against tooth decay. The American Dental Association has supported fluoridation since 1950.
The ADA's policies regarding community water fluoridation are based on the best available science showing that fluoridation is a safe, effective way to prevent dental decay. The ADA, along with state and local dental societies, continues to work with federal, state and local agencies to increase the number of communities benefiting from this very effective public health measure.
Dr. Benjamin’s letter to the National Oral Health Conference is available online at ADA.org.
Paul Gosar Seeks Support for Bill Repealing Insurance Antitrust Exemption
Rep. Paul Gosar (R-Ariz.) last week formally asked his congressional colleagues to support H.R. 911, his legislation that would repeal provisions in the McCarran-Ferguson Act that grant antitrust law immunity to health insurance companies.
“After over 60 years, it is apparent that the exemption created by Congress in 1945 was not wise,” Rep. Gosar wrote in a “dear colleague” letter.
“There was no evidence then, nor any today, that supports the unique treatment of the health insurance industry by exempting that industry from federal anti-trust laws.,” he wrote.
“This partial repeal of McCarran-Ferguson recognizes that the historical practice of exempting the health insurance industry from the full application of the federal anti-competition laws has had a deleterious impact on consumers in the form of artificially higher premiums, unfair insurance restrictions and harmful policy exclusions.”
Rep. Gosar introduced his “Competitive Health Insurance Reform Act” on Feb. 28 and it was referred to the House Judiciary Committee for consideration. The ADA is working to secure cosponsors for the bill.
ADA Supports Medical Malpractice Legislation
On March 29, the ADA sent a letter of support to Rep. Phil Gingrey (R-Ga.) for the “Standard of Care Protection Act” that he plans to introduce soon. The bill would ensure that federal health care laws would not establish national standards of care for health care professionals in medical malpractice cases. The legislation also would preserve state laws governing medical profession liability cases.
With the health care system adopting new measures for quality control and efficiencies of care, the ADA believes that this bill is necessary to prevent additional liability exposure for health care professionals. This protection would also be important as federal agencies continue to issue new guidance and rules implementing the Patient Protection and Affordable Care Act and other federal laws, such as Medicare and Medicaid.
CMS to Begin Enforcement of Medicare Ordering/Referring Requirement
The Centers for Medicare and Medicaid Services (CMS) recently announced that on May 1 the agency would begin enforcing an Affordable Care Act requirement that doctors must enroll in Medicare or opt out of the program if they order or certify Medicare-covered imaging services, clinical laboratory services or durable medical equipment, or home health services. Over the past two years CMS has delayed implementation of the requirement, about which the ADA and other organizations have raised concerns.
The ADA argued successfully to CMS for modification of the proposed requirement so that dentists referring Medicare patients to other health care professionals — e.g., oral surgeons — would not have to enroll or formally opt out of Medicare.
However, dentists ordering clinical laboratory or imaging services must either enroll or opt out in order for providers of those services to be reimbursed. The ADA has provided information to its members who believe they need to either enroll in or opt out of Medicare. As urged by the ADA, CMS developed a simplified enrollment form for use by doctors who enroll in Medicare solely to order and certify and who do not provide Medicare covered services.
One Step Closer to Medical Device Tax Repeal (But Miles to Go)
The Senate last Thursday approved by a vote of 79 to 20 an amendment to the budget resolution that paves the way for a repeal of the 2.3-percent tax on medical devices. The vote was largely symbolic, serving to put members on record in support of, or opposed to, repeal. Budget resolutions serve as roadmaps for crafting a fiscal year budget and do not have the force of law.
The amendment that passed last week urges the Senate Budget Committee to explore ways to offset the $30 billion cost that repealing the device tax would incur. Sens. Orrin Hatch (R-Utah) and Amy Klobuchar (D-Minn.) introduced the measure.
The Congressional Research Service quoted Sen. Hatch as saying, “Today’s action shows there is strong bipartisan support for repealing the medical device tax.”
The excise tax took effect at the beginning of 2013 as part of the Affordable Care Act. The ADA opposes the tax and has called for its repeal. At least three bills in Congress would do just that, but they do not include budgetary offsets, making their passage highly unlikely.
ADA Testimony Outlines Association’s Oral Health Requests for Indian Health Service Programs
Increases in Indian Health Service (IHS) funding and dentist recruitment efforts have led to demonstrable improvements in the oral health of Native children, said Dr. Henry Fields, chairman of the American Dental Association Council on Government Affairs, speaking before members of the House of Representatives last week. “In the 1990s the budget for the IHS Division of Oral Health was $65 million; today it is more than $159 million,” he said. He noted that funding has resulted in improvements in oral health care but added, “We also know more needs to be done.”
Testifying before the House Interior Subcommittee on Appropriations, Dr. Fields told lawmakers that a greater focus on recruiting more dentists has led to higher rates of utilization for Native patients, both adults and children. “Of course, more dentists mean more dental care,” he said, pointing out that the number of dentist vacancies in the IHS workforce has decreased significantly since 2009—from 140 to 40—largely thanks to Congress’s attention to funding needs.
Dr. Fields laid out the ADA's position on several IHS issues, including:
• The need for a report by the IHS Division of Oral Health showing how giving the agency the same direct hiring authority as other health disciplines could enhance recruitment.
• Adding $300,000 to the IHS budget to pay for the division’s Early Childhood Caries Initiative, a new program designed to promote prevention of and early intervention in tooth decay in young children.
Dr. Fields said that the ADA and several state dental societies whose jurisdictions include Indian Country have joined forces to advance oral health through the Native American Oral Health Care Project. The project emphasizes prevention programs, better access to dentures for elders and the creation of an educational pipeline to help more Native Americans enter careers in dentistry.
New Law Allows States to Incorporate Dentistry in Emergency Response Plans
President Obama last night signed a new law clarifying that dentists may be considered disaster response public health responders to disasters or other public health emergencies has drawn to a close. The president’s action brings to a close a two-year effort by the American Dental Association to include the language in the Pandemic and All-Hazards Preparedness Reauthorization Act (PAHPA). Congress passed the measure earlier this month. The law also clarifies that dental schools are eligible to receive federal funds to train public health and medical response workers.
The reauthorization will ensure that programs created almost 10 years ago to help the government manage medical responses to natural disasters and other emergencies will remain in place. The reauthorizing law contains language that includes dentistry in the response framework, taking advantage of dentists’ extensive education, training and professionalism.
The new language does not mandate participation by dentists, but allows states, at their option, to incorporate dentists and dental facilities into their planning.
Gosar Bill Would Remove Insurance Industry’s Antitrust Exemption
Dentist congressman Paul Gosar (R-Ariz.) last week introduced his antitrust bill. H.R. 911, would repeal those portions of the McCarran-Ferguson statute that exempt medical health insurance plans and dental benefit plans from federal antitrust laws. The ADA will work in the coming months to build bipartisan support for the measure.
What Budget Sequestration Means for Dental Programs
The automatic budget cuts, or sequestration, that went into effect March 1 as a result of the failure of the president and Congress to compromise on ways to reduce the deficit will affect all discretionary funding. That is, all money used to pay for non-entitlement programs, from the Food and Drug Administration, the National Park Service and the Defense Department.
Federal dental programs are not immune.
The automatic 5.1 percent sequestration cut will reduce dental funding by more than $29 million overall. This figure may be no more than “budget dust” in Capitol Hill parlance, but it will amount to a real hardship for dental programs that have to fight every year just to maintain the funding they had the year before.
Here is how some key programs will be affected:
- The National Institute of Dental and Craniofacial Research will take the biggest hit, losing up to $21 million. Research and oral health researcher training programs will suffer disruptions.
- Sequestration will lead to a reduction in the number of federal dental residencies that provide vital support for postdoctoral training in general, pediatric and public health dentistry and deliver clinical care in facilities for the underserved.
- The Ryan White Dental Reimbursement Program, which helps fund the training of dental professionals and provides care to more than 37,000 HIV-positive patients, will lose a substantial amount of its $13 million annual budget.
- The Centers for Disease Control and Prevention’s Division of Oral Health will have to cut back on its activities, including its support for oral health preventive programs in 20 states.
- The Indian Health Service dental program, which has never been adequately funded, will lose as much as $8 million, seriously constricting the agency’s ability to hire dental specialists.
- Reductions in funds for military dental research will reduce the Army’s ability to research ways to prevent and treat head, neck and facial injuries at a time when more than 26 percent of all battle injuries are to the craniofacial region.
In a Feb. 27 letter to members of Congress, ADA President Robert Faiella, DMD, and Executive Director Kathleen O’Loughlin, DMD, asked lawmakers to work hard to avoid the across-the-board budget cuts that will severely affect dental programs. The ADA will continue to lobby Congress to ensure that when working on budget deals to address the crisis lawmakers keep in mind the critical needs of the underserved and military personnel who rely on these dental programs.
Pandemic Bill Passes Senate, Would Include Dentistry in Emergency Response Plans
The Senate unanimously passed legislation this week that would give official recognition to dentists and other dental professionals as emergency responders in responding to large-scale emergencies. The ADA-backed dental responder legislation would not, however, mandate participation by dentists.
The bill (H.R. 307) would reauthorize a set of programs created almost 10 years ago by the Project BioShield Act and the Pandemic and All-Hazards Preparedness Act. These programs help the government manage medical responses to natural disasters and other emergencies. They also provide preparedness grants to state and local health departments. Rep. Mike Rogers (R-Mich.) introduced H.R. 307 in early January and it passed the House on Jan. 22 by a vote of 395 to 29.
Because the Senate version contains amendments not found in the original, it now goes back to the House for final passage, which is likely to occur soon, and delivery to the president for his signature.
Obama Administration Releases Final Rule on ACA Essential Health Benefits
The Department of Health and Human Services (HHS) last week issued its long-awaited final rule on the Affordable Care Act’s essential health benefits requirement. The rule also addressed rules regarding the actuarial value of participating health plans and how those plans will be accredited.
The important provisions of the rule include the following:
- Any consumer (including those with dependents) may purchase a qualified health plan (medical) in the exchange that does not cover the pediatric dental essential health benefit (EHB) without purchasing a stand-alone dental plan. So, according to HHS, there is no mandate to purchase the pediatric dental EHB in the exchange. States that are running their own exchanges, however, will likely make the call on this. Even states that are letting the federal government set up their exchanges might have latitude to fix this oversight. The question is: will the states act in the best interest of pediatric oral health? The ADA will hold a conference call with state dental association executive directors on March 1. The purpose of the call is to determine next steps at the state level.
- In contrast to HHS’s decision regarding plans within the exchanges, the rule requires that everyone purchasing health care in the individual and small group market outside the exchanges must purchase the pediatric dental EHB.
- To the extent that accreditation standards for stand-alone dental plans do not exist, such plans will not be required to meet the accreditation requirement or timeline outlined for QHPs. (ADA staff have scheduled a call with HHS to discuss accreditation issues.)
The ADA has prepared a full summary of the HHS rule on EHBs, actuarial values of health plans and accreditation issues, which is available at ADA.org.
Congressmen Ask Colleagues to Repeal Medical Device Tax
Reps. Erik Paulsen (R-Minn.), Ron Kind (D-Wis.) last week urged their fellow members of the House of Representatives to consider repealing the medical device tax enacted this year as part of the Affordable Care Act. Reps. Paulsen and Kind are seeking cosponsors to legislation they plan to introduce soon.
"This legislation repeals the nearly $30 billion medical device tax from the Affordable Care Act,” they state in their letter. “Members don’t have to agree on the merits of health care reform to find common ground in the need to promote American innovation and protect American manufacturing and R&D jobs.”
In the Senate, Sen. Orrin Hatch (R-Utah.), ranking member of the Finance Committee, introduced similar legislation(S. 232) this week.
The American Dental Association opposed the tax when it was first considered and has lobbied for its repeal ever since.
Pandemic Bill, with New Dental Language, Moves a Step Closer to Passage
The Senate Health, Education, Labor and Pensions Committee will mark up legislation reauthorizing and updating the 2006 Pandemic and All-Hazards Preparedness Act (PAHPA, PL 109-417) on Feb. 13.
The bill, H.R. 307, would encourage state and local officials to involve dentists in their planning for large-scale emergencies. The ADA-backed dental responder legislation would not, however, mandate participation by dentists.
It is likely that the legislation, which passed the House last month, will make it to the president’s desk for his signature sometime in the next few months.
Pandemic Bill Passes House, Would Include Dentistry in Emergency Response Plans
The House of Representatives last week passed legislation that would give official recognition to dentists and other dental professionals in government plans to deal with large-scale emergencies such as pandemics, terrorist attacks and natural disasters. The ADA-backed dental responder legislation would not, however, mandate participation by dentists.
H.R. 307 would reauthorize the federal government’s pandemic medical disaster and emergency response programs. Rep. Mike Rogers (R-Mich.) introduced the bill earlier this month. It passed Jan. 22 by a vote of 395 to 29. It will next be considered in the Senate, by the Health, Education, Labor and Pensions Committee. The outlook for this legislation in the Senate looks good.
Wrap-Up Report on the Final Months of 2012
The partisan gridlock that affected most of the activity in the 112th Congress solidified at the end of 2012, ensuring that legislative results in the waning months would be anemic. The 2012 elections only added to the congressional inertia. Given that situation, the Washington Office is pleased to have seen as many victories as it did.
Health Care Reform: Health care reform implementation continues to take up much staff time. Communicating developments to constituent societies and the full membership remains a priority. Staff has stressed the importance of knowing exactly how health care reform affects, or will affect, the practice of dentistry. Of course, the Association is actively attempting to shape health care reform as it is implemented.
In comments to HHS, the ADA identified four main goals that it believes the agency should stress with state officials as they move forward in implementing their health insurance exchanges and develop the benefit plans those exchanges will offer to individuals and small businesses.
In another set of comments (jointly sent with the American Academy of Pediatric Dentistry) the ADA reiterated its position that plan transparency (on price, benefits, consumer protections and provider network adequacy) is a critical component to the establishment of “multi-state” plans (MSPs) in the health insurance exchanges. These are plans that will be offered in more than one state and must offer a uniform benefit package and include the essential benefits required by the law. Each exchange must contain at least two MSPs.
Working with the National Association of Dental Plans, the ADA helped organize Senate support for a letter from 17 Democratic senators to HHS Secretary Kathleen Sebelius urging her to clarify some important points regarding pediatric coverage and stand-alone dental plans.
Taxes: ADA dentists set a high-water mark recently when more than 8,000 of them sent nearly 17,000 emails to Capitol Hill seeking a repeal of the 2.3-percent medical device tax. In addition to its own grassroots efforts, the ADA joined forces with more than 700 other health care organizations, including dental manufacturers and laboratories, in supporting repeal of the new tax, a provision in the ACA. Communications on this issue have been robust, including a primer on the tax and what it will mean for dentists. By the close of 2012, lawmakers took no action on repeal but some believe that this might change in the 113th Congress.
Call to Action: Government and Public Affairs staff continues to work on the Call to Action. The new thrust (at the president-elect’s conference as well as council meetings) will be to have the volunteers take the initiatives home with them and work to have them implemented.
The community dental health coordinator (CDHC) program has taken a big step forward in New Mexico, where a CDHC will contract with a health center in Farmington for three to six months. The ADA is working with the New Mexico Dental Association and San Juan Community College to initiate a CDHC training there in conjunction with Rio Salado College.
Fluoridation: Despite the best efforts of the anti-fluoridationists (who have scored some victories), the ADA believes the tide is turning on the fluoridation front. The Pinellas County Commission voted 6-1 Nov. 27 to reinstate fluoridation to its 700,000 residents served by county water. The commission listened to three hours of public testimony for and against fluoridation before voting. The county expects to be fluoridating again by March 1, 2013.
In the States: State Government Affairs assisted two states in fending off midlevel provider legislation in the last quarter of 2012: California and Michigan.
America's Leading Advocate for Oral Health
The voice of the dental profession