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Advocacy highlights of a busy 2016

December 22, 2016 Washington — From working with federal agencies to developing stronger legislation on opioids and tobacco to urging Congress to re-examine antitrust exemptions to ensuring the importance of dental research, 2016 was a busy year for the Association’s Washington office.

Here are some of the key advocacy issues the ADA tackled in 2016:

For the dental practice:

EPA Final Rule on Amalgam Separators. The Association worked with the U.S. Enviromental Protection Agency to create a final rule on amalgam separators that is consistent with ADA Best Management Practices. The new rule, released Dec. 15, meets the nine principles established by the ADA House of Delegates. The date for compliance for most dentists will be the end of 2019.

Medicare Part D Prescriber Requirement. As the rule stands today, providers who write prescriptions to Medicare beneficiaries with Part D coverage must be enrolled in or opted-out of Medicare Part B prior to January 1, 2019, in order for the prescription to be covered by the beneficiaries’ Part D plans. In 2016, the ADA aggressively advocated to exclude dentists and other health care professionals not participating in Medicare from this requirement with the help of Rep. Kenny Marchant, R-Texas, and Rep. Earl Blumenauer, D-Oregon, through H.R. 4062.  

Section 1557 of the Affordable Care Act. On July 18, compliance began on the Office for Civil Rights final rule on nondiscrimination. While the ADA strongly supports nondiscrimination in health care and equal access to health care for all patients, the Association has commented the rule is “confusing, duplicative and burdensome, as well as unnecessary.” As part of regulatory reform legislation to be considered in 2017, the ADA has proposed that OCR rescind the rule or “simply enforce the regulation as written, which can be done without the promulgation of regulations.” If the regulation is not rescinded, the Association recommends a small business exemption of 25 employees or fewer.

Ordering and Referring (Medicare). As part of regulatory reform legislation to be considered in 2017, the ADA is seeking changes to the rule to exclude dentists who are not participating in Medicare from the Medicare Ordering and Referring requirements.

Substance Abuse and Mental Health Services Administration Recordkeeping/Confidentiality Mandate. The Substance Abuse and Mental Health Services Administration issued a proposed rule on Feb. 9, to expand federal regulations regarding the confidentiality of patient records associated with substance abuse. This expansion could affect dentists who provide screening, brief intervention and referral services. The ADA has asked for a dental exemption and will lobby to have this issue addressed in regulatory reform legislation being considered by Congress in 2017.

Antitrust Reform (McCarran-Ferguson). On April 15, the Senate Judiciary Committee held a hearing on unfair methods of competition. The ADA submitted comments for the record urging committee members to reexamine the antitrust exemption enjoyed by health insurance companies as a result of the 1945 McCarran-Ferguson law. In a Sept. 15 letter to Chairman Rep. Bob Goodlatte, R-Va., Rep. Paul Gosar, R-Ariz., asked that the House Judiciary Committee officially request that the Government Accountability Office study the health insurance industry’s exemption. The ADA also supports inclusion of the provisions of H.R. 494, the Competitive Health Insurance Reform Act, in Affordable Care Act “replace and repeal” legislation in 2017.

Health Reimbursement Arrangements Reinstated. With the signing of the 21st Century Cures Act into law, small businesses are once again permitted to offer ADA-supported Health Reimbursement Arrangements to their employees. HRAs allow small businesses to offer pre-tax dollars to help employees pay for health care coverage premiums and out-of-pocket medical costs. The IRS, pursuant to an interpretation of the ACA, had made stand-alone HRAs illegal.

For the dental profession:

Potential Reduction of Rank for Chief Dental Officers. The ADA has fought for more than a decade to maintain current law which allows the Army and Air Force Dental Corps Chiefs to retain the rank of two-star generals (current law allows the Navy Dental Corps Chief to serve as a one-star). Despite the ADA’s best lobbying efforts, the 2017 Defense Authorization bill’s conference report would allow each branch to determine the rank of the dental corps chiefs (instead of an absolute reduction in rank as sought in 2015).

Appropriations for federal dental programs. Congress passed a stopgap spending bill that will fund the government through April 28. Federal dental programs were funded at current levels.

Indian Health Service Loans Tax Free and Easing Credentialing Obstacles. Rep. Kristi Noem, R-S.D., introduced ADA-supported legislation, “Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act” (H.R. 5406), that makes student loans received from the Indian Health Service Loan Repayment Program tax free. The legislation would also streamline credentialing for dentists wishing to volunteer on Indian reservations and Indian Health Service facilities. Senator John Thune, R-S.D., worked to ensure the credentialing provisions were also included in the package considered by the Senate Indian Affairs Committee (S. 2953) designed to overhaul the IHS.  

Protect Military Dental Research. The ADA successfully defeated a proposal in the Senate to seriously restrict oral health research at military facilities. Such research is critical in maintaining the health and fitness of the Armed Forces and in treating battle wounds.

For patients:

Community Water Fluoridation. According to an April 2016 report from the Centers of Disease Control and Prevention, the 2014 Fluoridation Census shows that as of 2014, 214.2 million people (74.7 percent) in the United States have access to optimally fluoridated water. This is the seventh consecutive increase for the U.S. population on community water supplies, meaning 52.3 million additional people now receive optimally fluoridated water than did in 2000.

FDA Food Labeling Requirements. In May, the Food and Drug Administration finalized new requirements for Nutrition Facts labels, which for the first time will require food manufacturers to declare the amount of added sugars in packaged foods. The new labeling requirements also include a recommendation that consumers limit added sugar intake to less than 10 percent of daily caloric intake. The ADA has lobbied for this change since 2014.

FDA Expands Tobacco Regulation. In May, the Food and Drug Administration issued a final rule that expands the agency’s authority to regulate the latest generation of tobacco products such as electronic cigarettes, e-cigarette cartridges, dissolvable tobacco, tobacco gels, hookah tobacco and other products. The ADA has lobbied for this rule since 2014.

Comprehensive Addiction and Recovery Act. In July, the ADA-supported Comprehensive Addiction and Recovery Act was signed into law. This legislation authorizes a number of activities to help curb the widespread misuse and abuse of prescription opioids. Find out more at ADA.org/opioids.

Older Americans Act. On April 19, the Older Americans Act was signed into law. For the first time, the law allows regional aging agencies to use funds for oral health screenings.

Health Savings Accounts and Flexible Savings Accounts. The ADA and nine other groups in the Organized Dentistry Coalition asked Congress to lift the ACA’s limit on individual contributions to flexible spending accounts. As part of ACA “replace and repeal” legislation in 2017, the ADA will support an expansion of health savings accounts and flexible savings accounts, which will, at a minimum, lift the ACA restrictions.

Dental Chapter in Health Care Report. Rep. Robin Kelly, D-Ill., chair of the Congressional Black Caucus Foundation’s subcommittee on health care, authorized the publication of individual chapters of last year’s report on the state of minority health care, including the chapter on dental health.

For a downloadable PDF, click here.