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'Separate guidance' urged on health reform's pediatric benefit

February 01, 2012

By Craig Palmer, ADA News staff

Washington - Initial guidance is unclear on whether health reform will provide “a comprehensive pediatric oral health benefit that meets the needs of all children, including children with special health care needs,” an eight-organization dental coalition told the Department of Health and Human Services.

HHS, charged with issuing a rule on benefits that must be included in insurance plans offered in state-run exchanges created under the Patient Protection and Affordable Care Act, issued a guidance bulletin Dec. 16, 2011 but has not proposed a regulation. The law specifies ten categories that must be included in the essential benefit package, including a pediatric oral health benefit.

“Our organizations believe that the benchmark plans identified by HHS fall short of finding the proper balance between affordability and ensuring a comprehensive set of pediatric oral health benefits for the EHB package,” the Organized Dentistry Coalition said in Jan. 31 comments on the guidance bulletin.

“The potential for the selection of an inadequate dental benefit embedded in a benchmark plan is simply too great. We believe this problem needs to be remedied and urge HHS to address the pediatric oral health benefit in a separate guidance.”

Comments were offered by the Academy of General Dentistry, American Academy of Oral and Maxillofacial Pathology, American Association of Oral and Maxillofacial Surgeons, American Academy of Pediatric Dentistry, American Academy of Periodontology, American Association of Orthodontists, American Dental Association and Hispanic Dental Association.