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ADA comments on surprise billing legislation in Senate, House

June 07, 2019

By Jennifer Garvin

Washington — The ADA has submitted comments to the Senate Committee on Health, Education, Labor and Pensions encouraging the committee to focus on transparency in all aspects of health care, including dentistry.

In a June 5 letter to HELP Chair Lamar Alexander, R-Tenn., and Ranking Member Patty Murray, D-Wash., the ADA commended lawmakers on their commitment to improving transparency with the proposed Lower Health Care Costs Act. To do that, the Association urged the committee to support S 350, the Competitive Health Insurance Reform Act, legislation that would empower the Justice Department and Federal Trade Commission to enforce the full range of federal antitrust laws against health insurance companies.

“When health insurance companies are permitted to disregard antitrust principles, prices for patients can go up, coverage can decrease and reimbursement rates do not always keep up with costs,” wrote ADA President Jeffrey M. Cole and Executive Director Kathleen T. O’Loughlin, who noted the ADA has long advocated for McCarran-Ferguson reform.

In addition, the ADA would like the legislation to:

  • Explicitly exclude private dental offices in the definition of a “health care facility.” The bill currently expands the definition to include “any other facility that provides services that are covered under a group health plan or health insurance coverage,” which could include dental offices and which goes beyond the scope of this bill’s focus on emergency services.
  • Revise the provision that prevents anti-steering clauses in contracts between providers and health plans. The ADA strongly believes that patients should be able to use the services of any licensed dentist of their choice and patients should have the freedom to pick their dentist and all legally qualified dentists should be eligible to provide that care.
  • Include dental claims in all-payer claims databases. The ADA supports these databases but is concerned this bill would designate an entity to run a database that would only include medical and pharmacy claims, not dental. Additionally, the ADA believes that the database included in the HELP Committee bill would duplicate the efforts of nearly 30 states that have developed or are already in the process of developing their databases. A federal grant program to incentivize the remaining states would be more efficient than a new entity.
  • Eliminate the 30-day requirement for health care facilities and providers to send bills to patients. “Often, dentists will not know what the final cost to a patient will be until after the insurance company has reviewed and paid the claim, which can take more than 30 days. Additionally, lost mail or other delays could unfairly penalize dentists for factors beyond their control,” Drs. Cole and O’Loughlin wrote.
  • Increase the number of adolescents who receive recommended doses of the human papillomavirus virus vaccine. “We are particularly concerned about the recent surge—in one case up to a 225% increase—in HPV-related oropharyngeal cancer,” wrote Drs. Cole and O’Loughlin. “Increasing the number of adolescents who receive recommended doses of the HPV vaccine would help reverse that trend. Alleviating misplaced fears about vaccines would be a positive step in that direction.”
  • Establish a federal guide on evidence-based obesity prevention and control strategies for state and local health departments, and Indian tribes and tribal organizations. “The ADA supports the findings of a 2015 World Health Organization systematic review finding a moderate degree of consistent evidence about whether dental caries rates fluctuate based on the volume of added sugar(s) consumed. We would like to see additional research in this area. In the meantime, we support WHO’s recommendation to limit added sugar(s) to a maximum of 10 percent of total daily caloric intake.”
  • The ADA supports a Government Accountability Office study on the existing gaps in privacy and security protections for patients using apps that are not covered by HIPAA privacy and security rules.
  • Look at additional instances where patients may be subject to surprise bills such as those resulting from carriers not honoring benefit payments after services were submitted through the prior authorization process.

In a May 24 letter to House Energy and Commerce Chair Frank Pallone, D-N.J., and Ranking Member Greg Walden, R-Ore., the ADA asked the lawmakers to confirm that the No Surprises Act’s definition of a hospital emergency department or an independent freestanding emergency department be consistent with that of the Public Health Service Act’s definition and not be expanded further.

The Association also asked to confirm that the bill’s mention of “health care facility” does not include dental practices and is limited only to the facilities explicitly laid out in the bill.

“These clarifications are necessary for ensuring that patients and providers are able to understand and navigate the health care benefits system,” wrote Drs. Cole and O’Loughlin.

For more information, visit ADA.org/regulatory.