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ADA asks Congress to pass Ensuring Lasting Smiles Act

Bill requires private health plans to cover medically necessary services

January 09, 2020

By Jennifer Garvin

Washington — The American Dental Association is asking Congress to pass the Ensuring Lasting Smiles Act — legislation that would require all private group and individual health plans to cover medically necessary services that repair or restore congenital anomalies.

In a Jan. 6 letter to Health Subcommittee Committee on Energy and Commerce Chair Anna G. Eshoo, D-Calif., and Ranking Member Michael C. Burgess, R-Texas, ADA President Chad P. Gehani and Executive Director Kathleen T. O’Loughlin told lawmakers that HR 1379, known as ELSA, would positively impact the quality of life for patients with congenital anomalies and also eliminate the existing burdens that prevent access to necessary diagnosis and treatment. The Association sent the letter ahead of the committee’s Jan. 8 hearing, Legislation to Improve Americans' Health Care Coverage and Outcomes.

“We appreciate your leadership in recognizing the importance of ensuring access to the care and services necessary to improve or restore body function or approximate a normal appearance due to a congenital anomaly, such as cleft lip and palate, skeletal and maxillofacial abnormalities, facial paralysis, microtia, hypodontia, and craniosynostosis,” wrote Drs. Gehani and O’Loughlin.

The ADA also joined forces with 15 other health care organizations urging the legislators to pass the bill, which currently has 266 bipartisan cosponsors in the House.

In the letter to Energy and Commerce, the Association noted that the Centers for Disease Control and Prevention classifies birth defects as “common, costly, and critical” and reports that one in 33 newborns in the United States is born with a congenital anomaly.

“Craniofacial anomalies, for example, can restrict a patient’s ability to breathe, eat and speak in a normal manner,” Drs. Gehani and O’Loughlin said. “Therefore, highly personalized surgery to repair an anomaly helps the patient grow and function normally. Early intervention by a team of specialists, including plastic surgeons, oral and maxillofacial surgeons, pediatric dentists, orthodontists, dermatologists, and speech therapists, is necessary to assess and oversee the patient’s treatment and development, sometimes over the course of several years.”

The ADA also said that while many private health insurance companies cover preliminary procedures, they “routinely deny or delay follow-up or corrective procedures claiming that they are cosmetic in nature — which fails to recognize the medical conditions of these patients.”

“Delays in medically necessary care can negatively impact a child’s developmental milestones and coverage denials of a child’s reconstructive surgery, can result in families turning to Medicaid, the State Children's Health Insurance Program, or other safety net programs for coverage,” the letter concluded.

Follow all of the ADA’s advocacy efforts at ADA.org/advocacy.