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ADA urges committee to support Ensuring Lasting Smiles Act

HR 1379 requires medically necessary dental procedures be covered for those with congenital anomalies

September 10, 2020

By Jennifer Garvin

Washington — The ADA is asking Congress to pass legislation that would require all private group and individual health plans to cover medically necessary services, including those needed to address craniofacial abnormalities resulting from a congenital anomaly or birth defect.

In a Sept. 8 letter sent to leaders of the House Committee on Energy and Commerce, ADA President Chad P. Gehani and Executive Director Kathleen T. O’Loughlin said the Association “strongly supports” HR 1379, the Ensuring Lasting Smiles Act. The committee favorably reported the legislation on Sept. 9 and the bill now heads to the full House of Representatives.

“This legislation is crucial to ensure that children suffering from congenital anomalies and birth defects are able to receive the treatment they need,” wrote Drs. Gehani and O’Loughlin, noting that “one in every 33 children in the United States is born with a congenital anomaly or birth defect that affects the way they look, develop or function.”

Drs. Gehani and O’Loughlin told the committee that many of these congenital anomalies include severe oral and facial defects such as cleft lip or palate, skeletal and maxillofacial deformities, hypodontia and enamel hypoplasia.

“These anomalies can interfere with a child’s ability to breathe, speak and/or eat in a normal manner,” they wrote. “Specialized surgery is needed to correct these anomalies. These procedures are reconstructive in nature and are performed to correct abnormal structures of the body.”

They pointed out that despite this, “many insurance companies consider these services to be cosmetic, and while they may cover the preliminary surgeries, they will delay or deny follow-up or corrective procedures, including dental work related to the anomaly. This can further delay a child’s developmental milestones.”

“Passage of HR 1379 would help patients with craniofacial anomalies, and would also ensure they have the necessary coverage to restore their ability to function. On behalf of our members and their patients, we would like to thank you for considering this important legislation,” the letter concluded.

For more information about the ADA's advocacy efforts, visit ADA.org/advocacy.