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Health exchanges

Coalition seeks dental input at state level

Washington—The health insurance exchanges scheduled to open for business in 2014 should maximize competition among dental plans and assure transparency in benefits information, a coalition of national dental organizations will tell the Obama administration, which is writing rules for employers, insurers and the states.

My practice, my patients and the health insurance exchange

Beginning in 2014 your state will have an exchange to facilitate the purchase of health insurance, unless the U.S. Supreme Court overturns the 2010 health reform law.

Access will be limited in a participating plan’s first few years to businesses with fewer than 100 employees, which may offer you an opportunity to purchase coverage for yourself and your employees or to continue coverage at competitive rates. Individuals without coverage will also have access and some may be or become your patients.

Your patients may come to you with questions about coverage through the exchange. Which plan is best for me, doctor? Of course, those answers are not available now.

You will have questions, too. What do the participating plans offer? What are their reimbursement policies? Your Association will keep you informed as the new exchanges take shape.

Think of the exchange as a new marketplace organized to encourage plan competition. Every state must have one or participate in a regional exchange.

If the state doesn’t set up the exchange, the federal government will. Some states will have more than one.

The ADA is working to see that every exchange offers a number of dental plans for patient choice.

Here’s how the rule-crafting regulatory agency put it, “These state-based, competitive marketplaces, which launch in 2014, will provide millions of Americans and small businesses with ‘one-stop shopping’ for affordable coverage. They will also provide the sole venue where members of Congress will get their health insurance.”

Asserting a professional voice in a process that has little public resonance to date, the coalition will urge state and federal officials to engage state dental societies in the “early development” of the exchanges and as advisers on patient protections, access to care and other matters. The administration’s July 15 proposed rule would implement the 2010 health reform law provision for establishing “Affordable Insurance Exchanges.”

“We have asked our members to reach out to relevant state officials,” says the Organized Dentistry Coalition’s response to the administration’s regulatory notice. “We ask that the agency modify section 155.130 (of the proposed rule) to require relevant authorities to include representatives of organized dentistry among the stakeholders they consult in developing an exchange.”

Comments on the proposed rule were due Sept. 28, but the administration extended the deadline to Oct. 31 giving the coalition of specialty and other national dental organizations, including the ADA, additional time to grow the number of supporting groups.

The state-based exchanges are intended to provide “competitive marketplaces for individuals and small employers to directly compare available private health insurance options on the basis of price, quality and other factors.”

The coalition statement offers “suggestions that apply to exchanges affecting both the individual and small business markets” and recommends that:

  • Stand-alone dental plans that participate in exchanges should provide consumers with the same consumer protections and other safeguards and benefits (such as plan transparency) that are available to consumers who purchase their dental coverage through medical plans operating as “qualified health plans” (QHPs) in the exchanges. In addition, we request that the [Department of Health and Human Services] secretary recommend that the exchanges consider additional consumer protections suggested by state dental societies.
  • Stand-alone dental plans should be subject to the same certification requirements as medical plans operating as QHPs in the exchanges except in instances where a criterion is clearly not applicable to stand-alone dental plans, such as accreditation requirements and perhaps actuarial values of coverage requirements.
  • State or federal officials who develop the exchanges should strive to maximize the dental plan choices available to consumers in the exchanges.
  • Dental benefits offered by QHPs and stand-alone dental plans in the exchanges should allow for an “apples-to-apples” comparison so that consumers can easily understand their choices based on price, quality and other factors.
  • State or federal officials who develop the exchange or exchanges in each state must seek input from state dental societies in the early development of the exchanges to help assure consumer-friendly web sites for dental patients.
  • Access to dental health care for special needs individuals with disabilities should be specifically addressed in the exchange design and implementation.
  • Individuals serving as consumer navigators in the exchanges should have a full understanding of the dental coverage options because the dental delivery system is very different from the medical system.

The coalition will address its comments to the Department of Health and Human Services Center for Consumer Information and Insurance Oversight. The HHS, Labor and Treasury Departments are coordinating regulatory guidance on the exchanges for employers, insurers and the states.