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National Legislation and Legislation in Other States

Congress

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ADA 2018 Lobbying Highlights

McCarran-Ferguson

The American Dental Association (ADA) is pleased that Rep. Peter DeFazio, D-Ore., and Rep. Paul Gosar, R-Ariz., introduced H.R. 1418, the “Competitive Health Insurance Reform Act.” This bipartisan legislation would help encourage more competition in the health insurance marketplace by providing that the full range of federal antitrust law applies to the health insurance industry.
The bill is also co-sponsored by Rep. Warren Davidson, R-Ohio, Rep. Scott DesJarlais, R-Tenn., Rep. John Garamendi, D-Calif., Rep. Raul Grijalva, D-Ariz., Rep. Stephen Lynch, D-Mass., Rep. Gregory Meeks, D-N.Y., Rep. Ralph Norman, R-S.C., and Rep. Ted Yoho, R-Fla.
On February 7, Sen. Steve Daines, R-Mont., and Sen. Patrick Leahy, D-Vt., introduced S. 350, the companion bill to the House’s recently introduced legislation. The ADA applauds this bipartisan effort of Congress to deal with this important issue of health care insurance reform. Mccarren-Furgeson Press release


Funding Requests for Federal Oral Health Programs


The ADA, American Dental Education Association, American Academy of Pediatric Dentistry and American Association for Dental Research are urging Congress to increase funding in 2020 for several programs important to dentistry and oral health.

In letters sent March 27 to the House and Senate Labor, Health and Human Services, Education, and Related Agencies Subcommittee on Appropriations, the four organizations asked lawmakers to prioritize the nation's oral health as they prepare the Labor-HHS-Education-Appropriations bill.

Funding requests included:

$25 million for CDC’s Division of Oral Health.
$40 million for HRSA’s Oral Health Workforce Programs (Including Title VII General and Pediatric Dental Residency Programs).
$40 million for Area Health Education Centers.
$18 million for HRSA’s Ryan White Part F Dental Programs.
$15 million for HRSA’s Health Careers Opportunity Program.
$5.25 million for HRSA’s Maternal Child Health Special Projects of Regional and National Significance program.

The organizations also singled out the Action for Dental Health Act, which became law in 2018. The ADH initiative “will allow CDC’s Division of Oral Health and HRSA to expand their roles in dental disease prevention, education, and continuity of care in underserved communities.”

[Contact: Jennifer Fisher 202-789-5160 fisherj@ada.org]

Student Loan Repayment Reform

The “Resident Education Deferred Interest Act” (H.R. 1554) or REDI Act was introduced in Congress earlier this month.  The bill would allow borrowers to qualify for interest-free deferment on their student loans while serving in medical or dental internship or residency programs. The passage of the bill is an important part of the student loan repayment reform that could save physicians and dentists thousands of dollars in interest. It could also make the concepts of opening practices in underserved areas or enter into faculty or research positions more attractive and affordable to residents.

The ADA along with other supporters sent a letter of endorsement to the five original cosponsors of the bill including Rep. Brian Babin, R-Texas, Rep. Paul Gosar, R-Ariz., and Jeff Van Drew, D-N.J., who are also dentists and ADA members.

[Contact: Megan Mortimer 202-898-2402 or mortimerm@ada.org]

RAISE Act 2019

The ADA and members of the organized dental coalition, led by the American Association of Orthodontists sent a letter of support to Congressional leadership on the Responsible Additions and Increases to Sustain Employee (RAISE) Health Benefits Act of 2019 (S. 503, H.R. 1366).  

The bill would allow for consumers to set aside pretax dollars in flexible spending accounts (FSAs) to pay for healthcare services and items not covered by insurance, such as vision and dental services, doctor copayments, prescription drugs and medical supplies.  The RAISE Act would significantly expand the current flexible spending account annual contribution cap to $5,000. This bill would also allow families with more than two dependents to save an additional $500 a year for each additional dependent.

The coalition also urges legislators in the Senate Committee on Finance and House Committee on Ways and Means to overturn a “use-it-or-lose-it” rule that restricts families from carrying over the full balance in these savings accounts from one year to the next.


Other States

Prior Authorization Payment
Mississippi now prohibits payment denials for services previously authorized unless certain circumstances apply, requires authorization request to be answered within a set amount of time and prohibits recoupment of payment if the insurer erroneously confirmed coverage. Appeals procedures must be established for denials based upon lack of medical necessity; denials must be executed by dentists with specialty experience where needed. Medical necessity based denials must include specific identifying and contact information of the dentist making the adverse determination. Dental consultants may not be employees of the dental service contractor or dental insurer adjudicating the claim(s).

Patient Identification Card-ERISA/Fully Funded Declaration
A new law in Arkansas would require healthcare payers to issue their patient identification cards
with a notation indicating whether the health benefit plan is fully insured or self-funded. The
intent is to clarify which transactions are subject to state law and regulations and which are
exempt from state laws through ERISA preemption.

Provider Network Leasing
A Virginia law enacted last month prohibits leasing without proper notification and disclosures to network dentists and requires contract provisions and fee schedules to remain unchanged when leased. It requires entities gaining access to the network(s) to include provider contact information in their in-network provider directories delivered to enrollees of the insurer. Remittance advice notifications must identify the contract source relied upon to discount a payment.

Non-Covered Services-Establishing/Originating a Law
West Virginia is the 39th state to enact a law that limits insurers’ ability to determine what contracted dentists may charge for non-covered services. Insurers may only set participating dentists’ fees for services that are covered or would be covered if not for defined contractual limitations such as annual maximums.

Non-Covered Services-Amending Existing Law
A new Idaho law ends insurers’ ability to set the fees a contracted dentist may charge for dental services once the patient meets and exceeds twice the annual benefit limit established under their plan. It would require dentists to notify enrollees when they exceed twice the annual maximum; dentists may not charge more than the lowest fee they charge their uninsured patients.

In-Office Dental Plans
A new Arizona law add dentists to the state’s in-office/direct primary care agreement law which exempts these plans from state insurance regulation, establishes patient notification and contract term requirements and prohibits filing claims with insurers for services provided under the in-office care agreement.

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