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National Legislation and Legislation in Other States

Congress

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ADA 2018 Lobbying Highlights

In Congress

DOC Access Act Introduced

On July 15th, Rep. David Loebsack of Iowa and Rep. Earl “Buddy” Carter of Georgia introduced the Dental and Optometric (DOC) Access Act, H.R. 3762, in the House of Representatives. The act would prohibit certain dental and vision plans from setting fees for non-covered services. The bill also would also prohibit these plans from imposing restrictions on medical plan participation and setting limits on a doctor's choice of lab.

Currently, 39 states have passed laws limiting the ways that insurance companies can interfere in terms of fee-setting and the doctor-patient relationship. The DOC Access Act is narrowly drawn to apply only to certain employer-funded dental and vision plans regulated by the federal government. This legislation would not interfere with the states’ abilities to maintain and enforce their own insurance regulations and laws, as well as complement the work already done by most state legislatures across the country.

The ADA strongly supports H.R. 3762, and believes that the DOC Access Act would bring needed balance to contract negotiations between providers, who are often small business owners, and large dental insurance companies. Several dentist members of Congress, including Rep. Mike Simpson of Idaho, Rep. Paul Gosar of Arizona, Rep. Drew Ferguson of Georgia, and Rep. Jeff Van Drew of New Jersey, also served as original cosponsors of this bill. The ADA encourages the passage of the DOC Access Act, as it is time to curb anti-patient and anti-competitive practices of dental insurance plans.

[Contact: Natalie Hales 202-898-2404 or halesn@ada.org]

House Approves Multiple Appropriations Bills

The House has passed 10 out of 12 appropriations bills for Fiscal Year 2020. The Labor, Health and Human Services Appropriations Bill included a $23 million increase for the National Institute of Dental and Craniofacial Research (NIDCR). The bill also included appropriations report language requested by the ADA and other dental groups, including language asking the Health Resources and Services Administration (HRSA) and the Centers for Medicare and Medicaid Services (CMS) to appoint Chief Dental Officers. The Interior Appropriations Bill, included a $23 million increase for the Indian Health Service (IHS) dental programs, as well as report language on the IHS dental support centers and electronic dental records.

Last week, the House approved the Bipartisan Budget Act by a vote of 214-149. The measure raises the spending caps by $321 billion and suspends the debt ceiling until July 2021. The agreement would also cancel automatic cuts that would have reduced domestic spending by $55 billion and military spending by $71 billion compared to 2019. Assuming the budget deal clears the Senate before the August recess, it is expected that the Senate Labor-HHS appropriations subcommittee will aim to markup its FY 2020 spending bill the second week of September.

Fiscal Year 2020 House-approved funding includes:

  • Centers for Disease Control Division of Oral Health: $20 million
  • HRSA Oral Health Training Program: $40 million
  • HRSA Area Health Education Centers: $39 million
  • HRSA Health Careers Opportunity Program: $14 million
  • HRSA Ryan White Dental Part F: $13 million
  • NIDCR: $484 million
  • IHS Dental Program: $227 million
  • Department of Defense Military Dental Research: $10 million

The Senate has not advanced any appropriations bills for Fiscal 2020, which begins Oct. 1, 2019. Senate appropriators have opted to wait until they pass a deal on overall spending levels with the House of Representatives and the White House.

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

ELSA Action Alert

The Ensuring Lasting Smiles Act, (S. 560/H.R. 1379) or ELSA, would help patients with craniofacial anomalies. ELSA would require all private group and individual health plans to cover medically necessary services resulting from a congenital anomaly or birth defect. This legislation is crucial to ensure that children suffering from congenital anomalies and birth defects are able to receive the treatment they need.

This month, in celebration with National Cleft and Craniofacial Awareness Month, the ADA sent action alerts asking dentists to urge your members of Congress to co-sponsor ELSA legislation. Sign up today to get involved with critical public policy issues, and to stay in contact with your legislators.

[Contact: Natalie Hales 202-898-2404 or halesn@ada.org or Peter Aiello 202-789-5168 or aiellop@ada.org]

 


 


 

Federal Agencies

ADA Urges CMS to Better Protect Children’s Dental Health

The ADA, with the support of the American Academy of Pediatric Dentistry (AAPD) and Children’s Dental Health Project (CDHP), urged CMS to “better protect children’s dental health” by not implementing the waiver concepts outlined in the Request for Information on Section 1332 State Relief Empowerment Measures.

In October 2018, CMS announced four 1332 waiver concepts designed to empower states to come up with better health care solutions for their residents. ADA, AAPD and CDHP expressed support in a December 2018 letter for the concept of providing states with more flexibility but also shared their collective concern that the guidance may weaken the Affordable Care Act’s Essential Health Benefits — also known as EHBs. The stakeholders said they were particularly worried that the guidance will weaken the ACA’s comprehensive oral health benefit for children.

The group shared those concerns again in a recent June 28 letter to the agency. The letter pointed out that “under the ACA guardrails in Section 1332, a state’s plan waiver must provide comprehensive health coverage to at least as many residents as would have coverage without the waiver,” noting that the 2018 guidance doesn’t include that protection. The group encouraged the agency to work collaboratively to identify other potential reforms to reduce costs and improve care.

[Contact: Roxanne Yaghoubi 202-789-5179 or yaghoubir@ada.org]

ADA Contacts Federal Agencies About Business Practices & Patient Safety

The American Dental Association sent a complaint letter to the Federal Trade Commission’s (FTC) Bureau of Consumer Protection raising concerns over aspects of SmileDirect Club, L.L.C.’s (SDC) marketing and direct-to-consumer sales of plastic teeth aligners. The letter was sent approximately two months after the ADA filed a citizen’s petition with the U.S. Food and Drug Administration (FDA) in April stating that SmileDirectClub is placing the public at risk by knowingly evading the FDA’s “by prescription only” restriction the agency has placed on teeth aligning materials.

The ADA took these actions out of concern for consumer safety and customer recourse when negative outcomes from this direct to consumer dentistry product occur. For more information, read the ADA’s online news release.

Patients Over Paperwork Request for Information

The ADA provided comments to the Centers for Medicare and Medicaid Services (CMS) on the subject of Reducing Administrative Burden to Put Patients Over Paperwork. The request for information addressed five paperwork intensive administrative activities that have standards-based solutions.

The ADA stressed the importance of a strong patient-dentist relationship as the foundation for ongoing oral health. Paperwork, electronic or otherwise, requires time and resources to compile, complete, file or transmit. The distraction from the delivery of patient care is exacerbated when paperwork and associated administrative activities are proprietary and do not adhere to recognized standards known as HIPAA Administrative Simplification.

Between Medicaid, CHIP and Medicare Advantage, approximately 87.8 million individuals are covered for some oral health services. This volume of patients can be positively impacted were CMS to understand and promote changes to achieve administrative simplifications within the dental care system. The comments offered standards-based solutions to enable efficient and effective administrative processes for dentists in practice.

[Contact: Roxanne Yaghoubi 202-789-5179 or yaghoubir@ada.org]

ADA Asks FCC for Guidance

The ADA alerted the Federal Communications Commission (FCC) that a recent ruling issued to help eliminate illegal robocalls may block calls from legitimate businesses if they use automated calling systems. The ADA expressed concerned to the FCC that new guidance on call-blocking could inadvertently cause consumers to miss out on important calls from their dentists and other health care providers.

Last month, the FCC approved a declaratory ruling to affirm that voice service providers can protect consumers from unwanted robocalls by allowing them to proactively “block unwanted calls based on reasonable call analytics as long as their customers are informed and have the opportunity to opt out of the blocking,” according to an agency news release. The ruling also said that providers may offer their customers the choice to opt-in to tools that block calls from any number that does not appear on their contact list or other so-called “white lists.”

In a letter to FCC Chair Ajit Pai, ADA President Jeffrey M. Cole and Executive Director Kathleen T. O’Loughlin praised the agency for its attention to robocalls but said that calls from dental offices, including automated calls and voice messages, promote oral health by reminding patients to schedule teeth cleaning and other services and asked for clarification on the ruling with these considerations in mind.

[Contact: Roxanne Yaghoubi 202-789-5179 or yaghoubir@ada.org or Natalie Hales 202-898-2404 or halesn@ada.org]

 

Other States

New Hampshire enacted HB 692, entitled Adult Dental Benefit; Development of Plan.  The law calls for a comprehensive plan for the implementation of a Medicaid adult dental benefit.  The plan must be a value-based care platform, defined as a model where providers are paid based on making positive health outcomes while reducing costs.  The inclusion of a fee-for-service model in the plan is prohibited.  A report is due October 1, 2019.


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