National Legislation and Legislation in Other States

Congress

Improving Dental Access for Patients with Disabilities

The ADA showed support for equal access to dental care for all patients and offered several ideas on how Congress can ensure greater health outcomes for people with disabilities by providing accommodations in health care settings and further developing a health care workforce that understands the needs of people with disabilities.

In response to a Congressional request for information on “Disability Policies in the 21st Century: Building Opportunities for Work and Inclusion,” ADA President Cesar R. Sabates, D.D.S., and Executive Director Raymond A. Cohlmia, D.D.S., shared the ADA’s thoughts on how Congress can help the ADA and dentists meet these goals. The ADA leaders asked Congress to expand Section 741 of the Public Health Service Act to include more funding for dentists to make these accommodations and to increase the Disabled Access Credit that dental offices and other small businesses can use to make accommodations for people with disabilities.

The ADA also urged Congress to provide grants for the training and continuing education of dentists on treating patients with disabilities to dental schools, dental residency and fellowship programs, and dental associations like the ADA, American Academy of Pediatric Dentistry, and Special Care Dentistry Association.

Impacts on dentistry: Many dental practices are small businesses and may struggle to pay for the equipment and renovations necessary to see patients with disabilities. The grant funding is needed to help dental offices purchase equipment or to build, renovate, and expand in order to see patients with disabilities. This will help expand access to care for this vulnerable population.

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

MOBILE Health Care Act Passes Congress

In September, the House of Representatives passed the Maximizing Outcomes through Better Investments in Lifesaving Equipment (MOBILE) Health Care Act. This bipartisan legislation supported by the ADA would give community health centers more flexibility in using New Access Points grants for mobile health care units. As an organization dedicated to improving the oral health of the public, the ADA recognizes the critical role that mobile dental units play in bringing care to underserved areas and populations and promoting oral health equity. The legislation also passed the Senate earlier this month and now awaits the President’s signature.

Impacts on dentistry: Passage of this legislation will provide expanded flexibility that would allow health centers to use grant funds in the best way possible to reach underserved communities

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

Partnership for Medicaid Urges Congress to Address Inequities in Medicaid Affecting U.S. territories

The Partnership for Medicaid, of which the ADA is a member, is urging lawmakers to pass legislation addressing the upcoming Medicaid fiscal cliff in Puerto Rico and the U.S. territories. The partnership urged Congress to address the impending Medicaid fiscal cliff in the Sept. 29 letter sent to leaders of the House of Representatives and Senate.

Without Congressional intervention, each territory’s federal medical assistance percentage will be lowered back to 55% in December, harming access to care for millions of Medicaid beneficiaries.

Impacts on dentistry: Due to limitations in the funding statute, the Medicaid program operates differently in the U.S. territories compared to those of the states through capped funding and a fixed federal medical assistance percentage. This results in fewer federal dollars supporting the territories, which affects the financial viability of their Medicaid programs, including dental.

[Contact: David Linn 202-789-5170 or linnd@ada.org]

Federal Agencies

The American Academy of Pediatric Dentistry, American Dental Association and American Association of Oral and Maxillofacial Surgeons are urging the Centers for Medicare & Medicaid Services to increase access to dental surgeries in ambulatory surgical centers.

The three organizations are leading a coalition of dental stakeholders in supporting a proposed rule that would increase access to dental surgeries in hospital operating rooms but would like CMS to make sure that ambulatory surgical centers (ASC) are included as well by including a single CDT code on the ambulatory surgical centers Covered Procedures List.

In the comments filed Sept. 13, the AAPD, ADA and AAOMS applauded CMS for taking the first step in addressing the critical lack of operating room access for dental procedures for patients who require general anesthesia but remain concerned that dental rehabilitation and other dental procedures performed in ambulatory surgical centers are not yet eligible for coverage.

Impacts on dentistry: Without access to ASCs, dentists are concerned that the current crisis in OR access for children, the disabled and those with special needs as well as those without timely access to a hospital due to geographic limitations will continue.

[Contact: Roxanne Yaghoubi 202-415-0187 or yaghoubir@ada.org]

ADA Supports Department of Education Efforts to Improve Student Loan Borrowing Terms

The ADA is applauding the U.S. Department of Education’s proposal to eliminate interest capitalization on certain federal student loans and reform the Public Service Loan Forgiveness program. In comments filed Aug. 26, the ADA is largely supportive of the proposals but urged the department to counsel students that its student loan interest proposal would not eliminate interest capitalization for those exiting deferment, but forbearance only. In response to the COVID-19 pandemic, the agency paused loan payments and set interest rates to 0% for eligible federal student loans. That pause has now been extended through Dec. 31.

The ADA also supports the department’s proposal to improve the Public Service Loan Forgiveness program by streamlining the application process and clarifying and expanding the definitions for full-time employment, qualifying employers and qualifying monthly payments.

Impacts on dentistry: These reforms will not eliminate the financial hardship for early career dentists, but they will help offset the unprecedented financial challenges these essential health care providers face at graduation.

[Contact: Robert J. Burns 202-789-5176 or burnsr@ada.org]

ADA, DQA comment on CMS proposed rule on Medicaid, CHIP Core Set

The ADA and Dental Quality Alliance (DQA) submitted joint comments on Sept. 26 in response to the Centers for Medicare & Medicaid Services proposed rule on Mandatory Medicaid and CHIP Core Set Reporting. CMS included three DQA measures into the Core Set of Children’s Health Care Quality Measures for Medicaid and the Children’s Health Insurance Program. The measures included are the Oral Evaluation, Dental Services measure; Prevention: Topical Fluoride for Children measure; and Sealant Receipt on Permanent 1st Molars measure. In addition to supporting the mandatory reporting of the oral health measures in the Child Core Set, the organizations also urged CMS to include oral health measures in the Adult Core Set and require that these measures be reported by the states.

Impacts on dentistry: The ADA and DQA believe that requirements of reporting of these measures in the core set will lead to robust age-appropriate preventive pediatric dental care services.

[Contact: Roxanne Yaghoubi 202-415-0187 or yaghoubir@ada.org]

ADA supports Title VII grants for dental hygienists, assistants

In a Sept. 6 letter to the Health Resources and Services Administration (HRSA), the ADA emphasized its support for Title VII grants for the education and training of dental professionals. The ADA urged the agency to prioritize training programs for hygienists, as well as make dental assistant programs eligible to receive these grants.. ADA President Cesar R. Sabates, D.D.S., and Executive Director Raymond A. Cohlmia, D.D.S., jointly composed the missive addressed to HRSA’s chief dental officer Adam Barefoot, DMD, MPH. The letter follows an Aug. 5 meeting between the ADA and HRSA where the ADA called for a renewed focus on dental workforce issues.

The ADA emphasized that HRSA should prioritize programs for existing professions like dentists, dental hygienists, and dental assistants, rather than divert very limited training funds for expensive new mid-level training programs that have not been effective at improving oral health or increasing access to care.

Impacts on dentistry: ADA Health Policy Institute Economic Outlook and Emerging Issues in Dentistry on the workforce cite difficulties that ADA members report experiencing, including the recruiting and hiring of dental hygienists and assistants.

[Contact: Corey McGee 202-789-5175 or mcgeec@ada.org]

E-Prescribing in Medicare Part D

The ADA submitted comments regarding a CMS proposed rule requiring controlled substances to be prescribed electronically for Medicare Part D beneficiaries. The ADA shared concerns about how CMS can enforce or compel electronic prescribing of controlled substances by prescribers who are not billing under Medicare but who prescribe controlled substances to Medicare Part D or MA-PD beneficiaries. The ADA also offered concerns about publicly disclosing non-compliant prescriber’s names publicly on the CMS website and urged CMS to avoid coercive tactics.

Impacts on dentistry: Dentists who do not participate in Medicare Advantage plans have no practical way of knowing if and when their patients file Medicare Part D or MA-PD claims—much less how many prescription drug claims would have been filed over a given period and should not be penalized.

[Contact: Robert J. Burns 202-789-5176 or burnsr@ada.org]

Proposed rule on Sec. 1557

In a Sept. 23 letter to the U.S. Department of Health and Human Services (HHS) Office for Civil Rights, ADA President Cesar R. Sabates, D.D.S., and Executive Director Raymond A. Cohlmia, D.D.S., explained concern about the effect of proposed Section 1557 requirements on dental offices, especially the regulatory burdens and costs dentists will face if the U.S. Department of Health and Human Services finalizes the requirements of the proposed rule.

The ADA expressed particular concerns about the cost and regulatory burden of the regulation’s requirement that dental offices provide Notices of Availability in the 15 most common languages spoken by Limited English Proficiency individuals in the state or states.

Impacts on dentistry: The proposed effective date of these requirements is only 60 days after publication of the final rule. Many dentists are small businesses that do not have the large staff necessary to familiarize themselves with the Section 1557 requirements and make the changes in a short amount of time and should be given time to comply with any additional regulatory burdens.

[Contact: Roxanne Yaghoubi 202-415-0187 or yaghoubir@ada.org]

Update on Information Blocking & Interoperability

The Office of the National Coordinator for Health Information Technology (ONC) shared a blog post with reminders for dentists and other health care providers about the full implementation of information blocking restrictions starting on October 6. Information blocking requirements now apply to all electronic protected health information in the designated record set (DRS). ONC also shared reminders about exceptions to information blocking prohibitions. ONC experts will host virtual office hours on October 27 from 2-3 PM Eastern to discuss your questions about information sharing and blocking regulations. Register for the Information Sharing event and visit the ADA fact sheet to learn more about complying with information blocking rules and requirements.

Impacts on dentistry: Dentists and practice staff should be aware of new information blocking restrictions in order to ensure they are in full compliance. All dentists who store their patients’ electronic health information should plan to avoid practices that are likely to interfere with information sharing.

[Contact: Corey McGee 202-789-5175 or mcgeec@ada.org]

State News

In 2009, Hawaii chose to limit its dental Medicaid program for adults to emergency-only. The 2023 Executive Supplemental Budget, adopted in July, set aside over $25 million in total funds for the state’s Medicaid program to restore full dental benefits for adults. The funding also is allotted for additional non-dental-specific services such as home and community-based health services and extended post-partum categorical coverage for enrollees.

The American Dental Association and Massachusetts Dental Society are leading the campaign to advance dental insurance reform with ballot question 2 in November. Success in this state means momentum for advancing this reform nationwide, and you can help advocate to make this happen. Visit VoteYESon2forDental.com and consider how your individual contribution will improve access to quality dental care.

[Contact: Paul O'Connor 312-440-2873 or oconnorp@ada.org]