2010 Legislation and Health Care Reform;

How it will affect dentistry?

This is an overview of the impact HCR and other legislation will have on

dentists as providers and employers.

This includes the “Patient Protection and Affordable Care Act”, signed into

law on March 23, as well as other pertinent legislation and regulations.

The ADA’s three main goals with HCR:

Fix Medicaid

Improve Oral Health Prevention and Wellness

Rebuild the Public Health Infrastructure

Fix Medicaid

Coverage was expanded to 133% of the FPL

However – the final bill did not include dental coverage for Medicaid-eligible

adults and did not include any provisions that would improve the

program.

Improve Oral Health Prevention and Wellness

The final law did a good job on oral health prevention, including sealants

and community water fluoridation programs, a public education

campaign focused on oral health, and grants for research-based caries

management.

Improve Oral Health Prevention and Wellness

It is important that CDC must consult with professional health organizations in establishing a 5 year National Public Education Campaign focused on Oral

Health Care Prevention and Education.

Rebuild the Public Health Infrastructure

The final law also does a good job of improving public health infrastructure; but includes authorization for

alternative dental providers pilot project opposed by the ADA.

Title VII is amended to create a “dental cluster” that supports dental training.

The Title VII “dental cluster”

Provide grants to plan, develop, and operate dental training programs.

Provide grants that will fund financial assistance for dental students and

dentists in these programs.

The Title VII “dental cluster”

Provide grants that will fund financial assistance and loan repayment for

dental faculty.

Provide grants for geriatric education training centers.

The Title VII “dental cluster”

Provide more funding for FQHC’s.

Provide grants to establish school based health center facilities in

schools with large Medicaid and CHIP eligible children.

The Title VII “dental cluster”

Award grants to 15 entities to establish demonstration programs to train

“alternative dental health providers” but the program must be accredited by the Commission on Dental Accreditation or within a dental education program in an

accredited institution.

Other Provisions in the Bill:

The new health care law also amended the Indian Health Care Improvement

Act. In this section, DHATs are limited to Alaska, except DHATs could be permitted in the lower 48 states if

requested by a tribe that is located in a state that already permits DHATs or midlevel providers to practice. This

program would have to adhere to the state’s licensing law.

Other Provisions in the Bill:

Businesses with less than 50 employees are not required to provide

medical coverage.

Other Provisions in the Bill:

State Health Plan Exchanges and an individual mandate to buy health

insurance takes effect in 2014.

Other Provisions in the Bill:

Stand alone dental plans are permitted in the State Health Plan

Exchanges.

Other Provisions in the Bill:

QHP’s must include a pediatric oral care provision to the age of 21.

Other Provisions in the Bill:

Health Care Savings Accounts (HAS) will be limited to $2500 by 2013.

Other Provisions in the Bill:

A tax on indoor tanning services replaced the proposed tax on

“voluntary cosmetic surgery and medical procedures including cosmetic

dentistry”

Where do we go from here with the ADA’s Lobbying efforts?

HCR Implementation --Ensuring Dentistry’s Voice is Heard

The ADA is tracking the activities of eleven commissions and committees established or enhanced by the new health care reform law. They address a wide range of activities, including workforce, quality, and prevention.

Since passage, the ADA has supported legislation to overturn harmful provisions in the new HCR law. For example, repealing the expanded use of IRS Form 1099. We are also working with others in the dental community to fight a possible tax on dental devices.

Beyond HCR – the ADA has a very full legislative and regulatory agenda, such as antitrust and ERISA reform; fixing the dental Medicaid program; improving access to oral health care for the elderly population; supporting numerous annual appropriations for dental training and research.

Red Flags RuleHR 3763 exempts businesses with less

than 20 employees from the requirement of implementing a

“written identity theft program”. This bill passed the House by a vote of

400-0 and could save dentists up to $72 million dollars. We need to get the

Senate to act on this bill before this session ends.

McCarran-Ferguson

A bill passed in 1945 that exempts insurance companies from antitrust laws.

HR 4626 passed the House by a vote of 406-19. We are asking the Senate to repeal this bill which will encourage competition

in the marketplace by allowing greater scrutiny of insurance company practices by

the Federal Trade Commission and the Department of Justice .

ERISA Reform

ERISA makes it very difficult for states to regulate self-funded plans. HR

5000, “The Dental Coverage Value and Transparency Act of 2010”, drafted

and supported by the ADA, will require ALL health plans with a dental benefit

to adhere to a series of value and transparency provisions.

HR 5000 ERISA Provisions

Provide uniform COB up to 100% of the claim.

Require insurance companies to pay the same dollar amount of coverage

on a procedure even if the dentist does not belong to the network.

HR 5000 ERISA Provisions

Prohibit insurance companies from dictating fees on non covered services.

Prohibit down coding.

Prohibit bundling of services.

The ADA Council on Governmental Affairs thanks you for the opportunity

to meet with you and share this information on the advocacy issues

that mean so much to our continued success as a profession.

Questions?