2. 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.
3. The ADA’s three main goals with HCR:
Fix Medicaid
Improve Oral Health Prevention and
Wellness
Rebuild the Public Health
Infrastructure
4. 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.
5. 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.
6. 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.
7. 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.
8. 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.
9. 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.
10. 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.
11. 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.
12. 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.
13. Other Provisions in the Bill:
Businesses with less than 50
employees are not required to provide
medical coverage.
14. Other Provisions in the Bill:
State Health Plan Exchanges and an
individual mandate to buy health
insurance takes effect in 2014.
15. Other Provisions in the Bill:
Stand alone dental plans are
permitted in the State Health Plan
Exchanges.
16. Other Provisions in the Bill:
QHP’s must include a pediatric oral
care provision to the age of 21.
17. Other Provisions in the Bill:
Health Care Savings Accounts (HAS)
will be limited to $2500 by 2013.
18. 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”
19. Where do we go from here with
the ADA’s Lobbying efforts?
20. 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.
21. 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.
22. 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.
23. Red Flags Rule
HR 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.
24. 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 .
25. 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.
26. 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.
27. HR 5000 ERISA Provisions
Prohibit insurance companies from
dictating fees on non covered services.
Prohibit down coding.
Prohibit bundling of services.
28. 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.
