current legislative issues update jonathan d. shenkin, dds, mph 1 st vice president, american dental...
TRANSCRIPT
Current Legislative Issues Update
Jonathan D. Shenkin, DDS, MPH
1st Vice President, American Dental Association
Clinical Associate Professor of Health Policy, Health Services Research and Pediatric Dentistry
Boston University
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Disclaimer
The following opinions are my own and do not represent those of the American Dental Association.
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ADA Legislative staff State Issues
State Public Affairs (SPA) program Mid levels Maine Other issues
Federal Issues ADPAC Regulatory-EPA separator mandate Legislative
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American Dental Association
DC and Chicago staff devoted to state and federal issues
DC staff includes 8 lobbyists Chicago office heads state government affairs with 5
active staff members assisting states.
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State Issues
State Public Affairs program (SPA) Mid-level legislation Dental Benefits (Minimum Loss Ratio) Group Practice Regulations
Expanding Dental Board oversight of Corporate practice
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State Public Affairs program
$2.8 million allocated for 2014 Dispersed by an ADA committee of volunteers and
staff Program assists states in need of public affairs
financing and staffing on a broad array of topics. So far this year 23 states have received funds.
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Arizona – Native American program, CDHC; California – Minimum Loss Ratio legislation; Colorado – Workforce, Medicaid, Community Water Fluoridation, ER Referral, RAC
Audits; Connecticut – Workforce and RAC Audits; Florida – Workforce and Action For Dental Health (ADH) implementation; Idaho – Workforce, Medicaid; DC – Workforce; Kansas – Workforce and ADH Implementation; Maine – Workforce and RAC Audits; Michigan – one lump grant for a Community Water Fluoridation project; Missouri – Medicaid, ADH Implementation; Montana – Denturism, Dental Board Structure; RAC Audits; New Hampshire – Workforce and ADH Implementation; New Mexico – Native American, workforce, ADH Implementation including a new
CDHC education program
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North Dakota – Native American and workforce; Pennsylvania – Community Water Fluoridation, amalgam, non-covered
services; Puerto Rico – Mandatory dental exams for school enrollment legislation; Rhode Island – Modifying the Dental Practice Act to provide due process and
guidelines pursuant to Dept. of Health dental office inspections; South Dakota – Native American and CDHC implementation; Vermont – Workforce, Medicaid, Single-payer issues in the state, ADH
Implementation; Virginia – Long-term care pilot implementation/ADH Implementation; Washington – Native American and Workforce; Wisconsin – ADH Implementation, Community Water Fluoridation, Loan
Forgiveness
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Mid-Level Legislation
Maine In the hands of BODEX
Expected states with legislation this year VT, CT, ND, NM, WA, KS, and CO.
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What happened in Maine?
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Aroostook County
Aroostook County 6,829 sq miles71,870 population 10.7/sq miConnecticut 5,543 sq miles3.6 million 739/ sq mi
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Maine’s Oral Health Stats
NOHSS-2012 3rd graders
Untreated decay-14.6% 2nd lowest in nation
Caries experience 32.7% Lowest overall in nation
Sealants 68.5% Highest in the nation
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Access to preventive services for kids with Medicaid is low in Maine.
But decay levels are among lowest in the nation, and access to appropriate treatment appears to be among the best in the nation for children.
Answer should be that we improve availability of basic prevention for children, not more treatment.
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What did Pew do to win?
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AHRQ, 2006
AHRQ 2009
ER use in the US, 2006-09
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ER spending for Dental in Maine
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Number of actively practice dentists in Maine, 1997-2009
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Entities that paid registered lobbyists the most in Maine, 2013
Source: Maine Commission on Governmental Ethics and Election Practices
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California A.B. 1962Medical Loss Ratio Legislation
Some dental plans spend as little as 38% of dental premiums for reimbursement of care
Goal is for 80% of premiums to be used for reimbursement of services
This legislation requires reporting back to the legislature actual percentage spent on dental services, which will enable the legislature to develop a medical loss ratio requirement for dental plans.
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Group Practice Regulation
Washington State v Pacific Dental Complaint filed that PD was practicing dentistry
without a license Also filed a complaint against an owner dentist, stating
that aiding and abetting practice of dentistry without a license
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Small Smiles
Multiple lawsuits filed against dentists Small Smiles bankrupt and had no insurance Insured employed dentists, who are now targets Lawsuit in NY found Small Smiles dentists guilty of
malpractice, but with no financial judgment.
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Federal Issues
ADPAC RAC audits Federal Regulatory Issues Students loans Affordable Care Act Action for Dental Health campaign GME funding
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ADPAC
In 2012 cycle, $3.6 million collected 2nd largest Healthcare PAC after Anesthesiologists. Successfully have kept 2 dentists in Congress and
likely to elect a 3rd in November. Donate now as a student.
http://www.ada.org/en/advocacy/adpac/
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June 22, 2012
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RAC Audits
Mandated under ACA States given great latitude on how they implement
audits Louisiana and CT have passed legislation will limit and
control audit processes Nebraska recently had an ADA member testify before
Congress about RAC audits.
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Federal Regulatory Issues
4 full time lobbyists Full spectrum of federal agencies Rulemaking that impacts infection control to Medicaid
policies Outside of the realm of Congress
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EPA Amalgam Separator Rule
Hearing on November 10th
Will mandate amalgam separators in dental offices Follows ADA best management guidelines Currently only 12 states mandate separators
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Student Loans
Federal Student Loan Refinancing Act S 1066 Enable students to consolidate or refinance Direct Unsubsidized
Stafford Loans at 4%
Student Loan Interest Deduction Act of 2013 HR 1527 Would allow interest deductions and allow them regardless of income
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Affordable Care Act
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Increase in Medicaid since ACA
CMS 2014
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ADH campaign consists of many initiatives such as:
- ER Referral- Community Dental Health Coordinator- Fluoridation- MoMs programs and GKAS- Long-term Care- Medicaid Reforms
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GME funding
Critical in funding of post graduate residencies in dentistry
HRSA is planning on eliminating the funding for Children’s Hospital
Appears DOA
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Title VII
Funds GPR and Pediatric Dental Residencies Senate just included expanded funding for Title VII
funding $9 million will go to each program.
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Conclusions
A constant flow of new and evolving legislation Most issues arise and are solved in the states Being active early in your career is critical Be a part of ADPAC now, and tell a friend Start local
