Advocacy From The ADA

For over a year I’ve had the privilege of being a member of the ADA’s Council of Government Affairs. During that time I’ve been privy to the ADA’s advocacy efforts on a national level. I’ll attempt to list a small portion of what the ADA has done during my time on the council.

Massachusetts Ballot Initiative

The ADA authorized a significant contribution to a statewide ballot initiative—Question 2 in Massachusetts—which could mark a significant change for dental insurance across the country. In doing so, the ADA took a decisive stand on behalf of dentists, dental team members, and patients and shining a light on a practice that has gone on for far too long—dental insurance companies pocketing premium dollars from patients with no requirement to provide a minimum percentage of those dollars in actual patient care. Dental insurance is one of the most frustrating issues for dentists nationwide. And as doctors, dentists want their patients to get the most value possible for the dental insurance premiums they pay. This issue has national implications— the win in Massachusetts will set the stage for future dental insurance reform nationwide.

Question 2 in Massachusetts requires dental insurance companies to spend at least 83% of premium dollars collected on dental services or refund the difference to patients, as opposed to insurance companies using the money for executive salaries or other administrative costs. This type of percentage requirement—called a medical loss ratio (MLR)—is already in effect in Massachusetts for medical health insurance. The passing of this ballot initiative established the same type of requirement for dental insurance in that state as well. The ADA, UDA, and most state Dental Societies along with individual dentists across the country joined with the Massachusetts Dental Society to donate almost $10 million to help support this measure. The public realized that voting yes on Question 2 will hold the dental insurance companies accountable when it comes to the hard earned dollars patients have paid in premiums. Dental plans should serve patients first and foremost, and the companies that offer them should welcome transparency and accountability, which is what voting yes on Question 2 accomplished. The win in Massachusetts will spur future advocacy in other states. This ballot initiative has national implications.

Lobbying Efforts

With guidance from CGA, the ADA’s Congressional and Regulatory teams lobby the federal government on issues of interest to the ADA. This lobbying is focused around supporting legislation and regulations that increase the value of ADA membership and reflect the values of ADA members. Recent highlights of this advocacy include the following:

Medicare Medically Necessary Dental Care

The Centers for Medicare and Medicaid Services (CMS) invited comment by September 7 on its 2023 Medicare Physician Fee Schedule proposed rule, which includes proposals on a targeted expansion of Medicare to cover dental care deemed medically necessary prior to procedures such as organ transplants, cardiac valve replacements, and valvuloplasty. The ADA said that it largely supports CMS’s targeted expansion; yet the ADA also wants CMS to address issues related to the administration and reimbursement of the benefits in Part B especially as they may be rendered in out-patient settings. The ADA’s concerns include the fee schedule, claims submission, coding, and ensuring an adequate network of dentists to treat Medicare patients. The CMS proposal asks commenters to share their opinion as to whether Medicare dental coverage for conditions such as diabetes is warranted given the emerging evidence for improved health outcomes. It is important to note that the current proposal does not expand Medicare to cover dental services for patients with clinical conditions such as diabetes. The ADA acknowledged the evidence but sought clarity from CMS on the cost and financing mechanisms for such a broader benefit expansion. This clarity is of the utmost importance before the ADA can determine the viability of potential future Medicare expansion proposals beyond the current, targeted proposed expansion.

Medicare Advantage

The ADA sent suggestions to CMS on improving Medicare Advantage (MA) plans and their dental benefits to provide value and transparency for dentists and their patients.

McCarran-Ferguson Reform

At the request of the ADA, five bipartisan members of the House of Representatives sent a letter to the Department of Justice (DOJ) to ask for information on how the DOJ is enforcing McCarran-Ferguson reform and examining anticompetitive activities by health insurance companies. Ensuring that the DOJ investigates the anti-competitive activities of health insurance companies would help with dental insurance reform and provide value to dentists.

Dental Team Workforce Shortages

Given the ongoing shortages of hygienists and assistants, the ADA sent a letter on September 6 to the Health Resources and Services Administration (HRSA) that emphasized the ADA’s support for Title VII grants for the education and training of hygienists, and urged HRSA to make dental assistant programs eligible for these grants.

In response to a report from the HRSA Advisory Committee on Training in Primary Care Medicine and Dentistry that recommended that Congress include dental therapy programs in Title VII, the ADA urged HRSA to prioritize training for hygienists and assistants rather than fund expensive and unproven new programs.

Operating Room Access

The ADA has been working with the American Academy of Pediatric Dentistry (AAPD) and the American Association of Oral and Maxillofacial Surgeons (AAOMS) to ask CMS to increase operating room access for dental surgeries on young children and people with special needs and disabilities. Hospitals and ambulatory surgical centers are booking surgeries with a higher reimbursement rate and denying access to dentists and their patients. In July, CMS issued a proposed rule that would increase the facility fee for dental surgeries in hospital operating rooms from $203.64 to $1958.92. The ADA, AAPD, and AAOMS are continuing to ask CMS to increase the facility fee for dental surgeries in ambulatory surgical centers. Twenty bipartisan members of Congress also sent CMS a letter at the dental groups’ request in regard to dental surgeries in ambulatory surgical centers.

Student Loan Reform

To support dental students and new dentists and provide value to them, the ADA sent out a grassroots action alert that asked ADA members to contact Congress in support of several student loan reform bills. The grassroots alert resulted in over 6,000 emails from ADA members being sent to Congress. The ADA also commented to the Department of Education on a proposal to eliminate the interest capitalization on certain federal student loans and reform the Public Service Loan Forgiveness program.

Medicaid

To support the values of ADA dentists, including the values of health equity and providing care to the underserved, the ADA has been advocating for the Medicaid Dental Benefit Act, which would mandate comprehensive adult dental Medicaid benefits in every state. Currently, less than half the states provide these benefits to adults.

As part of the advocacy on this bill, the ADA hosted a Capitol Hill briefing on “Making the Case for Dental Coverage for Adults in All State Medicaid Programs.” ● The ADA also led a coalition letter to Congress in support of the Medicaid Dental Benefit Act.

● Additionally, the ADA continues to work with Rep. Mike

Simpson (R-ID) on introducing a bill that would reduce administrative burdens in Medicaid, which would also increase the value for ADA members. private group and individual health plans to cover medically necessary services resulting from a congenital anomaly or birth defect. These services would include inpatient and outpatient care and reconstructive services and procedures, as well as adjunctive, dental, orthodontic, or prosthodontic support. Insurance coverage of these services would provide value to dentists who provide them, and it would also align with the ADA’s values.

● In April, ELSA passed the House of Representatives. The bill currently has 42 bipartisan Senate cosponsors. Non-Covered Services

● The ADA has been working to prevent dental insurers from dictating fees a participating dentist may charge for noncovered services.

● The Dental and Optometric Care (DOC) Access Act continues to gain support in the House of Representatives and Senate.

If passed, this bill would provide value to dentists who are struggling with insurer mandates.

Mobile Dental Units

Another values related issue is that the ADA is supporting legislation to expand the ways health centers are permitted to use grant funds in order to care for underserved communities with mobile dental units.

The Maximizing Outcomes through Better Investments in Lifesaving Equipment (MOBILE) for Health Care Act passed the Senate Committee on Health, Education, Labor, and Pensions, and also passed the House Energy and Commerce Subcommittee on Health.

Military Dental Care

The ADA sent a letter to Rep. Andy Kim (D-NJ) and Rep. Trent Kelly (R-MS) to thank them for introducing the Dental Care for Our Troops Act. The Dental Care for Our Troops Act would provide no-fee dental coverage through TRICARE to the over 800,000 Americans in the National Guard and Reserve. This would support the ADA values of providing oral health care to those who serve the country.

Military Spouse Licensing Relief Act

The ADA supports the Military Spouse Licensing Relief Act, which would give military spouses with valid professional licenses in one state reciprocity in the state where their spouse is currently stationed on military orders. It is not uncommon for civilian dentists to be the spouses of military servicemembers, and this bill would provide value to them. The House Veterans Affairs’ Subcommittee on Economic Opportunity held a hearing on this bill in May.

VA

The ADA recommended changes to the VA Workforce Improvement, Support and Expansion (WISE) Act that would better support the VA’s dental workforce so that veterans can