Legislative Corner

THE FDA ADDRESSES WORKFORCE CHALLENGES

Workforce issues have become a common topic of discussion. The COVID-19 pandemic brought to light a dilemma that is impacting every industry from health care to hospitality. Initially, it appeared that some workforce issues would be temporary, and things would go back to “normal” once vaccines were widely available and immunity was built up for the virus. Unfortunately, this is not the case. Many industries are still trying to figure out how to address the current workforce shortages and grapple with the demands presented to get people back to work.

As businesses contemplate the right formula of incentives and benefits to offer potential employees, it’s evident that the way things were done in the past will not be enough going forward in the future. The pandemic has invited people to look at employment in a different light and pushed some employers to implement lucrative propositions to address their staffing issues. This has created a new phenomenon that is challenging the status quo and has forced businesses to be open-minded about alternative work options to accommodate employees’ desire for more flexibility. These new demands and expectations have stressed the labor market into a workforce epidemic.

The Florida Dental Association (FDA) is aware that workforce challenges may be impacting dental offices across the state. During the June annual meeting, the House of Delegates (HOD) adopted a resolution to examine the opportunities that may be fostered by supporting educational programs that help recruit talented candidates to pursue a career in dentistry. It is evident that the current educational system for dental auxiliaries is not sufficient enough to meet the demand. The FDA’s Workforce Innovation Task Group has been meeting with dental stakeholders to evaluate the current state of the dental workforce and educational opportunities. The task group will provide a report of its findings to the January 2022 FDA HOD. If you are interested in sharing feedback about dental workforce challenges you may be experiencing, please send your comments to jahart@floridadental.org.

Resolution adopted by the June 2021 FDA HOD:

DENTAL AUXILIARY WORKFORCE

The House ADOPTED WITH AMENDMENT resolution 2020H-035:

[Policy] RESOLVED, that the FDA supports innovation in educational programs and active recruitment of talented candidates for careers as dental hygienists, dental assistants, and dental laboratory technicians, and be it further,

RESOLVED, that the FDA President refer to the Workforce Innovation Task Group the duty of examining dental auxiliary workforce within Florida and making recommendations as appropriate to the FDA BOT and report back to the January 2022 FDA House of Delegates.

JOE ANNE HART FDA CHIEF LEGISLATIVE OFFICER

For additional information on legislative issues, you can reach Joe Anne Hart at jahart@floridadental.org or 850.350.7205.

2022 LEGISLATIVE ISSUES*

FDA SUPPORTS

SUPPORT FUNDING FOR THE DENTAL STUDENT LOAN REPAYMENT PROGRAM (ch. 381.4019) & DONATED DENTAL SERVICES (ch 381.40195)

In 2019, the Florida Dental Association (FDA) was successful in passing into law legislation to reinstate the Dental Student Loan Repayment Program and codify in statute the Donated Dental Services (DDS) program. Unfortunately, the Legislature did not appropriate any funding necessary to implement these programs. Based on an estimate provided by the Florida Department of Health (DOH) in 2019, the state would need to allocate approximately $773,000 to fund these programs.

Dental Student Loan Repayment Program

This program encourages dentists to work as full-time Medicaid providers in rural and underserved areas around the state. In exchange for this commitment, dentists will be eligible to receive financial assistance in the amount of $50,000 for the repayment of their dental student loans.

This program was very successful in the early 1990s, but due to budget shortfalls, the funding was cut and because the statute was inactive for many years, the statute was eventually removed in 2012.

Since Florida has a robust workforce with more than 14,000 licensed dentists and three dental schools graduating more than 300 new dentists each year, there is a great opportunity for the Legislature to invest in a program that will help increase access to comprehensive dental care by investing in Florida’s current workforce.

Donated Dental Services Program

The DDS program provides a platform for dentists and dental labs to donate free, comprehensive dental treatment to people who are disabled, elderly or medically compromised, and are unable to afford dental care. To continue providing services to individuals who would qualify for this program, the FDA supports state funding for two full-time coordinators and operational expenses. The DDS program is administered through Dental Lifeline Network, which works with all 50 states to help facilitate dental care to those in need. Florida’s DDS program is currently active with more than 500 volunteer dentists and more than 200 dental labs; however, there is only one parttime employee managing the requests for care. The FDA Foundation is providing resources necessary to help keep the program functioning. The DDS programs that are the most successful are the ones that have dedicated funding from the state.

SUPPORT FUNDING FOR COMMUNITY WATER FLUORIDATION

The FDA supports $200,000 in state funding for community water fluoridation efforts administered through the DOH. Community water fluoridation has proven for more than 75 years to significantly reduce the amount of tooth decay among individuals of all ages, especially those without access to routine dental care. Fluoride is naturally present in all water sources. Community water fluoridation is simply the adjustment of fluoride to the level recommended for optimal health. Communities that invest in water fluoridation save an average of $32.19 per capita in dental treatment costs. In fact, the average lifetime costs per person to fluoridate a water system is less than the cost of one dental filling. For more information about community water fluoridation, visit floridafluoridation.org.

SUPPORT REDUCING INSURERS’ RECOVERY OF OVERPAYMENT TO PROVIDERS (CLAWBACK) SB 440 by Sen. Gayle Harrell (R-Stuart)

The FDA supports shortening the clawback period to 12 months in which the insurer can recover an overpayment to a health care provider. Currently in Florida, an insurer can recover an overpayment made to a health care provider, in good faith, 30 months from the date of overpayment. This practice is known as a clawback. Since clawbacks can occur several years after a service was provided and can occur with little to no warning to providers, it makes it difficult for providers to maintain financial stability for their businesses if overpayments have to be paid back retroactively to insurance plans. Fourteen other states have legislation dictating how many months an insurer can look back/clawback to recover an overpayment from a provider. The times vary from six months to 24 months. In contrast, a provider has, on average, 90 days to submit a claim to an insurance plan if he/she wants to be reimbursed. While contractually a plan has the authority to recover an overpayment made to a provider (which is the manner in which managed-care plans operate), the FDA believes that the 30-month period in Florida is an outlier and is not in line with look-back/clawback provisions in other states. Shortening the clawback period to 12 months will not prevent dental plans from retracting payment for fraudulent billing, nor will it prevent dental plans from retracting claims by seeking judicial intervention if there is legal cause. It would simply set a limit on how long dental plans have to recover payments made in good faith.

SUPPORT NON-PATIENT BASED DENTAL LICENSURE EXAM HB 517 by Rep. Tyler Sirois (R-Merritt Island)

The FDA supports the use of the non-patient (high fidelity restorative CompeDont™ human tooth simulation) American Board of Dental Examiners (ADEX) exam as administered by the Commission on Dental Competency Assessments (CDCA) for licensure in the state of Florida. Currently, dental students who seek licensure in Florida must find a patient to come in person on the day of their dental licensure exam. This patient must have specific dental decay outlined by the ADEX that the dental student must treat in order to pass his or her examination. Finding these types of specific patients has become a burden for students. Many of these patients do not show up on the date of the exam, and if they do, they arrive with the expectation of payment from the dental student after the examination is over. During the height of the COVID-19 pandemic, the governor of Florida issued two executive orders that suspended the in-person, live-patient component of licensure exams for various health care industries, including dental. Florida’s dental schools used the ADEX CompeDont™ human tooth

Henry Schein Professional Practice Transitions

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simulation during this time for dental licensure exams. Since then, data has been collected and presented to show the comparability of live-patient to non-patient dental licensure exams. Forty-seven other states accept the use of the non-patient-based ADEX exam. Based on this information, the FDA supports moving to the CompeDont™ model exam for dental licensure in Florida.

SUPPORT INCREASING MEDICAID DENTAL FUNDING

Florida’s Medicaid program does not provide adequate resources to fund dental care. The FDA supports an increase in the overall funding allocation for dental care in the Medicaid program, along with a thorough assessment of the policies and administration of the program. Currently, Florida ranks near the bottom of all states for Medicaid reimbursement rates. Dentists who participate as Medicaid providers may receive 25 cents on every dollar spent to provide dental care. This is not sustainable and has caused many dentists to leave the program. Whether dental care is a stand-alone program or embedded with medical care, a larger portion of funds must be designated for dental care to allow for increased reimbursement rates. Without making significant adjustments to the program, it will continue to be a challenge to recruit dentists to participate.

SUPPORT MAINTAINING EDUCATIONAL STANDARDS FOR INTERNATIONALLY TRAINED DENTISTS

Current law requires that graduates of non-accredited dental schools complete a two-year supplemental general dentistry education program before taking the Florida licensure exam. The purpose of the supplemental education program is to: 1) ensure that internationally trained dentists attain the same knowledge and skills as graduates of accredited programs and 2) familiarize internationally trained dentists with the oral health care delivery system in the U.S., including the techniques, procedures and standards of oral health care.

In the past, there have been legislative efforts that tried to create a “backdoor” pathway to licensure in Florida for internationally trained dentists. There have been proposed changes to the current law that would provide exemptions for the internationally trained dentists who agree to treat Medicaid recipients in exchange for bypassing the supplemental education requirement. The FDA believes that all Floridians should have access to the same standard of care regardless of economic status. These supplemental education programs are offered to ensure that a minimum standard of care for Floridians is consistently achieved for all dental licensees in the state.

The FDA supports maintaining the current supplemental education requirement for internationally trained dentists.

MONITOR DO-IT-YOURSELF DENTISTRY/DIRECT-TO-CONSUMER DENTISTRY

For years, consumers have engaged in do-it-yourself (DIY) services in many different aspects of their lives. It’s now more prevalent than ever that many DIY services are encroaching over to medical and dental services. While there are several at-home products that can be safely used, directly by consumers, there is a growing desire for consumers to try services at home that may be better administered in a dental office to garner the desired results.

In 2019, the American Dental Association (ADA) launched a public awareness campaign discouraging DIY dentistry. According to the ADA, DIY dental treatments can affect the gums, bones and ligaments that support the teeth or the teeth themselves. Depending on the oral health issue being addressed and the nature of the treatment, there may be risks for long-term issues, including jaw problems, abnormal bite, tooth decay and loss, as well as gum disease. If teeth are improperly aligned, gum tissue may be negatively impacted or stripped away from teeth, causing additional gum problems.

It’s unfortunate that many people have suffered major dental setbacks with DIY dentistry, which eventually costs them more in the end. Consumers should always seek the opinion of a licensed dentist first before using unconventional dental methods or products.

OPPOSE DENTAL THERAPY LEGISLATION SB 184 by Sen. Jeff Brandes (R-St. Petersburg)

The FDA does not support adding dental therapists as new licensed dental providers in Florida. Proponents claim that this is a solution to address access to dental care in underserved and rural areas. Unlike the extensive training required to be a dentist, dental therapists are educated for only three years out of high school and would be authorized to administer local anesthesia and perform surgery or major irreversible procedures like extractions and partial root canals. Lowering the standard of care for dentistry — particularly among our state’s most vulnerable populations, who often suffer from some of the most complex medical issues and higher rates of tooth decay — is not a viable solution for Florida.

FDA OPPOSES

*AS OF 11/5/21

FDA TASK GROUP COMES TO AGREEMENT ABOUT GOOD GOVERNANCE

DR. DREW JOHNSON, FDA GOVERNANCE TASK GROUP CHAIR Questions or comments about the governance review process? Feel free to reach out to Governance Task Group Chair Dr. Drew Johnson at jajomfs@aol.com or FDA Executive Director Drew Eason at deason@floridadental.org. In 2020, then-Florida Dental Association (FDA) President Dr. Andy Brown reached out to me about chairing a new FDA task group that would analyze FDA governance. He chose me, in part, because I served as chair of the FDA Council on Ethics, Bylaws and Judicial Affairs. In that council, we did extensive work relating to the FDA’s Bylaws and Governance Manual, so he knew about my interest in the nitty gritty, inner workings of the association. Dr. Brown also appointed the rest of the task group, which included a young, diversified recruitment of two members from each district.

The charge of the newly developed FDA Governance Task Group was to review all areas of the FDA’s governance and make recommendations to either keep things the same or suggest changes. With the help of well-respected, nationally recognized facilitator Michael Gallery, Ph.D. and the efforts of a team of invested, engaged FDA members, there has been much progress.

From the beginning, the plan was to be objective. We didn’t want to take action or make changes just to do it, but because it was necessary. So, we started with defining good governance. We asked questions like, “What principles and performance requirements should the FDA’s governance structure meet?” By determining which elements are most important for good governance, we could compare our structure to see how we measure up.

Task group members worked cooperatively and independently through meetings, homework assignments and facilitated

discussions. We came to agreement about governance performance requirements for the FDA — concepts like the following:

n The governance system facilitates a constant stream of communication among all elements of the governance system.

n Term limits achieve a balance between the need for new leadership and the need for continuity within leadership.

n The governance structure ensures that decision-makers are provided the appropriate knowledge, information and time to make informed and timely decisions.

n Committees are formed (or disbanded) and structured based on the strategic plan and/or needs of the association.

A list of 20 specific performance requirements drafted by the task group was presented to the FDA Board of Trustees (BOT) in May for review. The BOT approved the performance requirements to be used as a basis for evaluating the association’s current governance structure. Those same performance requirements were presented to the House of Delegates (HOD) in June and were approved.

What Comes Next?

The next steps in the process included comparing current FDA practices and systems with the newly defined ideal performance requirements. The exercise was to compare “what is” with “what should be.” Areas the FDA did not fully meet were defined as gaps. Critical gaps between what is and what should be were defined as problems. Problems need to be addressed. But we shouldn’t talk about solutions until we understand and agree on the problems. So, the critical gaps identified by the task group must be presented to the BOT and the HOD.

We finished the gap analysis and presented our findings to the BOT in August; the gaps identified by the task group were approved. Next, the gap analysis will be presented to the HOD in January 2022. If both the BOT and HOD approve the gaps, the task group will shift our focus to solutions. What can the FDA do to address these differences between the status quo and ideal governance? Which gaps should be addressed? What are the potential solutions?

This is when the work becomes even more detailed. We’ll have to look at our bylaws and governance manuals and potentially propose meaningful changes. But it’s important to note that

Members of the FDA Governance Task Group

Dr. Drew Johnson, chair (CFDDA)

Dr. George Kolos (ACDDA)

Dr. Tom Brown (NEDDA)

Dr. Joseph Pechter (SFDDA) Dr. Katie Miller (CFDDA)

Dr. Kaitlin Blackburn (NWDDA) Dr. Doug Starkey (ACDDA)

Dr. Makeba Earst (NWDDA)

Dr. Kris Harth (NEDDA) Dr. Mariana Velazquez (SFDDA)

Dr. Reza Iranmanesh (WCDDA) Dr. Melissa Grimaudo (WCDDA)

(continued)

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having a gap doesn’t necessarily mean that we must take action. The ultimate deciding body is the HOD, and they could decide to accept or modify the gap analysis. They represent the entire FDA membership and are responsible for going back to their local members to keep them informed, get input, etc. One positive thing about this process is that it has been — and will continue to be — fully transparent.

While the task group started out as an initiative developed by Dr. Brown, current FDA President Dr. Dave Boden has taken the ball and run with it. He has done an excellent job encouraging the group, educating the membership and ensuring the process is moving forward.

Why Should Members Care?

Throughout this process, led by a facilitator, our task group (and, by extension, our BOT and HOD) are coming to agreement about good governance. That’s not only best practice, it’s also healthy and productive. Every organization that has bylaws and a governance structure, including the FDA, should regularly review the structure to ensure it is running as well as possible.

It’s important for our association to operate efficiently, and that impacts every single member. I, for one, am proud that the FDA is committed to running the tightest ship.

It says so much that members of the task group were willing to commit their time and energy to work toward improving the FDA. Over a period of months, we’ve had numerous Zoom calls, countless email exchanges, individual assignments and much more. They all jumped directly into the deep end and, together, we’ve been able to accomplish a great deal. We’re not anywhere close to being finished, but we’ve certainly learned a lot along the way. I look forward to continuing our work with additional guidance from our governing bodies.

I am confident that this governance exercise will ensure that the FDA is a forward-thinking and nimble organization for years to come. I am honored to be a part of it and to serve with such an outstanding group. Dr. Eddie Martin (FDA BOT liaison/ nonvoting)

Dr. Andy Brown (FDA immediate past president/nonvoting)

Dr. Don Ilkka (FDA HOD liaison/ nonvoting)

Dr. Dave Boden (FDA president/ nonvoting)

Governance Reorganization Process

Step 1: Establish Performance Requirements Step 2: Approval of Performance Requirements Step 3: Identify Gaps Between Performance Requirements and Current Structure Step 4: Approval of Gaps Step 5: Revise Structure to Address Gaps Step 6: Approval of Structure Step 7: Revise Bylaws Consistent with New Structure Step 8: Approval of Bylaws