Current Legislative Issues Update

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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 miles 71,870
population 10.7/sq mi Connecticut 5,543 sq
miles 3.6 million 739/ sq mi
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Maines 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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ER use in the US, 2006-09
AHRQ, 2006
AHRQ 2009
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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
  Childrens 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

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Questions?

• shenkinj_at_ada.org