Action for Dental Health Bill would Provide Grant Money for Dental Care and Access Initiatives
Rep. Robin Kelly (D-Ill.) this week introduced ADA-supported legislation that would provide grants totaling $10 million annually to constituent and component dental societies and other organizations at the state and local level offering free dental services for underserved populations. The Action for Dental Health Act, which as of this writing doesn’t have a number, also would provide a second $10 million annual grant to implement Action for Dental Health initiatives that reduce the barriers to care, such as community-wide prevention programs and reducing the reliance on hospital emergency departments for dental services.
ADA staff are seeking a Republican cosponsor for the bill.
California Legislation would Mandate Warning Label on Sugary Drinks
Legislation introduced in California would require warnings on beverage containers with added sweeteners that have 75 or more calories per 12 ounces. The Sugar-Sweetened Beverages Safety Act (SB 1000), would warn consumers of the risk of sugary beverages with a label that includes the following text:
“STATE OF CALIFORNIA SAFETY WARNING: Drinking beverages with added sugar(s) contributes to obesity, diabetes and tooth decay.”
The warning would appear on containers, vending machines and on signs displayed at restaurants. The California Dental Association supports the measure.
House Subcommittee Invites ADA Input on Indian Health
ADA President Charles Norman, D.D.S., is preparing to testify before the House Appropriations Subcommittee on the Interior on the need to improve dental health care for American Indians and Alaska Natives. The ADA regularly presents testimony to this subcommittee urging appropriators to fully fund the Indian Health Service’s oral health programs. During his April 8 testimony, Dr. Norman will highlight some of the activities of the Association and its constituent societies to advance oral health care in Indian country through collaborations with tribes.
ADA Endorses Two Student Loan Bills
The Association this week endorsed two student loan measures on Capitol Hill.
In the Senate, S. 1066, the Federal Student Loan Refinancing Act, introduced by Sen. Kirsten Gillibrand (D-N.Y.), would allow college graduates to consolidate or refinance direct unsubsidized Stafford Loans at a fixed rate of 4 percent.
A House bill (H.R. 1527) introduced by Rep. Charles Rangel (D-N.Y.) would expand the federal income tax deduction for student loan interest and remove the current income cap that limits the availability of the deduction.
CMS Backs Off Medicare Prescription Drug Changes
Bowing to pressure from congressional lawmakers and health care groups, the Centers for Medicare and Medicaid Services (CMS) this week announced that it would temporarily abandon controversial plans to change the Medicare Part D prescription drug program.
The announcement came just two days after the ADA told the agency that one of the rules would have put patients at risk by requiring dentists to either enroll or officially opt out of Medicare simply for the purpose of prescribing medication to Medicare beneficiaries.
This enrollment rule was just one of many that CMS had planned to adopt before agency director Marilyn Tavenner told Congress on Monday that her agency would not implement them. While the ADA is satisfied with CMS’s decision, it is warning its members that some of the proposed regulations, including the dentist enrollment requirement, are far from dead.
The Association will continue to lobby on this issue and will alert members as it learns more.
ADA Activates Grassroots in Support of Pro Bono Dental Care Bill
The ADA Washington Office on March 11 alerted approximately 47,000 of the Association’s dentist members to the need to build more support in Congress for the Coordination of Pro Bono Medically Recommended Dental Care Act (H.R. 963/ S. 466). This legislation would provide grant money to support national dental programs that coordinate medically recommended dental care for low-income children and adults. Volunteer dentists deliver this care at no cost to patients who have medical conditions like diabetes, cancer, or kidney disease. This legislation would ensure that money is available to coordinate the provision of care and to verify the medical, dental, and financial needs of eligible low-income patients. The alert urges ADA members to contact their representatives and senators and stress the importance of cosponsoring this legislation. ADA members have sent more than 3,000 emails to their lawmakers on the issue.
So far the bill has 23 cosponsors in the House, and four in the Senate. Note: If you are not receiving grassroots action alerts, you can sign up to do so here.
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Association Asks CMS to Exclude Dentists from Medicare Requirement
The ADA last week told the Centers for Medicare and Medicaid Services (CMS) that a proposed rule could cause unnecessary hardship to Medicare beneficiaries by requiring dental providers to either enroll or officially opt out of the program for the purposes of prescribing medication. While most physicians who prescribe to Medicare beneficiaries may well be enrolled in the program, as CMS noted in its proposed rule (technically a “notice of proposed rulemaking,” published Jan. 10), in a letter to the agency last week the ADA observed that most dentists are neither enrolled in Medicare nor have formally opted out.
Although there would be no direct consequence to a prescribing dentist who is not enrolled or registered, pharmacies that submit claims would have those claims denied if the provider that wrote the prescription was not enrolled or registered. The end result, of course, is that the patient will either have to pay for the medication or go without. According to the notice, this requirement would take effect on Jan. 1, 2015.
The Association asked CMS officials to exclude dentists from this requirement, citing both the negative impact it could have on patients and the unnecessary administrative burden it would place on dental practices. Return to Top
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Congressman Praises ADA and Nation’s Dentists for Give Kids A Smile
Commending the ADA for its “tireless effort to raise awareness and develop solutions so more people can receive dental care,” Rep. Danny Davis (D-Ill.) today spoke from the floor of the House in recognition of the Association and the thousands of dentists who participate every year in Give Kids A Smile Day.
While originally occurring on one day a year, Give Kids A Smile events now take place year round across the country, with one day in early February serving as the kick-off date. This year’s kick-off occurred Feb. 7 at Washington, D.C.’s Howard University College of Dentistry.
“Since the ADA’s ‘Give Kids A Smile’ program was founded twelve years ago in St. Louis, it has grown to become the world’s largest oral health charitable program,” Rep. Davis said.
The text of Rep. Davis’s statement is here.
NIDCR Lays Out Strategic Five-Year Plan
The National Institute for Dental and Craniofacial Research recently released its five-year plan. While the plan doesn’t touch on funding requirements, it does lay out where the director, Dr. Martha Somerman, and researchers expect to exert their energies. ADA President Dr. Charles Norman and Executive Director Kathleen O’Loughlin wrote to Dr. Somerman to express the Association’s support for the plan:
“We are particularly pleased with the attention given to bioengineering, genetic and environmentally determined molecular factors associated with disease, and other directions in transformative research,” they wrote. “We are also encouraged by the prospect of new research on the social, behavioral, and biological determinants of oral and dental disease.”
Drs. Norman and O’Loughlin noted that all major areas important to ADA members have been addressed in the draft strategic plan, including public health issues related to social, behavioral, and biological determinants of oral and dental disease.
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ERISA Legislation Continues to Pick Up Support
While the outlook for passage of Rep. Paul Gosar’s (R-Ariz.) legislation amending the Employee Retirement and Income Security Act (H.R. 1798) remains in question, it continues to draw bipartisan support. As of this week, the bill has 32 cosponsors, 18 Democrats and 14 Republicans. The bill would require all self-insured health plans that offer dental benefits to provide uniform coordination of benefits and would also require them to permit assignment of benefits. The bill also would permit consumers to designate payment of dental benefits to a provider who is not participating in the network.
President signs 2014 Spending Bill
The President signed the FY 2014 $1.1 trillion spending package January 17. The law will fund the government for the remainder of the fiscal year, until the end of September.
Here are the major dental provisions in the spending measure:
• Once again Congress has decided not to fund the workforce demonstration projects that the Affordable Care Act called for.
• The report accompanying the bill specifically states that Congress has included “not less than” $8 million for general dentistry and not less than $8 million for pediatric dental residencies. This puts these programs back to 2012 levels. Last year, the sequester resulted in no new dental residency funding.
• The report also contains language requesting a report from the Health Resources and Services Administration outlining its requirements for allowing community health centers to add new, or expand existing, dental facilities. Congress specifically wants to know if HRSA considers the number of providers already available to populations before providing health centers with dental grants.
Centers for Disease Control and Prevention—Division of Oral Health
The bill funds this division at $14.75 million, $869,000 above the sequestration figure and $106,000 above the fiscal year 2012 level. This is definitely good news for dentistry.
This agency of the National Institutes of Health is funded at $398.7 million, which is $14 million below the fiscal year 2013 pre-sequestration funding. The accompanying report language requests (but doesn’t direct) the NIH director to “make the development of alternative dental restorative materials a high priority.”
Other Dental Programs
• Oral Health Training)
This important dental program is funded at $32 million, an amount that includes the $16 million for dental residencies (see above) as well as grants to the states for programs designed to improve dental care access for underserved populations. This is $384,000 below the fiscal year 2012 funding level.
• Maternal Child Health
Report language requires that oral health set-asides continue. This funding prior to the sequester was $3.78 million.
• Ryan White Dental
The dental portion of this AIDS/HIV program is funded at $13.12 million, which is $446,000 below fiscal year 2013 levels, pre-sequester.
Military Dental Research
While this amount ($6 million) remains the same as fiscal year 2013 levels, the ADA considers this a victory considering that under the Omnibus bill the Defense Department funding was $24 billion below the House approved amount. This research focuses on improving treatment for facial wounds and gum disease and cavity prevention among troops overseas.
Indian Health Service
Lawmakers have not determined an exact funding level for IHS due to a technical matter regarding a mandatory program. The accompanying report language, however, states that the bill:
- Includes funding for the early childhood caries initiative. The ADA expects that this will be $300,000 for a caries coordinator the Association and several requested.
- Encourages IHS to work with the Bureau of Indian Education (BIE) and to consult with tribes about increasing preventive dental care for children by bringing dentists and hygienists into BIE schools.
- Instructs IHS to continue to make significant strides towards completion of electronic dental records. This was an ADA request.
- Encourages IHS to explore establishing a centralized credentialing system to address workforce needs similar to those of the Departments of Defense and Veterans Affairs, to consider a pilot program for the credentialing of dentists, and to propose funding for fiscal year 20 15. (This was another joint ADA/tribal request)
Important Tax News for Small Businesses
With its budgeting work done for the year, Congress this week leaves town for its holiday break. One tax relief measure that lawmakers did not see fit to enact for 2014 is an extension of the current Sec. 179 capital expenditure deduction for small businesses.
Under current tax law, small businesses may expense (immediately deduct) up to $500,000 of investments in qualified equipment. This deduction phases out if a taxpayer purchases more than $2 million of property in the same year. These investment thresholds are scheduled to drop to $25,000 and $200,000, respectively, on Jan. 1, 2014, absent congressional action to retain the 2013 levels. Despite Congress's failure to pass legislation extending the higher limitations through 2014, it's possible that it may act next year to restore the limitations and even apply them retroactively. The ADA will continue to lobby for the higher limitations.
Association Urges Ways and Means Committee Chairman to Revise Draft Tax Proposal to Continue Permitting Small Businesses to Use Cash Basis Accounting
The ADA this week urged Rep. Dave Camp (R-Mich.), chairman of the House Ways and Means Committee, to revise his draft tax reform proposal to retain the provision in the tax code allowing small businesses with $5 million or less in gross receipts to use a cash basis of accounting.
Cash accounting is simpler and requires less bookkeeping than the accrual method, which is why many small businesses, including dental practices, prefer to use it. In a cash accounting method, income and expenses are recorded only when funds are received or disbursed.
In accrual accounting, income is recorded when a sale is made, not when payment is received. Expenses are recorded when services or goods are received, not when they are paid.
ADA and Friends of Indian Health Urge Congress to Pass Bill to make IHS Loan Repayment Awards Tax-Free
Twenty-six member organizations of the Friends of Indian Health, including the American Dental Association, the American Dental Education Association and the American Academy of Pediatric Dentistry, today asked all members of the House of Representatives to support H.R. 3391, the Indian Health Service Health Professions Tax Fairness Act. This bill, introduced by Rep. David Valadao (R-Calif.) would amend the tax code to provide health care professionals who receive student loan repayments from the Indian Health Service (IHS) the same tax free status enjoyed by those who receive National Health Service Corps (NHSC) loan repayments. Under the IHS and NHSC programs, health care professionals provide needed care and services to underserved populations.
Association Addresses Dental Crisis, Lays Out Action for Dental Health Campaign in Letter to Senate Subcommittee
The ADA presented its solutions to the national dental crisis in a letter sent this week to every member of the Senate Health, Education, Labor and Pensions Subcommittee on Primary Health and Aging. The Association sent the 10-page letter to subcommittee members in lieu of submitting official testimony for the Sept. 12 hearing organized by subcommittee chairman Sen. Bernie Sanders (I-Vt.).
Also this week, the ADA thanked Sen. Sanders for introducing his Comprehensive Dental Reform Act, outlining in a letter to the senator the various provisions of the legislation that the ADA supports as well as parts it opposes, particularly language that calls for demonstration projects that would train or employ dental therapists in various locations.
Federal Government Shutdown Has Little Impact on Dentistry
Medicare, veterans and other claims might be delayed as processing is suspended during the shutdown. Medicaid and CHIP payments will continue on time. Those claims are paid by the states, which receive the money from the federal government ahead of time, on a quarterly basis. Dentists working in Indian Health Service clinics will be expected to report to work, although many other employees may be furloughed.
The federal department that most affects dentistry as a health profession is Health and Human Services. According to a “contingency staffing plan” released by HHS just days before the shutdown, the department has put 40,512 employees on unpaid furlough and retained 37,686. Grant-making, research-oriented and “employee intensive” agencies like the Administration for Children and Families and the Agency for Healthcare Research and Quality are largely shuttered. Agencies that focus on direct service to patients have for the most part remained in operation.
Below is a list of major HHS agencies and what activities they will and will not perform during the shutdown:
• Centers for Medicare and Medicaid Services—CMS has continued its activities related to Affordable Care Act implementation. Health care fraud and abuse investigations are largely suspended. The agency has stopped performing routine provider monitoring during the shutdown period.
• Indian Health Service—IHS will continue to provide direct clinical health care services as well as referrals for contracted services that cannot be provided through IHS clinics. While activities necessary to meet the immediate needs of patients, medical staff, and medical facilities will continue, other activities, like policy development and program oversight, will be suspended.
• Health Services and Resources Administration—HRSA would continue activities funded through sources other than annual appropriations, including Community Health Centers and the National Health Service Corps. The agency will suspend oversight activities and grant payments.
• Centers for Disease Control and Prevention—CDC has furloughed nearly 9,000 people. The agency will have only a limited ability to monitor disease outbreaks and to perform research and oversight. Programs operated with mandatory funding, such as the Vaccines for Children Program, will continue.
• The National Institutes of Health—NIH, which includes the National Institute for Dental and Craniofacial Research, will continue to provide care for patients already in its clinical center, but will not admit new patients. Agency staff will continue performing necessary care of laboratory animals, but all research and grant oversight and administration has been suspended.
• The Food and Drug Administration—The agency is continuing its limited activities funded by fees, such as providing export certificates for human and animal drugs and activities in the Center for Tobacco Products. The FDA will continue critical activities like handling high-risk recalls, civil and criminal investigations, and import entry review. The agency has suspended routine food inspection and other food, cosmetic and nutrition activities. Most laboratory research is suspended.
ADA President Blogging at Huffington Post
The Huffington Post this week accepted ADA President Robert Faiella as one of its regular bloggers. His first column is entitled, “A Dentist’s View on Tackling the National Dental Health Crisis."
ADA Tells Congress of Ways to Expand Access to Dental Health Care
While dental costs, like all other services and commodities, have risen in the past decade, dental insurance caps have remained the same, exacerbating the burden patients bear in seeking oral health treatment, the ADA said in testimony provided to the Primary Health and Aging Subcommittee today. The Association also outlined a number of ways Congress, states and other stakeholders can improve dental health among all populations. The the subcommittee, chaired by Sen. Bernie Sanders (I-Vt.), will add the ADA's testimony to the official record of a hearing on addressing costs in dental care, held Sept. 12.September 9
ADA Develops Dental Checklist for Patients, Health Law Navigators
The ADA recently developed a tool to help patients choose dental plans right for them. The checklist can also help the navigators appointed to help consumers negotiate the complexities of the new health care exchanges. The ADA is making the checklist available to its constituent and component societies, who are encouraged to use it any way they see fit, whether by printing up copies and distributing them to state officials or reworking the text for their own publications. The checklist is available here.
ADPAC Releases Annual Report Detailing 2010-2012 Donations
Reflecting its commitment to transparency, the American Dental Political Action Committee (ADPAC) this week released its annual report, showing receipts and disbursements for the 2012 election cycle, which began in November 2010 and ended November 2012. The report shows what members of Congress received contributions, as well as the House and Senate committees the PAC concentrated on. The report further highlights some of the legislative victories the American Dental Association won over the past two years.
The report is available here.
ADA Asks House Members to Consider a Number of 'Principles' in Crafting Final Student Loan Reform Legislation
In a letter sent to every member of the House of Representatives, the ADA today asked lawmakers to keep certain principles in mind as they go forward in crafting compromise student loan interest rate legislation:
• Tie the interest rate on student loans to prevailing market rates plus just enough to administer loan programs.
• Cap the amount of interest that can accrue on student loans at no more than 50 percent of the principal.
• Allow borrowers to consolidate and refinance all their student loans more than once into private loans to take advantage of lower interest rates. This should includes post-2006 loans.
• Extend the deferral period for repaying student loans from six months until at least one year after completing school.
• Require lending institutions to take a collaborative (rather than a punitive) approach to handling borrowers who fail to pay their full repayment amount for a taxable year.
ERISA, McCarran-Ferguson Legislation Picking Up Support in House
The ADA continues to seek a Senate companion to Rep. Paul Gosar's (R-Ariz.) Dental Insurance Fairness Act (H.R. 1798).
H.R. 1798 would require dental plans to allow policy holders to use both their primary and secondary policies to pay for care. In some states without coordination-of-benefit laws, plan rules that prohibit this kind of coordination, leaving people paying premiums to two dental plans, while receiving benefits from only one. The assignment-of-benefits provisions allow patients to direct plan payments directly to treating dentists who are non-participating providers. Patients would not have to pay out-of-pocket for covered services and then wait to be reimbursed by their plans. So far the bill has 23 cosponsors, almost evenly split between Republicans and Democrats.
Despite the fact that very similar ERISA legislation was introduced during last Congress without objection from insurers, Delta Dental this year has mounted a campaign against the legislation, sending all co-sponsors of the bill an e-mail reprimand, arguing that the bill would increase the cost of dental coverage, allow dentists to charge patients more, force patients to pay more out of pocket, erode the efficiencies associated with in-network dentists, and lead to unwarranted government intrusion. The bill continues to gain bi-partisan support.
The ADA is mobilizing the grassroots membership to urge their lawmakers to cosponsor a second Gosar bill H.R. 911, which would remove the McCarran-Ferguson Act's antitrust exemption for health insurers while specifically excluding other forms of insurance. H.R. 911 so far has 12 cosponsors.
ADA Urges President to Appoint Dr. Grim to Serve as Nation’s First Dentist Surgeon General
The American Dental Association has nominated Dr. Charles Grim to serve as the nation’s first dentist surgeon general. In a letter to the White House sent earlier this week, ADA President Dr. Robert Faiella and Executive Director Dr. Kathleen O’Loughlin praised Dr. Grim for his tenure as head of the Indian Health Service.
“During his term as IHS director, Dr. Grim carried out several major initiatives emphasizing disease prevention and health promotion, chronic care management and behavioral health. Dr. Grim built a strong relationship with the Senate Indian Affairs Committee and received significant bipartisan praise for his work,” Drs. Faiella and O’Loughlin wrote.
Should the president appoint him to the post (and he wins Senate confirmation) Dr. Grim would also be the first American Indian surgeon general.
Rep. Velasquez Asks CMS to Postpone Sunshine Act Enforcement
On August 1, CMS will begin enforcing provisions of the ACA’s Sunshine Act. Under that provision, manufacturers of drugs, medical devices, and biologicals that participate in U.S. federal health care programs are required to report certain payments and items of value given to physicians (including dentists) and teaching hospitals. The information contained in those reports will be disclosed on a public, searchable website maintained by CMS; however, the agency has failed to disclose specific detail about what will appear on the website and has not given the affected communities sufficient time to prepare. While the law and subsequent final regulations attempt to provide transparency in areas where potential conflicts-of-interest can arise, the regulations as written will cause a number of unintended consequences, primarily for small businesses.
The ADA approached Rep. Nydia Velasquez (D-N.Y.), ranking member of the House Small Business Committee and urged her to ask CMS for a postponement of enforcement of this provision until providers have a better understanding of what it entails.
Rep. Velázquez stated in her July 18 letter to the Administration that “with solo practitioners making up nearly 70 percent of all dental practices, many lack the time and resources to dedicate towards researching the new rules. The burden of compliance, from implementing proper recordkeeping to correct reporting, will harm the 92 percent of small manufacturers in the dental industry because uncertainty still remains in the final rules.”
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