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 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.”
ADA Asks Senate to Move on Student Debt Interest
On July 1, the fixed interest rate on subsidized Stafford loans for undergraduates is set to double, from 3.4 percent to 6.8 percent. Most dental students already face heavy debt associated with the next four years; they certainly don’t need the added burden of increased interest on their existing undergraduate loans.
In a letter to the Senate this week, ADA President Dr. Robert Faiella and Executive Director Dr. Kathleen O’Loughlin asked senators to keep Stafford loans “at or as close to 3.4 percent as possible and work on a long term solution to bring the graduate loan rates down.”
“Educational debt plays a major role in postgraduate career planning,” they wrote. “It can influence whether a recent graduate will choose to enter private practice, focus on underserved communities or pursue a career in public service, teaching, research and/or public health.”
The ADA is also lobbying to keep rates down on graduate school loans. The Association stresses the role heavy student debt plays in keeping new dentists from setting up practice in underserved communities or pursuing careers in public health.
In 2011, the average educational debt per graduating dental school senior was $180,557.
New CMS Requirement to Mandate National Provider Identifier Numbers on Medicare Prescriptions
All health care providers, including dentists, who write prescriptions for Medicare beneficiaries are encouraged to obtain national provider identification (NPI) numbers, according to a new rule issued by the Center for Medicare and Medicaid Services (CMS).
While there is no federal requirement for non-covered dentists to obtain an NPI, an agency official told the ADA that because pharmacies must include prescriber NPIs on claims submitted to Medicare Part D, dentists might want to obtain a number for the convenience of the pharmacies that fill their prescriptions. More information is available at the CMS web site.
Bill would Fix Insurance Payment Problems for Some Dental Patients
Rep. Paul Gosar (R-Ariz.), one of two dentist members of Congress, has taken the lead in addressing insurance practices that hurt dental offices and patients by requiring plans to allow both coordination of benefits and assignment of benefits.
Rep. Gosar’s recently introduced bill, the Dental Insurance Fairness Act (H.R. 1798), would require dental plans to allow policy holders to use both their primary and secondary policies to pay for the cost of care. In some states without coordination-of-benefit laws, plan rules that prohibit this kind of coordination leave the beneficiaries on the hook for a portion of the care provided, notwithstanding the fact that they’re paying for two policies.
The assignment-of-benefits provision would allow patients to direct dental plan payments directly to their treating dentists, even non-participating providers. Permitting this would mean that patients would not have to pay out-of-pocket for covered services and then wait to be reimbursed by their dental plans.
So far the bill has five cosponsors.
Association Tells Senate to Support Antitrust Reform
The ADA asked members of the Senate Judiciary Antitrust Subcommittee last week to support legislation that would eliminate the antitrust exemption for health insurers. Specifically, the Association seeks introduction of a Senate companion to H.R. 911, the bill introduced in the House of Representatives earlier this year by Rep. Paul Gosar (R-Ariz.). The Gosar bill would remove the McCarran-Ferguson Act’s antitrust exemption for health insurers but would specifically exclude other forms of insurance.
The ADA letter to members of the Senate subcommittee is available online at ADA.org.
ADA Welcomes Surgeon General Endorsement of Community Water Fluoridation
U.S. Surgeon General Dr. Regina Benjamin today officially endorsed community water fluoridation as “one of the most effective choices communities can make to prevent health problems while actually improving the oral health of their citizens."
Dr. Benjamin made her endorsement in a letter sent to the National Oral Health Conference being held this week in Huntsville, Ala. Attendees heard the letter read aloud at the conference opening ceremony this morning.
"Fluoridation’s effectiveness in preventing tooth decay is not limited to children, but extends throughout life, resulting in fewer and less severe cavities,” Dr. Benjamin said. “In fact, each generation born since the implementation of water fluoridation has enjoyed better dental health than the generation that preceded it.”
Every surgeon general for the past 50 years has endorsed community water fluoridation of community water supplies as a safe and effective weapon in the war against tooth decay. The American Dental Association has supported fluoridation since 1950.
The ADA's policies regarding community water fluoridation are based on the best available science showing that fluoridation is a safe, effective way to prevent dental decay. The ADA, along with state and local dental societies, continues to work with federal, state and local agencies to increase the number of communities benefiting from this very effective public health measure.
Dr. Benjamin’s letter to the National Oral Health Conference is available online at ADA.org.
Paul Gosar Seeks Support for Bill Repealing Insurance Antitrust Exemption
Rep. Paul Gosar (R-Ariz.) last week formally asked his congressional colleagues to support H.R. 911, his legislation that would repeal provisions in the McCarran-Ferguson Act that grant antitrust law immunity to health insurance companies.
“After over 60 years, it is apparent that the exemption created by Congress in 1945 was not wise,” Rep. Gosar wrote in a “dear colleague” letter.
“There was no evidence then, nor any today, that supports the unique treatment of the health insurance industry by exempting that industry from federal anti-trust laws.,” he wrote.
“This partial repeal of McCarran-Ferguson recognizes that the historical practice of exempting the health insurance industry from the full application of the federal anti-competition laws has had a deleterious impact on consumers in the form of artificially higher premiums, unfair insurance restrictions and harmful policy exclusions.”
Rep. Gosar introduced his “Competitive Health Insurance Reform Act” on Feb. 28 and it was referred to the House Judiciary Committee for consideration. The ADA is working to secure cosponsors for the bill.
ADA Supports Medical Malpractice Legislation
On March 29, the ADA sent a letter of support to Rep. Phil Gingrey (R-Ga.) for the “Standard of Care Protection Act” that he plans to introduce soon. The bill would ensure that federal health care laws would not establish national standards of care for health care professionals in medical malpractice cases. The legislation also would preserve state laws governing medical profession liability cases.
With the health care system adopting new measures for quality control and efficiencies of care, the ADA believes that this bill is necessary to prevent additional liability exposure for health care professionals. This protection would also be important as federal agencies continue to issue new guidance and rules implementing the Patient Protection and Affordable Care Act and other federal laws, such as Medicare and Medicaid.
CMS to Begin Enforcement of Medicare Ordering/Referring Requirement
The Centers for Medicare and Medicaid Services (CMS) recently announced that on May 1 the agency would begin enforcing an Affordable Care Act requirement that doctors must enroll in Medicare or opt out of the program if they order or certify Medicare-covered imaging services, clinical laboratory services or durable medical equipment, or home health services. Over the past two years CMS has delayed implementation of the requirement, about which the ADA and other organizations have raised concerns.
The ADA argued successfully to CMS for modification of the proposed requirement so that dentists referring Medicare patients to other health care professionals — e.g., oral surgeons — would not have to enroll or formally opt out of Medicare.
However, dentists ordering clinical laboratory or imaging services must either enroll or opt out in order for providers of those services to be reimbursed. The ADA has provided information to its members who believe they need to either enroll in or opt out of Medicare. As urged by the ADA, CMS developed a simplified enrollment form for use by doctors who enroll in Medicare solely to order and certify and who do not provide Medicare covered services.
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