Download “The Tooth of the Matter: A Update on State Oral Health Dental

Volume 5, No. 1, January 2016
Massachusetts State House
IN THIS ISSUE:
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States Begin Their Regular Legislative Sessions
Massachusetts Advances a Dental Hygiene Practitioner Bill
North Dakota Meets on Access to Dental Care Issues During Interim Session
Governors in Kentucky and Louisiana Begin Evaluating Medicaid Expansion
Dental Therapist Hired by Native American Tribe in Washington State
Massachusetts Continues to Tackle Prescription Drug Abuse
NCSL to Host Webinar on North Carolina Board of Dental Examiners v. FTC
Missouri Governor Announces Funding for Medicaid Adult Dental Benefits
State Regulatory Update
Reports of Interest
State Resources
Save the Date: ADEA Advocacy Day on Capitol Hill, April 12, 2016
ADEA Fellowship and Internship Opportunities
States Begin Their Regular Legislative Sessions
January 2016 marks the start of a new regular legislative session
for many states across the country. Thirty-six states and the
District of Columbia are expected to convene their legislative
sessions in January. Only four states will have no session in 2016:
Montana, Nevada, North Dakota and Texas. To find out which
dates your specific state is in session view the National
Conference of State Legislatures (NCSL) 2016 Legislative Session
Calendar.
According to the National Governors Association (NGA) and the National Lieutenant Governors
Association (NLGA), states will concentrate on the following issues during the 2016 legislative
session: passing state budgets, continued growth in Medicaid, opioid abuse and education (K–12
education, with a close eye on STEM [science, technology, engineering and mathematics] in an
effort to develop the state’s workforce, and higher education are major focuses).
States that do not carry over legislation from 2015 to 2016 began prefiling bills for the 2016 session
during the summer and fall.
The ADEA Advocacy and Government Relations (ADEA AGR) division is already beginning to see
prefiled bills emerging related to the following: establishing alternative workforce models;
authorizing reimbursement for children’s dental services provided by licensed dental hygienists in
a health access setting; regulating the addition or removal of additional fluoride in community water
by referendum; policy changes to prescription drug monitoring programs; and requests for
Congress to reform graduate medical education programs.
To track key legislation important to you or your academic institution, please visit the ADEA United
States Interactive Legislative Tracking Map at adea.org/State-Legislative-Tracker. As bills relevant
to ADEA members are introduced, they will be added to the interactive map.
Massachusetts Advances a Dental Hygiene Practitioner Bill
On Dec. 14, the Massachusetts Joint Committee on Public
Health sponsored S. 2076. The bill is a new draft of H. 249 and
S. 1118, which established an advanced dental hygiene
practitioner level of practice.
S. 2076 establishes a dental hygiene practitioner level of practice
and is drafted very differently from the two prior advanced dental
hygiene practitioner bills. The education, collaborative practice
agreement and supervision requirements have been changed. Specifically, S. 2076 requires the
following:
ADEA State Update
Volume 5, No. 1, January 2016
Page 2
Education Requirements
A dental hygiene practitioner must complete and adhere to the following:
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Currently be a dental hygienist who is a graduate of a “dental therapist education program
and dental practitioner education program” accredited by the Commission on Dental
Accreditation (CODA) and provided by a postsecondary institution accredited by the New
England Association of Schools and Colleges.1
Pass a comprehensive, competency-based clinical examination that is approved by the
Board of Registration in Dentistry (board) and administered independently of an institution
providing registered dental practitioner education.
Obtain a policy of professional liability insurance and shows proof of such insurance as
required by rules and regulations.
Register as a dental hygiene practitioner and has a certificate allowing the therapist to
practice in this capacity.
Have practiced under the direct supervision of a supervising dentist for at least 500 hours or
completed one year of residency before practicing under general supervision.
Written Collaborative Agreement and Supervision
A dental hygiene practitioner must enter into a written collaborative agreement with a local, state
or federal government agency or institution or with a licensed dentist prior to performing a
procedure or providing a service. The agreement must address such items as (this list is not
exhaustive): practice settings, any limitation on services established by the supervising dentists, the
level of supervision required for various services or treatment settings, administering and
dispensing medications and supervision of dental assistants and dental hygienists.
The collaborative agreement must include specific written protocols to govern situations in which
the dental hygiene practitioner encounters a patient requiring treatment that exceeds the
authorized scope of practice of the dental hygiene practitioner. A supervising dentist may have a
collaborative management agreement with no more than four dental hygiene practitioners at the
same time.
Scope of Practice
A dental hygiene practitioner licensed by the board may perform all acts of a public health dental
hygienist, all acts provided for in CODA’s dental therapy standards, as well as the following services
and procedures pursuant to the written collaborative management agreement without the
supervision or direction of a dentist: interpreting radiographs; the placement of space maintainers;
1
S. 2076 as currently drafted contains conflicting language in the definition of a dental hygiene practitioner: page 1, line 3 of the bill requires
the dental hygiene practitioner to be a dental hygienist who is a graduate of a dental therapist education program accredited by the CODA;
and page 2, line 22 of the bill requires the dental hygiene practitioner to be a dental hygienist who is a graduate of a dental practitioner
education program accredited by the CODA.” According to committee staff, the final bill language addressing/clarifying this discrepancy is
still under discussion.
ADEA State Update
Volume 5, No. 1, January 2016
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pulpotomies on primary teeth; an oral evaluation and assessment of dental disease and the
formulation of an individualized treatment plan authorized by the collaborating dentist; and
nonsurgical extractions of permanent teeth as limited in the following paragraph.
A dental hygiene practitioner may perform nonsurgical extractions of periodontally diseased
permanent teeth with tooth mobility of +3 to +4 under general supervision if authorized in advance
by the collaborating dentist. The dental hygiene practitioner shall not extract a tooth for any patient
if the tooth is unerupted, impacted, fractured or needs to be sectioned for removal. The
collaborating dentist is responsible for directly providing or arranging for another dentist or
specialist to provide any necessary advanced services needed by the patient. A dental hygiene
practitioner in accordance with the written collaborative agreement must refer patients to another
qualified dental or health care professional to receive any needed services that exceed the scope
of practice of the dental hygiene practitioner.
Reimbursement
The dental hygiene practitioner shall be reimbursed for services covered by Medicaid.
Evaluation
Within seven years of the proposed law taking effect, an evaluation must be conducted by the board
in consultation with the Executive Office of Health and Human Services. The evaluation process
shall focus on the following outcome measures: 1) number of new patients served, 2) reduction in
waiting times for needed services, 3) decreased travel time for patients, 4) impact on emergency
room usage for dental care and 5) costs to the public health care system.
On Dec. 14, S. 2076 was reported favorably by the joint committee and referred to the Committee
on Health Care Financing for further consideration.
North Dakota Meets on Access to Dental Care Issues During Interim Session
On Jan. 7, the Joint Committee on Health Services met to
continue the discussion regarding access to dental care in
North Dakota.
The 2013–14 Joint Committee on Health Services was tasked
during the interim legislative session with studying how to
improve access to dental services and ways to address dental
service provider shortages, including the feasibility of using
new dental professionals, whether the use of incentives for dental service providers to locate in
underserved areas in the state may improve access and whether the state’s medical assistance
reimbursement rates impact access to dental services. The joint committee received information
regarding state dental care programs, dental service provider programs, the North Dakota State
College of Science dental program, the dental health workforce and access to dental services. The
ADEA State Update
Volume 5, No. 1, January 2016
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2013–14 joint committee determined additional information was necessary and recommended
S.C.R. 4004 during the 2015 session, which directed the Legislative Management to continue to
study dental services in the state, including the effectiveness of case management services and the
state infrastructure necessary to cost-effectively use new dental professionals to improve access to
services and address dental service provider shortages in underserved areas of the state.
As a result of S.C.R. 4004, on Jan. 7, the joint committee heard invited testimony regarding the
following:
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Outcomes reported by providers benefiting from the North Dakota Department of Human
Services loan repayment program.
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Workforce challenges.
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Dental services offered at community health centers in the state.
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Plans to expand services in long-term care facilities and schools.
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Other opportunities to improve access to dental services in the state.
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An update on a survey of member hospitals and information available regarding emergency
room visits related to dental services.
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The credentialing process for dental assistants and dental hygienists on reservations.
ADEA AGR will continue to keep members updated as the joint committee meets during the interim
session to discuss access to dental care in the state, as there is no 2016 regular legislative session
in North Dakota.
Governors in Kentucky and Louisiana Begin Evaluating Medicaid Expansion
Kentucky
On Dec. 8, Matt Bevin was inaugurated as Governor of Kentucky. Gov. Bevin
(R-KY) won the election on Nov. 3, with 52.5% of the vote.
On Dec. 30, Gov. Bevin announced plans to develop a transformative
Medicaid program for Kentucky. “Gov. Bevin has requested Mark D.
Birdwhistell, a former Secretary of the Cabinet for Health and Family Services,
to assemble a team of experts to assist in the drafting of a Medicaid waiver
solution for the Commonwealth that addresses the financial unsustainability of the current Medicaid
program.”
“Our state is financially in trouble and cannot afford to continue down the current Medicaid path
that we are on. We have an opportunity to develop a transformational program that improves health
outcomes, encourages personal responsibility and does both in a fiscally sustainable manner. This
is exactly what we intend to do,” said Gov. Bevin.
ADEA State Update
Volume 5, No. 1, January 2016
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Louisiana
On Dec. 7, Governor-elect Jon Bel Edwards (D) of Louisiana announced a 44-member transition
committee to address health care issues in the state. 2 Dr. Robert Barsley, a professor at Louisiana
State University Health New Orleans School of Dentistry and former ADEA Legislative Advisory
Committee (LAC) member, will serve on the transition committee. The committee is tasked with
developing a plan to accept $16 billion in federal funds to expand Medicaid in Louisiana.
“Expanding access to health care for Louisiana’s working families is one of my top priorities,” said
Governor-elect Edwards. “These are our tax dollars going to other states when we could be using
them right here at home. Our budget challenges center on a deeply flawed health care system, and
I've asked this committee to develop a strategy to address this that we can begin implementing on
day one."
Dental Therapist Hired by Native American Tribe in Washington
On Jan. 4 the Swinomish Indian Tribal Community in
Washington State announced that it began offering its
members the services of a dental therapist, making the
Swinomish Indian Tribal Community the first tribe in the
Lower 48 states to employ a dental therapist to provide
certain oral health services.
“There are too few dentists in Indian Country,” said Brian
Cladoosby, Chairman of the Swinomish Indian Tribal Community, and President of the National
Congress of American Indians (NCAI). “We cannot stand by any longer and allow Native people to
continue to suffer tooth decay at a rate three times the national average. We have developed a
tribal approach to solve a tribal issue. This solution will help our people immediately address their
oral health needs in ways that have not been possible until today.”
By age five, 75% of American Indians and Alaska Natives experience tooth decay. Recent Federal
statistics for Washington, Oregon and Idaho show that Indian children suffer tooth decay at three
times the national average.
The Swinomish Indian Tribal Community program is modeled after the oral healthcare delivery
model used by Alaska Native communities, the dental health aide therapy model. This past summer,
a Swinomish Tribal member was sent to Alaska to begin the two-year dental health aide therapy
training.
2
On Jan. 11, Governor-elect Edwards will be sworn in as the 56th governor of Louisiana.
ADEA State Update
Volume 5, No. 1, January 2016
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Massachusetts Continues to Tackle Prescription Drug Abuse
Three bills related to regulating prescription drug abuse have been
moving through the legislative process recently. The bills are primed to
be heard on the floor when the 2016 session begins. Below is a brief chart
comparing certain provisions of the three bills (the Joint Committee on
Mental Health and Substance Abuse version [H.3926], the Senate version
[S. 2022] and the Governor’s version [H. 3817]).
First-time
opioid
prescriptions
Emergency
exception
Prescriber
Training
Prescription
Monitoring
Program
Committee Version (H.3926)
The bill would create a 7-day supply
limit for initial opioid prescriptions.
The bill also mandates that a
practitioner3 not issue an opioid
prescription with more than a
seven-day supply to a minor at any
time.
The bill contains exceptions for
emergencies and a notable
exception for chronic pain
management, a cancer diagnosis or
palliative care.
As a prerequisite to obtaining or
renewing their professional
licenses, practitioners who
prescribe controlled substances
must complete appropriate training
relative to: pain management;
patients at risk for substance abuse
disorders; and counseling patients
about side effects, storage and
disposal of prescription
medications.
Prior to issuing an extended-release
long-acting opioid in a non-abuse
deterrent form for outpatient use
for the first time, a practitioner
shall: utilize the prescription drug
monitoring program prior to issuing
the prescription.
Senate Version (S.2022)
The bill requires that all schedule II
opiate prescriptions be written in an
“up to” quantity, allowing patients to
voluntarily reduce the amount
dispensed. Also requires prescribers
to educate patients about their right
to receive lesser quantities of
opiates.
Governor’s Version (H.3817)
The bill would limit dentists
and physicians to
prescribing no more than a
72-hour supply of opioids to
patients the first time they
prescribe that class of drug
to the patient.
The bill contains exceptions
for emergencies.
N/A
As a prerequisite to obtaining or
renewing their professional licenses,
practitioners who prescribe
controlled substances must complete
appropriate training relative to: pain
management; patients at risk for
substance abuse disorders; and
counseling patients about side
effects, storage and disposal of
prescription medications.
The bill requires physicians,
dentists and other persons
who prescribe controlled
substances to complete at
least five hours of training
every two years on the risks
of addiction associated with
medications prescribed for
pain management.
Prior to issuing an extended-release
long-acting opioid in a non-abuse
deterrent form for outpatient use for
the first time, a practitioner shall:
utilize the prescription drug
monitoring program prior to issuing
the prescription.
The bill requires a
practitioner to employ the
prescription monitoring tool
before issuing any
prescription for an opiate.
Gov. Baker has strongly urged the passage of his version of the proposed opioid legislation. To
date, the Baker administration has budgeted more than $114 million in spending for substance
misuse prevention, education and treatment, increased bulk purchasing of Narcan in municipalities
3
Under the Massachusetts General Laws, "practitioner'' is defined as the following: A physician, dentist, veterinarian, podiatrist, scientific
investigator, or other person registered to distribute, dispense, conduct research with respect to, or use in teaching or chemical analysis, a
controlled substance in the course of professional practice or research in the commonwealth. However, the opioid abuse bills generally
exempt veterinarians.
ADEA State Update
Volume 5, No. 1, January 2016
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and changed reporting requirements for the Prescription Monitoring Program from seven days to
24 hours.
In addition, the Massachusetts Medical Society and the deans of the Commonwealth’s four medical
schools recently announced a set of medical education core competencies for the prevention and
management of prescription drug misuse. This new curriculum will be taught to the over 3,000
enrolled medical students for enhanced training on prescription drug misuse.
NCSL to Host Webinar on North Carolina Board of Dental Examiners v. FTC
On Jan. 21, the National Conference of State
Legislatures (NCSL) will host a webinar titled, “Active
Supervision After NC Dental.” This free webinar will
begin at 1 PM EST. Speakers include: Geoffrey Green,
Assistant Director, Bureau of Competition, Federal
Trade Commission; and Sarah Oxenham Allen, Senior
Assistant Attorney General in the Antitrust Unit of the
Virginia Attorney General’s Office. To register for the free webinar click here or to login on the day
of the webinar click here.
The issue before the U.S. Supreme Court (Court) in this case was whether the North Carolina State
Board of Dental Examiners (Board) violated federal antitrust laws by issuing cease-and-desist letters
to individuals without licenses who provided teeth whitening services in North Carolina. The Court
concluded that the Board did not receive active supervision by the State when it interpreted the
Act as addressing teeth whitening and when it enforced that policy by issuing cease-and-desist
letters to non-dentist teeth whiten[ing providers]. Therefore, if there is no active supervision by the
State, the Board has no immunity from antitrust laws.
As a result of the U.S. Supreme Court’s ruling, the FTC has provided a guidance document
regarding antitrust compliance for state boards responsible for regulating occupations. However,
many boards, commissions, and dentists still have questions. This webinar will discuss both active
supervision and the recently issued FTC guidance document.
Missouri Governor Announces Funding for Medicaid Adult Dental Benefits
On Jan. 5, Gov. Jay Nixon (D-MO) announced that the Missouri Department of Revenue will collect
an estimated $35 million from delinquent taxpayers this year under H.B. 384. The funds will allow
for the expansion of dental care to approximately 282,000 low-income Missourians in Fiscal Year
2016. In addition, the funds will enable a 1% rate increase for health providers who care for
Medicaid beneficiaries, including Missourians with disabilities.
“Healthy communities are strong communities, so I’m pleased that the dollars are available to fund
these services, while keeping the budget in balance,” Gov. Nixon said. “Moving forward, these
ADEA State Update
Volume 5, No. 1, January 2016
Page 8
kinds of services are simply too critical to be put at risk by funding them with one-time sources of
revenue. That’s why it’s important that we continue to keep our fiscal discipline for the remainder
of this fiscal year, so that next year’s budget can include ongoing and sustainable funding for
developmental disability providers – and others who care for our most vulnerable citizens.”
Currently, coverage of dental services for adults in Missouri is limited to trauma of the mouth, jaw,
or teeth as a result of injury or medical condition. However, according to the governor’s office, the
Missouri Department of Social Services will submit a state plan amendment to the Centers for
Medicare and Medicaid Services to expand this coverage to include preventive services, restorative
services, periodontal treatment, oral surgery, extractions, radiographs, pain evaluation and relief,
infection control, and general anesthesia. Children enrolled in Missouri’s Children’s Health
Insurance Program and Medicaid program currently do, and will continue to, receive dental
coverage.
State Regulatory Update
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Virginia
In response to a petition for rulemaking, the Virginia Board of Dentistry proposes to amend the
Virginia Administrative Code to recognize dental, dental hygiene, and dental assisting programs
accredited by the Commission on Dental Accreditation of Canada (CDAC) as acceptable for
licensure in Virginia.
The petition and public comment, including a letter of support from the Commission on Dental
Accreditation (CODA), was considered by the Board on June 9. The Board’s decision was to
amend its regulation by a fast-track action. The comment period deadline for this action is Jan.
13.
Reports of Interest
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The National Academy for State Health Policy (NASHP) released a report analyzing how dental
services are structured differently from other benefits offered through health insurance
marketplaces.
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The Medicaid and State Children’s Health Insurance Program (CHIP) Payment and Access
Commission (MACPAC)4 released its MACStats: Medicaid and CHIP Data Book. The data book
contains the most up-to-date information on key aspects of the Medicaid and CHIP available in
a single source—including national trend and state-specific data on enrollment and spending,
current eligibility levels across states and beneficiaries’ health, service use and access to care.
4
The Medicaid and CHIP Payment and Access Commission (MACPAC) is a nonpartisan legislative branch agency that provides policy and
data analysis and makes recommendations to Congress, the Secretary of the U.S. Department of Health and Human Services and the states
on a wide array of issues affecting Medicaid and the State Children’s Health Insurance Program (CHIP).
ADEA State Update
Volume 5, No. 1, January 2016
Page 9
State Resources
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ADEA Advocacy Website
The ADEA Advocacy website is updated daily and contains issues of importance
to academic dentistry and dental and craniofacial research. Also, it allows you to
communicate with your elected officials by simply entering your zip code or
address.
You can navigate the website by clicking through the drop-down menus at the
top of the page. While there, please subscribe to ADEA Action Alerts to maximize your ability to
send messages to your elected officials.
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ADEA/AGR Twitter Account
For the latest information on issues affecting dental education and dental
and craniofacial research in the state legislatures, please follow us on
Twitter at @ADEAAGR
ADEA Advocacy Day, April 12, 2016
Save the Date: ADEA Advocacy Day on Capitol Hill, April 12, 2016
Please join faculty and students from around the country as we gather in
Washington for Advocacy Day on Capitol Hill on April 12, 2016. We need
your help to make the case to Congress for funding for programs of
importance to dental education and dental and craniofacial research.
Registration for Advocacy Day is free, and ADEA will assist participants in
locating hotel accommodations near Capitol Hill. Please join us in Washington for this special event.
To register click here.
For information, please contact Ryne Chua at [email protected]
ADEA State Update
Volume 5, No. 1, January 2016
Page 10
ADEA Fellowship and Internship Opportunities
ADEA/Sunstar Americas, Inc./Harry W. Bruce, Jr. Legislative Fellowship
Dental school faculty members or administrators who want to
interface with members of Congress on issues of importance to oral
health are encouraged to apply for the ADEA/Sunstar Americas,
Inc./Harry W. Bruce, Jr. Legislative Fellowship. The selected fellow
spends three months (flexible schedule) in Washington, D.C., working
on issues and policies that could make a difference in the life of every
American. This public policy fellowship coincides with congressional
consideration of the federal budget and other legislative and regulatory activities important to
dental education and research. The fellow functions as an ADEA Policy Center staff member who
works within the ADEA AGR portfolio on ADEA’s specific legislative priorities.
The fellow’s responsibilities may include drafting policy, legislative language, position papers and
testimony; educating members of Congress and other decision-makers on matters of importance
to dental education; and participating in gatherings of various national coalitions. The fellow
receives a taxable stipend of $15,000 to cover travel and expenses for approximately three months
(cumulative) in Washington, D.C. ADEA is flexible in the arrangement of time away from the fellow’s
institution. The fellow’s institution continues to provide salary support for the duration of the
experience. Since its inception in 1985, the ADEA/Sunstar Americas, Inc./Harry W. Bruce, Jr.
Legislative Fellowship has been generously underwritten by Sunstar Americas, Inc. Interested
candidates should apply now.
ADEA/Sunstar Americas, Inc./Jack Bresch Student Legislative Internship
The ADEA/Sunstar Americas, Inc./Jack Bresch Student
Legislative Internship is a six-week, stipend-supported internship
in the Advocacy and Governmental Relations portfolio of the
ADEA Policy Center (ADEA AGR) in Washington, D.C. This
student legislative internship provides a unique learning
experience for predoctoral, allied and advanced dental students,
residents and fellows. The internship is designed to encourage
students to learn about and eventually—as dental professionals—become involved in the federal
legislative process and the formulation of public policy as it relates to academic dentistry. It is open
to any predoctoral, allied or advanced dental student, resident or fellow who is interested in
learning about and contributing to the formulation of federal public policy with regard to dental
education, dental research and the oral health of the nation. Funded through the generous support
of Sunstar Americas, Inc., the student intern will be a member of the ADEA AGR staff and will
participate in congressional meetings on Capitol Hill, coalition meetings and policy discussions
among the ADEA Legislative Advisory Committee (ADEA LAC) and ADEA AGR staff.
An applicant must be a full-time predoctoral, allied or advanced dental student, resident or fellow
whose institution is willing to work with the student to identify an appropriate time, consisting of six
ADEA State Update
Volume 5, No. 1, January 2016
Page 11
weeks, during the school year to pursue the internship. For additional information, please email
Yvonne Knight, J.D., ADEA Chief Advocacy Officer, at [email protected]. Interested applicants
should apply now. Applications can be found here.
ADEA publishes the ADEA State Update monthly. Its purpose is to keep ADEA members abreast of
state issues and events of interest to the academic dentistry and the dental and research
communities.
© 2016 American Dental Education Association
655 K Street NW, Suite 800, Washington, DC 20001
Telephone: 202-289-7201, Website: ADEA.org
Yvonne Knight, J.D.
ADEA Chief Advocacy Officer
([email protected])
Jennifer Brown, J.D.
ADEA Director of State Relations
([email protected])
Timothy Leeth, C.P.A.
ADEA Senior Director for Federal Relations
([email protected])
Ellen Kuo, J.D.
ADEA Director for Outreach and Advocacy
([email protected])
Evelyn Lucas-Perry, D.D.S., M.P.H.
ADEA Director of Public Policy Research
([email protected])
ADEA State Update
Volume 5, No. 1, January 2016
Page 12