FYI

Dentist blog from Delta Dental

Tag: policy news (Page 1 of 2)

Your dental policy brief: News updates as of June 10

From court rulings to new legislation that could affect your practice, FYI brings you the latest dental policy developments.

More than 3 million could lose insurance if ARPA tax credits expire, study finds

Health premiums will rise, health care spending will decrease by as much as $11.4 billion and more than 3 million people could become uninsured if Congress does not extend the American Rescue Plan Act (ARPA) subsidies, according to a new study released by the Urban Institute.

Originally passed in 2021 as a response to the COVID-19 pandemic, the ARPA increased premium tax credits for Affordable Care Act (ACA) health plans, drawing many more Americans into state health exchanges, where many in turn purchased optional adult dental coverage. Currently under the ARPA, the full cost of COBRA premiums for medical, pediatric dental and vision are subsidized for individuals who qualify after involuntary termination or reduction of hours. Without the ARPA COBRA subsidy, qualifying individuals must pay those premiums themselves, and many once purchasing optional adult dental would likely drop such coverage.

Delta Dental–sponsored bill allows for electronic communications with group opt-in

On May 2, Georgia Gov. Brian Kemp signed into law Georgia House Bill 1308, sponsored by Delta Dental Insurance Company. The legislation allows plan sponsors to consent to electronic mailings on behalf of their employees if certain criteria are met, including that the plan sponsor routinely uses electronic communications with their employees and the option to opt-out of electronic delivery is available to all employees at any time. The legislation applies to health benefit plans and dental and vision carriers licensed to do business in Georgia.  Supporters of the law hope that employer-based “opt-in” protocols can help ensure more consumers receive their documents faster and at lower cost, making for a better overall patient-provider experience.

Biden administration blocks Georgia’s attempt to privatize ACA

President Joe Biden’s administration is blocking Gov. Kemp’s attempt to privatize the state’s Affordable Care Act program. Kemp had planned to bypass healthcare.gov and have residents shop for federally subsidized health insurance through private agents. The move could breach federal rules on insurance waivers and cause too many people to drop coverage, according to the Centers for Medicare & Medicaid Services.

Dental hygienist’s medical marijuana case could reach Supreme Court

A Minnesota dental hygienist is petitioning the Supreme Court to rule on her medical marijuana case. The hygienist, Susan K. Musta, began purchasing cannabis to treat chronic pain due to work-related injuries in 2019 under Minnesota’s legal medical cannabis program and was not reimbursed for it under her workers’ compensation coverage for workplace injuries. Minnesota courts ruled that the federal Controlled Substances Act prevented her insurer from paying for medical cannabis, but the New Hampshire Supreme Court and the New Jersey Supreme Court reached opposite conclusions in similar cases, prompting Musta and her lawyers to ask the Supreme Court to rule on the issue.

Your dental policy brief: News updates as of April 6

From the latest on COVID vaccines and policy to new laws that could affect your practice, FYI brings you the biggest dental policy stories.

Millions of children could lose coverage when Medicaid requirement expires

Children in the U.S. currently insured through Medicaid or the Children’s Health Insurance Program (CHIP) have had stability in their coverage during the COVID-19 public health emergency due to a continuous coverage requirement mandated by Congress in March of 2020. This protection is likely to expire sometime in 2022, perhaps as soon as April. The Georgetown University Health Policy Institute estimates that at least 6.7 million children are likely to lose their Medicaid coverage, including dental care, and are at considerable risk for becoming uninsured.

ADA releases new resource for masking

In March, the American Dental Association (ADA) released Indoor Masking in Dental Practice Public Spaces, a new resource to guide dental practices in light of the latest masking recommendations from the Centers for Disease Control and Prevention (CDC). The CDC indicated in February that communities should now take into account new COVID-19 hospitalizations, hospital capacity and new COVID-19 cases to determine risk level and masking requirements in shared spaces. The ADA resource outlines steps dental practices can follow to align their practice with CDC recommendations.

Lawmakers in New York consider health benefits for uninsured immigrants

New York lawmakers are considering expanding the state’s Essential Plan, which offers free or inexpensive health insurance to low-income citizens, to cover undocumented immigrants. The program includes preventive care, prescription drugs and vision and dental benefits. The expansion would follow the lead of California and Illinois, which have recently offered health insurance to older low-income undocumented residents, but New York would be the first state to offer such coverage regardless of age. An estimated 46,000 people in New York who are currently ineligible for public health care programs due to immigration status would gain access to health insurance coverage, including dental benefits, under the proposed legislation.

Your dental policy brief: News updates as of February 7

From the latest on COVID vaccines and policy to recent court rulings, FYI brings you the biggest dental policy stories.

1. California law may expand dental coverage

A new law may open the door for some California adults and seniors to obtain dental insurance.

Set to take effect in 2023, California Assembly Bill 570, or the Parent Healthcare Act, will allow adult children to add their dependent parents and stepparents to their individual major medical insurance plans. The state estimates that as many as 15,000 people might be covered under the new law, which has no age limitations.

The law applies only to individual medical plans, including those that offer dental coverage, and doesn’t apply to specialized health care service plans that cover only dental. Employer-sponsored plans and Medicare supplement insurance are also excluded.

2. New federal law requires dentists to provide cost estimates to certain patients

The No Surprises Act, which went into effect Jan. 1, gives uninsured and self-pay consumers certain billing protections. Most notably for dentists, the act requires that many dentists, including those who practice in private dental offices, provide good faith estimates for the cost of care to these patients if they request them or schedule service.

  • After the request is made or service is scheduled, dentists and facilities must provide the good faith estimate in writing within three business days. Either a paper or printable electronic copy of the estimate is required.
  • If the actual charges exceed the estimate by $400 or more, the patient or an authorized representative can initiate a patient-provider dispute resolution process and seek a determination from an independent third-party certified by the United States Department of Health and Human Services.

There are no specific specialties, facilities or service sites that are exempt from this requirement, according to the Centers for Medicare & Medicaid Services (CMS). However, the requirement doesn’t apply to patients with coverage through Medicare, Medicaid, the Indian Health Service, Veterans Affairs Health Care or TRICARE.

For questions about good faith estimates and the dispute resolution process, CMS has provided this guidance to dentists and facilities.

3. Court blocks large-employer vaccine mandate, upholds mandate for federal facilities

Two recent decisions by U.S. Supreme Court concerning the COVID-19 vaccine may affect dental offices. The court ruled on Jan. 13 to block a federal mandate that required large employers (such as dental practices with 100 or more employees) to ensure that all their employees either received the COVID-19 vaccine or wear facemasks and submit to weekly tests.

Conversely, the court upheld a mandate that requires staff at federally funded health care facilities to receive the COVID-19 vaccine. The rule affects certain dentists, including those who work in Medicare or Medicaid facilities such as nursing homes, surgical centers and hospitals. However, the ruling excludes private dental practices that serve Medicare or Medicaid patients.

What you need to know about Medicare Advantage plans

Did you know that every day 10,000 Americans turn 65? That means they become eligible for insurance coverage through Medicare and can purchase supplemental Medicare Advantage dental plans through approved vendors like Delta Dental.

Why should you join Delta Dental’s Medicare Advantage networks?

Joining the Medicare Advantage network can be a great choice for your practice. Nearly 20% of the United States’ population will be 65 or older by 2030, according to Census projections. That will mean about 65 million eligible Medicare Advantage patients.

Our Medicare Advantage network provides you with a great way to keep your retirement-aged patients and continue to provide them with quality dental care. And, since you’ll appear in our online Medicare Advantage directory, you can attract new patients as well.

Most Medicare Advantage groups offer a closed-panel benefit package. This means patients covered under these plans must see a dentist contracted in the Medicare Advantage network, giving you access to an exclusive pool of patients.

What if you’re not enrolled?

The Centers for Medicare & Medicaid Services (CMS) recently clarified that rules that prohibit payment to providers who have opted out of participation in Medicare don’t apply to supplemental benefits like dental. This policy became effective January 1, 2022. That means that if you’ve opted out of Medicare through CMS, you can still join the Delta Dental Medicare network and provide services to our Medicare Advantage members.

How to join Delta Dental’s Medicare Advantage networks

If you’re interested in joining, all you need to do is send us an email.  Email ProviderConcierge@delta.org for the DHMO Medicare Advantage network and medadv@delta.org for the PPO Medicare Advantage network. We’ll email you an application.

Your dental policy brief: Current issues and news updates as of December 14

From Medicare news to the latest on COVID policy, FYI brings you the biggest dental policy stories.

1. New Medicare Advantage network policy for dentists

The Centers for Medicare & Medicaid Services (CMS) has clarified that rules prohibiting payment to providers who have opted out of participation in Medicare don’t apply to supplemental benefits, such as dental. The new policy will become effective January 1, 2022.

The new policy means that dentists who have opted out of our Medicare Advantage (MA) network can now file MA claims, and Delta Dental will pay claims for MA enrollees who participate in closed-panel MA group plans.

Note that Delta Dental can accept and pay these claims from dentists outside our MA network only as long as this policy remains in effect. Therefore, we strongly encourage dentists who have opted out of this network to enroll.

Our MA network provides you with a great way to keep your retirement-aged patients and continue to provide them with quality dental care. And since you’ll appear in our online MA network provider directory, you can attract new patients as well. Reimbursement is based on your current Delta Dental PPO fees.

Be advised that the MA network opt-out period is two years and will automatically renew unless you notify us 30 days before your current opt-out period ends that you’d like to enroll. Since you may not be aware that you’ve opted out, we encourage you to review your MA network status as soon as possible.

2. New York City vaccine mandate now includes dentists

All private employers in New York City, including dentists and their employees, must be vaccinated against COVID-19, Mayor Bill de Blasio announced December 6. The mandate will take effect December 27. Dentists and their staff must provide proof they’ve received at least one dose of the vaccine. An exception for people who agree to regular COVID-19 testing instead of the receiving the vaccine won’t be allowed.

New York state currently has a vaccine mandate for all health care workers (which the United States Supreme Court upheld on December 13); however, it doesn’t apply to private practices such as dental offices.

3. White House pledges to help address dental care shortages in underserved communities

The Biden administration announced it will invest $1.5 billion to help tackle a shortage of dentists and other health care workers in disadvantaged communities. The funding will come from the $1.9 trillion American Rescue Plan passed in March.

The resources will go to the National Health Service Corps, Nurse Corps and Substance Use Disorder Treatment and Recovery programs. These federal programs offer scholarships and assistance with student loans to health care workers and students who agree to work in underserved communities.

Your dental policy brief: Current issues and updates in the news as of November 8

From Medicare policy news to the effects of COVID-19 on the industry, FYI brings you the biggest dental policy stories.

1. Dental benefits cut from proposed 2022 Biden spending plan

Dental benefits won’t be paid for through Medicare under the Biden administration’s proposed $1.85 trillion U.S. spending plan, released on October 28. Vision benefits were also cut, while hearing benefits remain as of November 8. The three benefits, part of the original $3.5 trillion plan, were estimated to cost more than $350 billion over a decade. The cut potentially leaves 20 million people who receive Medicare but don’t receive dental benefits without dental coverage.

2. Plan extends Affordable Care Act tax credits through 2025

Biden’s spending plan extends tax credits for insurance purchased on Health Insurance Marketplace exchanges — including dental insurance — through 2025. The extension will help as many as 3 million uninsured people get coverage, according to the White House, and 4 million more may be able to get insurance through state exchanges. The proposed credits, worth approximately $130 billion, are expected to reduce annual premiums for insurance purchased through the ACA by an average of $600 per person.

3. Practices can ask for patient and employee COVID-19 vaccination status, HHS says

Asking whether patients and dental practice employees have received a COVID-19 vaccination doesn’t violate the HIPAA Privacy Rule, according to the Department of Health and Human Services (HHS). Asking employees to provide documentation of their COVID-19 vaccination is also permitted. Finally, the rule doesn’t prohibit patients or employees from disclosing this information. The rule does limit how practices can use and disclose the vaccination status information they gather, however.

4. Dentistry’s COVID recovery slipping, poll suggests

Dental practices that report their operation as “business as usual” have been declining steadily since July, poll data released October 25 indicates. 

  • Dental practices that reported being both open and having normal patient volume was down to 62% in October from 68% during July.
  • Practices reporting lower-than-average patent volumes has steadily increased, to 37% in October from 31% in July.
  • Approximately 12% of practices reported reducing staff hours in October, and 6% downsized their teams.

5. Fluoride toothpaste added to WHO’s essential drug list

The decision of the World Health Organization (WHO) to add several dental medicines, including fluoride toothpaste, to the WHO Model List of Essential Medicines is being hailed as a major achievement for global oral health. The medicines, which also included silver diamine fluoride (SDF) and glass ionomer cement, are the first dental medicines added to the list since 1973. A new section on dental preparation was also added to the list. This action comes after the WHO’s recent resolution on oral health, which calls for a global strategy action plan.

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