FYI

Dentist blog from Delta Dental

Tag: vaccines (Page 1 of 2)

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.

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.

The latest COVID-19 guidelines in the dental office

From the rise of the delta variant to issues about vaccination, the past few months have seen questions arise about the best ways for dental practices to adapt.

The latest recommendations from the ADA

On July 13, the American Dental Association (ADA) released updated recommendations for office procedures during COVID-19. Key points of the update include:

  • Maintain hazard assessments, as required by the Occupational Safety and Health Administration. You must have a safety plan for exposure control and COVID-19. Repeat the hazard assessment regularly as COVID-19 conditions change. Consider the incidence and prevalence of COVID-19 in your area and the rate of testing in your area. The ADA has created a guide and checklist to walk your practice through the process of creating an assessment. 
  • Stay up to date on local mandates. Consult your state dental boards and state and local health departments for current local information for requirements specific to your jurisdiction. 
  • Pre-screen and assess patients for symptoms upon arrival. Call patients prior to their scheduled appointments to ask about their current health status. Consider using temperature checks to screen patients and staff for COVID-19 symptoms on arrival. Although screening for symptoms will not identify asymptomatic or pre-symptomatic individuals, symptom screening can still help to identify those who could have COVID-19, so appropriate precautions can be implemented. Self-assessment information that patients provide themselves is not always reliable.
  • Use your judgment. The adoption of COVID-prevention tactics has largely been left to individual practices. Use your best professional judgment when making decisions. Take an integrative approach, incorporating evidence-based scientific data in conjunction with psychosocial, state and community factors, such as the prevalence of testing in your area.

Delta variant prompts renewed recommendations on masks, vaccination

Concerns about the spread of the delta variant have prompted the American Dental Association to release a new fact sheet.

With the release of the document, the organization strongly reiterates its previous recommendations of:

  • Being vaccinated against the virus. The ADA recommends vaccinations in dental settings (California is the only state where vaccines for health care workers, including dental staff, are currently required). When recommending the vaccine to patients or staff who are resistant, the ADA offers a toolkit of ideas on how to address their concerns.
  • Using personal protective equipment in office settings. Monitor staff for appropriate implementation of PPE. Advise dental staff members to wear additional personal protective equipment (PPE) as appropriate, such as surgical masks or N95 masks, full face shields or goggles with side shields to ensure an environment that is as safe and healthy as possible for patients and the dental team.
  • Practicing social distancing. Avoid close contact with others by keeping six feet of distance whenever possible.

Consistent guidelines

Overall, the ADA and the Centers for Disease Control and Prevention‘s guidelines remain consistent throughout the rise of the delta variant. The guidance from each organization provides thorough, detailed patient management and facility information to consider before, during and after dental appointments.

How to manage office safety throughout the pandemic

The advent of the delta variant reinforces the importance of proper implementation of COVID-prevention tactics.

Successful guideline adherence and low infection rates in dental practices may be the primary reasons why dentists were largely exempted from recent federal COVID-19 requirements for health care settings mandated by OSHA, according to the ADA.

Guidance documents create no new legal obligations and don’t change or establish compliance responsibilities. As always, you need to use your best professional judgment when making decisions for your practice.

“Staying current with recommended safety protocols is important to building the safe environment for patients to seek care and the dental professionals delivering that care,” said Dr. Daniel Croley, Delta Dental’s chief dental officer.  “While following these recommendations is an individual practice choice, we encourage all dentists to adhere to these new guidelines to prevent the introduction of COVID to anyone seeking or delivering dental care.” 

Your dental policy brief: The 5 biggest stories as of August 4, 2021

From mask mandates to Medicare promises, it’s been a busy month for dental news and policy updates. Here are the five biggest stories from the past month for you to peruse.

1. Vaccine mandates become a reality for California and VA dentists

Starting August 9, health care workers in California, including dentists and staff, will be required to show proof of COVID-19 vaccination or submit to regular tests if unvaccinated. Full compliance is required by August 23. Additionally, on July 26, the Department of Veterans Affairs (VA) announced that dentists who serve Veterans must get fully vaccinated within eight weeks. The VA mandate covers Title 38 health care personnel, including dentists and other patient-facing workers.

2. The American Dental Association updates its guidelines

On July 13, the American Dental Association updated its pandemic procedures for offices to help fight COVID-19. Hazard assessments are encouraged, pre-appointment screenings are still necessary, and dentists are encouraged to exercise their best judgment when setting a safety plan for their practices.

3. Senate Democrats’ proposed budget would add dental coverage to Medicare

On July 13, Senate Democrats agreed to pursue a $3.5 trillion reconciliation bill that would add dental coverage to Medicare. Medicare serves almost 63 million members, so this could mean an influx of senior citizen patients if the bill passes.

4. Paycheck Protection Program (PPP) loan forgiveness deadline coming due

If you received a PPP loan last year, be sure to apply for forgiveness before the next deadline passes you by in September. Under the program’s rules, borrowers who don’t apply for forgiveness within 10 months of the end of the covered period will need to begin making payments to their lender.

5. Department of Health and Human Services bans balance billing

At the beginning of the month, the Department of Health and Human Services prohibited balance billing, effective January 1, 2022. The new rule, “Requirements Related to Surprise Billing; Part I,” applies to dental plans embedded in medical plans, but not to standalone dental.

New CDT codes for COVID-19 vaccination

In March 2021, the Code Maintenance Committee of the American Dental Association (ADA) added seven new codes designed to report the delivery of COVID-19 vaccine. These codes have been added to the preventive category of service.

Additionally, a new code for molecular testing has been added to the diagnostic category of service.

These services are covered under medical plans and therefore will not be covered by Delta Dental. If you administer COVID-19 vaccines in your dental office, check with your patients’ medical carriers for more information about coverage.

New CDT codes as of March 29, 2021:

  • D0606 — molecular testing for a public health related pathogen, including coronavirus. This procedure is not a benefit of most Delta Dental plans. The fee is the patient’s responsibility
  • D1701 — Pfizer-BioNTech Covid-19 vaccine administration – first dose. This procedure is not a benefit of most Delta Dental plans. The fee is the patient’s responsibility.
  • D1702 — Pfizer-BioNTech Covid-19 vaccine administration – second dose. This procedure is not a benefit of most Delta Dental plans. The fee is the patient’s responsibility.
  • D1703 — Moderna Covid-19 vaccine administration – first dose. This procedure is not a benefit of most Delta Dental plans. The fee is the patient’s responsibility.
  • D1704 — Moderna Covid-19 vaccine administration – second dose. This procedure is not a benefit of most Delta Dental plans. The fee is the patient’s responsibility
  • D1705 — AstraZeneca Covid-19 vaccine administration – first dose. This procedure is not a benefit of most Delta Dental plans. The fee is the patient’s responsibility
  • D1706 — AstraZeneca Covid-19 vaccine administration – second dose. This procedure is not a benefit of most Delta Dental plans. The fee is the patient’s responsibility.
  • D1707 — Janssen Covid-19 vaccine administration. This procedure is not a benefit of most Delta Dental plans. The fee is the patient’s responsibility.
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