AGD Washington Briefing
May 20, 2013
Rep. Gosar Introduces Bill to Help Consumers Receive the Full Value of Their Dental Coverage
On April 26, 2013, Rep. Paul Gosar, DDS, R-Ariz., introduced H.R. 1798, the Dental Insurance Fairness Act of 2013, legislation that would provide a more equitable system for dental patients by making dental care more affordable and accessible. It would do this by requiring plans to allow both coordination of benefits and assignment of benefits.
More specifically, 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. The bill would also permit consumers to assign benefits by a dental plan to providers who do not participate in the network so that the patient’s family does not have to pay for covered services out-of-pocket and wait to be reimbursed by the plan.
Impact on General Dentistry: The AGD commends Rep. Gosar for introducing this important legislation and will closely monitor the bill as it moves through the legislative process.
CMS Announces Second Round of Health Care Innovation Grants – Includes Dentistry
On May 15, 2013, the Centers for Medicare and Medicaid Services’ (CMS) Innovation Center announced a second round of health care innovation grants that will divvy up $1 billion for creative projects focused on specific payment and delivery reform models. The new projects will address ways to: rapidly reduce costs for Medicare, Medicaid and CHIP outpatient and post-acute care costs; improve care for populations with specialized needs; improve clinical and financial models for specific provider types; and improve care through population-based approaches defined by geography or socioeconomic class.
Regarding the model for improving care for populations with specialized needs, CMS says priorities will include high-cost pediatric populations, children in foster care, children at risk for dental disease, adolescents in crisis, people with Alzheimer’s, those requiring long-term support and services, and those with serious behavioral health needs.
To read the announcement in full, click here.
Impact on General Dentistry: The AGD will continue to monitor CMS’ efforts to address the issue of untreated dental disease and increased access to oral health care.
House Votes to Repeal Obama’s Signature Health Law
On May 16, 2013, the House again voted to repeal the Patient Protection and Affordable Care Act (ACA) – a move House Republicans hope will pave the way for narrower votes that target specific parts of the law. This vote was also scheduled as a concession to conservative freshmen members, who were not yet in Congress for the House’s previous votes to repeal or defund all or part of the ACA. House leadership stated that freshman members requested a chance to go on the record supporting full repeal.
The House has voted more than 35 times to repeal part or all of the ACA, or to at least redirect money needed for various provisions of the 2010 law. Republican opposition is based on the argument that the law has caused economic uncertainty for American businesses, will cost more than the government can afford, and that it imposes a tax on those who do not comply with the insurance requirement. The bill isn’t expected to go beyond the House, but House Republicans are hopeful that the vote will put Democrats on the defensive going into the 2014 midterm elections.
Impact on General Dentistry: The AGD will continue to monitor the implementation of the ACA and provide updates on any legislative developments as they become available.
CMS Releases FAQ on Key Health Care Law Issues
On April 25, 2013, the Centers for Medicare and Medicaid Services (CMS) released an FAQ regarding the Patient Protection and Affordable Care Act (ACA). Many questions are related to the Qualified Health Plan (QHP) certification process, but answers to questions regarding coverage of dental services, including requirements for stand-alone dental plans, are included.
Impact on General Dentistry: The AGD will continue to provide information regarding the implementation of the ACA, specifically as it relates to dentistry, as it becomes available.