HB127/SB68:  Bill to establish independent dental hygienist in limited services

The ADS and Dental Board have successfully had SB68 modified and is neutral as to its passing.  HB127 still needs to be revised and is opposed by the ADS.  Neither bill has been scheduled this year. SB68: SB68, as a reminder, gives dental hygienists a measure of independence as written allowing them to work independently in underserved settings providing normal hygiene services, silver diamine fluoride (SDF) and atraumatic restorations (scoop and fill or ART).

HB216/SB157: Bill to move inspection of radiographic units back to the state department of radiologic health and give the responsibility of licensing review away from the board of dentistry to the Department of Occupational Licensing. 

Temp licenses would be given until an application is complete after which the application would be sent to the board for review.  ADS opposes this bill as written. This is an election year for the state house, the Alaska Dental Society Meetings have been filled with COVID related issues such as state testing inefficiencies and unattainable timelines, PPE shortages, and lack of member participation.  In short, no one is talking about dental legislation at this time.

Access to care issues:  

There has been a decrease in medical travel throughout the state making it more difficult for patients to receive care outside rural Alaska. 

The State quietly reversed a 5% decrease in fees that went into effect last year.  I am sure with an uncertain fiscal situation coming in the near future, especially during the slow-down in our economy and a new legislature, new cuts will be proposed.       

Access to care issues

• COVID-19 and the continuing recession in Alberta are putting more pressure on families and the social system to enable access to dental care, leading to increasing unemployment challenges.
• The past few years has seen a significant number of pediatric dentists move to Alberta; although this is helping increase the access to care by pediatric dentists, there is a considerable strain on access to OR time available to new practitioners.
• A couple of new private surgical suites have opened up in the past year and this has helped facilitate the OR time for healthy children.

Province/State Board Issues

• The inequity to pediatric dental access to public OR time in the hospital (children under 2 and children with medical issues) continues to be a primary road block. As there are only 2 centers in Alberta for this type of care the waitlists are long.

The CAPD (Canadian Association of Pediatric Dentistry) has an annual session. This year it will be held in Montreal from September 23-25^th/2021; next year it will be held in Whistler from October 27-29, 2022.

The BC dental association has collected a list of dentists willing to provide vaccines to the general population which would be administered at community based centres and not individual dental offices. This program has not started at this time as we wait to receive a greater supply of the vaccines.

Access to adequate PPE does appear to be an issue.

There are sufficient private pediatric dental clinics in the urban centres of British Columbia to serve the local communities, however, there are an insufficient number of practitioners in the rural areas of the province. Almost all dental offices are willing to accept, from lower income families that do not have private insurance plans, the provincially funded program that reimburse for procedures at lower rates than the provincial specialty fee schedule. The pediatric dentistry residency program at the University of British Columbia now accepts 4 trainees/year.

CSPD 2021 Legislative, Regulatory, and Public Policy Priorities Summary

Not surprisingly, COVID-19 dominated much of the 2020 legislative session and continues to do so this year. As a result of pandemic-related restrictions on social distancing, public gatherings, and stay-at-home orders, the Dental Board of California acted to accept an entirely mannikin-based assessment for California dental licensure, resulting in California becoming one of the first states in the country to move completely away from live-patient examination. Waivers extending the continuing education deadlines for licensure renewal of dental professionals were granted and provisions for allowing credit for prerecorded lectures were broadened. Given the proximity to unmasked patients during care and the essential nature of dental treatment, dental professionals and their support personnel were placed in the first tier of the state’s vaccination plan. And, as a public health measure, the Department of Consumer Affairs issued an emergency authorization for dentists to administer the vaccine in public health settings.

This year the attention is being directed to some of the economic impacts of the pandemic. As dental benefit plans experience record net profits as a result of continued premium collection during a nearly year-long period of office closures and decreased patient demand, many dental providers continue to find themselves in difficult financial condition. California regulators have acknowledged insurance plans have some responsibility to support distressed practices as a part of maintaining adequate provider networks. In this regard, the California Dental Association (CDA), supported by the specialty organizations, is advocating for targeted, time-limited relief in the form of grants, supplemental payments or PPE reimbursement that will help keep provider networks intact and prevent massive disruption to dental care access in California.

In addition, CDA is working with the California Department of Public Health and in the legislature (AB 526) to ensure that when reliable rapid testing technology is available, dentists can obtain and use COVID-19 test kits in the office to identify positive, asymptomatic patients, refer them to the appropriate medical venue, and receive reasonable reimbursement for administering the tests.

Other proposals in this year’s legislative session include a bill (AB 733) intended to increase access to dental care for children and pregnant women enrolled in California Medicaid (Medi-Cal) by allowing medical practices to engage already-existing Registered Dental Hygienists in Alternative Practice (RDHAPs) onsite to provide oral health education, preventive services, and care coordination through referral to a dental home as entry to the dental delivery system. Another bill (AB 1163) would repeal current law successfully sought by the beverage industry that preempts local governments from imposing taxes on sugary drinks until 2030. Also closely watch will be the development of law and regulation under legislation passed in 2018 which redefines the permitting process, training requirements, and patient supervision of general/deep sedation, moderate sedation, and pediatric minimal sedation in the dental setting.

On the budgetary front, the Governor’s FY 2020-2021 state budget, which went into effect July 1, maintained the continuation of tobacco tax funding approved in 2016 to support supplemental Medi-Cal provider reimbursement, dental student loan repayment grants in return for practice in underserved areas, and the state Office of Oral Health. After decades of declining participation, these programs have resulted in a steady increase of over 1,600 newly-enrolled Medi-Cal dental providers since 2017, helping solve access-to-care issues for disadvantaged populations. 

2021 Legislative session

The following bills did not advance in this legislative session:  Bills on eliminating the sale of flavored tobacco products, bills regarding taxation on sugary beverages, and bills on re-instating the adult Medicaid dental benefit. 

Advocacy

Due to COVID-19, the Give Kids A Smile event was cancelled for this year.  Oral health education in Head Start sites was given virtually and the community health event is planned for 2022.

Access to care issues

The University of Hawaii School of Nursing and Dental Hygiene obtained a five year HRSA grant to implement a program for Expanded Function Pediatric Dental Hygienists in which the NYU Langone residency will collaborate with the hygiene students. Hopefully these pediatric dental hygienists will go into the workforce in areas of need such as community health centers and implement the teledentistry program in remote areas.

Other Issues

Five new residents at the NYU Langone Hawaii site have matched and began their program on July 1, 2021. The residency has provided access to care for Hawaii’s children at community health centers on the islands of Hawaii, Lanai, Maui and Oahu for over ten years.

State Medicaid

Budget cuts to the state proposed a reorganization to Medicaid structure in Nevada that would require preauthorization for all services, including most preventative services, and would place all Medicaid recipients under the same administrative service (getting rid of Liberty).  This was not approved but a universal 6% decrease in Medicaid fees was approved.

Access to care issues

PPE limitations due to COVID-19

Other Issues

COVID-19 has significantly impacted practice of dentistry in Nevada.  Some support staff were very reluctant to return.  A few practitioners did not close during the mandatory shut down (6 weeks) so the board threatened loss of dental license and revoking business licenses if they did not follow the recommendations.  At this point, the likelihood of shutting down again is minimal. 

HB 2528: Dental Therapy

ODA and the OAPD had significant concerns with HB 2528 as introduced, and spent the entire session working with legislators and negotiating the bill to add critical constraints that will increase patient safety, increase education, and limit scope.

STATUS: Passed House 38-17, passed Senate 20-9 with additional amendments, House concurred 45-11 on amendments

HB 2627 Interim Therapeutic Restorations

The bill allows expanded practice dental hygienists to perform interim therapeutic restorations (or “scoop and fill”) and contains crucial sideboards around training, scope, and supervision. ODA supported the bill after its efficacy was proven through Pilot Project #200, a pilot project sponsored by OHSU and Capitol Dental Care. This bill expands access to dental care, particularly for children, by expanding the scope for dental hygienists in ways that are practical and safe. STATUS: Signed by the Governor

HB 2969 Oral Health Education

The Legislature passed HB 2969 this session, which requires school districts to provide age appropriate instruction in oral health as part of the overall health curriculum beginning July 1, 2025. ODA was pleased to join our oral health partners in advancing this bill.

STATUS: Passed House 53-1, passed Senate 25-2

Legislative issues:

• Dental quality assurance committee working on dental in office sedation guidelines, requirements and permit (no final announcement yet). Infection control (no final announcements yet)
• COVID-19 vaccine can be administered by dentists, currently phase 1A (does not include dentists or dental staff)

State Medicaid:

Report from 11/2019 required “the HCA must submit a report to the Governor, as well as appropriate committees of the Legislature, outlining a plan to improve access to dental services for Medicaid clients. The plan will need to address options for carve-in, carve-out, fee-for-service and other models, and include associated costs.”

State Medicaid:

Budget cuts continue to be a concern with the state being very reliant on the energy sector. Due to said budget cuts, the reimbursement rates will decrease 2.5% for all procedures and codes (effective 1/2/21).