By Jennifer Goodrum, CDA Director of Government Relations
From the Spring 2015 Journal of the Colorado Dental Association
The Colorado state legislature meets from mid-January until mid-May each year. During this time, the CDA is present daily at the Capitol advocating on your behalf. This year, the CDA is involved in tracking more than 30 bills with potential impacts on the dental profession. Primary bills of interest and their current status include:
• HB15-1191: Dentist Rating Bill
The CDA is running HB 1191 to help protect dentists from provider rating systems that rate a dentist solely on treatment fees. Last summer, one of the dental insurance plans in Colorado sought to implement a three-star rating system where dentists with higher fees for services would get lower ratings, and dentists with lower fees would get higher ratings. Colorado has an existing law—the Physician Designation Disclosure Act—that sets minimum standards for some insurer rating systems. This law requires that multiple factors be incorporated into these rating programs—measures like the physician’s quality of care, adjustments for patient population, a reasonable period of data, a robust appeals process and more. These standards help ensure that designation systems are fair, accurate and useful to consumers. However, Colorado’s existing law applies exclusively to physicians. It does not currently include other healthcare providers. HB 1191 would expand this existing law to include dentists.
CDA Position: Support
Status: The bill passed the House and the Senate Heath committee.
• HB15-1238: Tax Credits for Preceptors
HB 1238 is a bill that would offer up to $5,000 in personal state income tax credits to dentists and other providers in underserved areas (HPSAs) that offer preceptor services to students. Up to $1,000 in tax credits could be claimed for each student who served a four-week aggregate rotation. Medicaid providers may be able to claim up to $1,500 in tax credits per student, up to the $5,000 limit, if 10% or more of the provider’s practice is Medicaid patients. Hopefully, this bill will increase the availability of rotations in rural and underserved areas for dental students, and ultimately increase placement opportunities for future dentists in areas of unmet need.
CDA Position: Support
Status: The bill passed the House Health committee and is scheduled for a hearing by the House Finance committee in early April.
• HB15-1151: Floor for Medicaid Reimbursement Rates
Recognizing that current Medicaid dental reimbursements can be a barrier to provider participation in the program, the CDA has a strong commitment to work to improve Medicaid reimbursement rates. The CDA has worked to increase reimbursement by 6.5% since 2013, but recognizes there is still substantial progress to be made to even cover costs for many private practices. The CDA continues to message the importance of addressing dental rates to legislators, and we appear to be gaining some traction on this topic. This year, the state’s Joint Budget Committee introduced a bill—HB 1151—that would establish a floor for Medicaid rates at 60% of Medicare rates or usual and customary rates (UCR) as applicable to the provider population. The primary intent behind this bill is to allow the legislature to objectively review current provider reimbursement rates to see where the biggest discrepancies lie. HB 1151 was largely a theoretical exercise and was not expected to progress this year. It was killed by the House Health committee in mid-March. However, it provided a great opportunity to continue dialogue about how current dental Medicaid rates are unsustainable, and has continued to highlight the fact that dental reimbursements are some of the lowest among Medicaid programs. The discussion about a floor for reimbursement rates will continue into the 2016 legislative session. In addition, the CDA is continuing to work on improving Medicaid dental rates aside from this bill. While an increase to 60% of UCR will not be realistic this year, we are hoping for another incremental across the board rate increase and to raise some targeted codes to at least 60% of UCR.
CDA Position: Support
Status: This bill was postponed indefinitely by the House Health committee.
• SB15-031: License Reciprocity
SB 31 would have exempted people who move into Colorado from having to be licensed to practice their profession. This licensure exemption would apply to any profession, meaning that dentists and dental hygienists could move in from another state and practice for a year without having to be licensed with DORA. While the professional would have to meet certain basic standards to qualify for a license exemption, there were concerns that the bill could encourage dental professionals with questionable histories to move to Colorado, as there would be no tracking and little oversight. Since this licensure loophole did not even require registration with DORA, it might enable questionable individuals to nearly permanently evade licensure. Concerns were also raised that this exemption could offer a competitive advantage to non-Coloradans. As this bill did not seem in the best interest of patient safety and care, the CDA amended the bill to ensure dentists were not included, and then helped to kill the bill.
CDA Position: Amend
Status: This bill was postponed indefinitely by the Senate Business committee.
• SB15-074: Disclosure of Direct Pay Healthcare Prices
SB 74 would have required health professionals, including dentists, and health facilities to publish a list of cash pay patient prices on their Website (or on paper if the practice did not have a Website). The bill would have required inclusion of at least the top 25 most common procedure codes. In addition to potential logistical concerns for providers, there were a number of challenges with the way the bill was constructed, and concerns about whether it would actually provide useful consumer information. The bill was killed in mid-March in the House State Affairs committee.
CDA Position: Monitor
Status: This bill was postponed indefinitely by the House State Affairs committee.
• HB15-1309: Interim Therapeutic Restorations by Dental Hygienists
The CDA has been involved in discussions with the oral health community about authorizing dental hygienists to perform interim therapeutic restorations subject to certain training, experience and supervision requirements. The CDA has been helping lead efforts to ensure the parameters for this bill are crafted in a manner that maintains patient safety and a high standard of care. Research published by the ADA and other state dental associations supports the safety and efficacy of placement of ITR by dental hygienists with appropriate training and supervision. Over the last few years, the CDA has consistently messaged to legislators the importance of utilizing existing dental team members to their full capacity in lieu of adding a new type of dental provider. Colorado’s bill is being designed as a five-year pilot program with a focus on new tele-health technologies. The model is expected to largely mirror a program called the Virtual Dental Home that has been implemented in California, with the support of the California Dental Association. Additional details on this model will be shared with CDA members as the bill details are finalized.
CDA Position: Support
Status: The bill has been assigned to the House Health committee.
In addition to the bills listed above, the CDA is tracking more than 30 additional state bills. View a full synopsis of the bills applicable to dentistry at cdaonline.org/billstatus.
