By Jennifer Goodrum, CDA Director of Government Relations
From the Spring 2017 Journal of the Colorado Dental Association
Colorado’s 2017 legislative session is in full swing and it has been an extremely busy session for dentistry. The CDA represents its members every day at the state Capitol monitoring the nearly 500 bills being considered by the state legislature this year. This year, the CDA is actively tracking more than 60 bills with direct or indirect impacts on dentists and dental offices.
Health insurance reform is a top topic of conversation this year at the state Capitol. In addition to conversations at the federal level about the future of the Affordable Care Act, many state level conversations are underway about coverage mandates, carrier-provider relations and even a sunset review of the state office that regulates insurance. Some of the key insurance reform bills pertinent to dentists include:
- Senate Bill 190 would stop carriers from dictating fees for services they do not cover in dental plans. The practice of dental plans dictating fees for non-covered services has been an ongoing concern for many dental offices, as it can disrupt patient choice of dental services and the patient-provider relationship. It can also interfere in fair delivery of dental services for patients across the state, creating cost shifting and barriers to care. The bill seeks to add Colorado to the list of 39 U.S. states that prohibit this unfair contracting practice. Senate Bill 190 has passed the state Senate and will soon be considered by the state House Health, Insurance and Environment Committee.
- Senate Bill 88 seeks to address the growing trend of narrow networks with restricted provider panels. This bill would require carriers and any intermediaries used to manage or administer health benefits to disclose the standards used to select network providers and tier providers in tiered plans. This bill has passed the state Senate and will soon be considered by the state House.
- Senate Bill 133 would require the state Division of Insurance to investigate provider complaints against insurers, especially when there are patterns of complaints. The bill would require notification to the complaining provider about the outcome or resolution of the complaint. Senate Bill 133 has not yet had a hearing, and it appears that this bill may transition into a pilot study on provider complaints. The CDA is investigating whether dental complaints can be incorporated into the pilot program.
- House Bill 1173 would address situations where a carrier retaliates against a provider who disagrees with a medical policy or patient policy determination. The bill would prohibit an adverse action (such as termination of a provider’s contract) if a provider testifies, files a complaint, participates in an investigation or communicates with a public official or law enforcement about the carrier’s policy. There have been reports about dental carriers retaliating against dentists for such activities in the past. This bill has passed the state House and is scheduled for hearing in the state Senate Business Committee in late March.
- House Bill 1247 would address patient choice of provider and allow any provider willing to adhere to the terms of a carrier’s contract to participate in the carrier’s network. The bill as written pertains only to chiropractors, optometrists and pharmacists, though it would potentially set an interesting precedent for other professions if passed. Similar efforts have been routinely pursued in past legislative sessions, and have slowly gained traction with legislators. The bill will soon be considered by the state House Health, Insurance and Environment Committee.
- Senate Bill 206 would address charges and patient notice for services delivered by an out-of-network provider at an in-network facility, a situation sometimes encountered by oral surgeons and other dentists who provide hospital or facility-based care. The bill would require that health insurance plans pay either the billed charges or 80% of regional usual and customary fees to out-of-network providers that render services at in-network facilities. The bill creates a dispute resolution process for cases where the provider feels these payment criteria were not met. Senate Bill 206 would also require certain disclosures to the patient whenever an out-of-network provider offers services at an in-network facility. Senate Bill 206 was recently introduced and will have its first hearing before the Senate Business Committee in late March.
These 2017 insurance bills represent a first step in a broad conversation the CDA will continue to have with legislators in coming years about needed reforms to dental plan design and dental care delivery.
Healthcare licensure and regulation are another set of hot topics before the state legislature this year. There are a number of bills that could affect dentists and dental hygienists in this domain.
- House Bill 1010 was a bill that made a few technical changes to the Dental Practice Act, based on recommendations of a joint task force between the CDA and Colorado Dental Hygienists Association (CDHA). The bill addressed some clean-up items on lasers, dental hygiene prescribing and liability coverage requirements in follow-up to changes made during the 2014 Sunset Review. This bill has passed and has been signed by the Governor. Under the signed bill, the Colorado Dental Board will have a bit more flexibility to write rules on laser usage by dental hygienists, though any authorizations must comply with existing scope of practice. The bill also clarified that dental hygienists may maintain emergency drugs relevant to their scope of practice when acting in collaboration with a licensed dentist.
- House Bill 1121 would require all healthcare providers with prescribing authority, including dentists and dental hygienists, to undergo a background check at the time of initial licensure or during the provider’s next license renewal. Background checks are a requirement for licensure of healthcare providers in nearly all U.S. states. The CDA has worked hard to streamline this bill and associated processes for dental providers should it pass. The CDA successfully amended the bill to ensure the check would be a one-time (as opposed to ongoing) requirement, to give more convenient options for where the check may be done and to ensure that the requirements would not apply to retired licensees. While the bill has a lot of consumer and legislator support (though also some opposition in the provider community), it faces a tough road ahead due to a large cost to the state to implement. The bill has passed its first two committees in the state House and is waiting for its hearing before the House Appropriations Committee.
- House Bill 1165 would better outline timelines and notification processes related to disciplinary actions handled by the state Department of Regulatory Agencies (DORA), the state agency that includes the Colorado Dental Board. The bill could help ensure a bit more consistency and efficiency in DORA processes for both dentists responding to a complaint and any patients involved. This bill was drafted in response to a poor patient experience with discipline related to a dental laser injury case, though all overt references to dental have now been removed from this bill. The bill is scheduled for its first hearing in the state House Business Committee in late March.
- House Bill 1254 is a bill that seeks to remove current limits to non-economic damages in cases of wrongful death of a child under the age of 21. There is concern in the healthcare community that this bill could affect liability coverage premiums for healthcare providers, as there is not a specific exemption in this bill for healthcare cases (which fall under different and much higher limits in current law). This bill was just introduced in the state House.
- There is also a bill still expected to address opioid prescribing in light of growing attention to the opioid abuse and addiction epidemic. There has been interest in exploring a limit on initial prescriptions of opioids prescribed for acute conditions. A seven-day initial limit has been proposed with perhaps a partial fill option or streamlined refill process in cases of ongoing need. This requirement would not apply to the treatment of chronic pain. Mandatory CE for opioid prescribers and mandatory PDMP checks have also been proposed. Several initial concerns have been raised that will require continued conversation. The CDA will remain engaged in conversations and negotiations as the exact details of these bills are determined.
Finally, there are several bills this legislative session to address Medicaid program integrity and patient communications. With these bills, the CDA is working to address several unique challenges associated with the Medicaid dental benefits—specifically complications around collecting required co-pays in cases where a Medicaid patient has dual coverage (private insurance and Medicaid), cases of patient misrepresentation of Medicaid coverage status where the provider may be liable for any billing of the patient, and cases where it may be in a patient’s best interest to see a non-Medicaid provider due to the unique nature of the capped dental benefit. The CDA hopes to be able to streamline several of these issues to help reduce challenges for both dentists who participate and do not participate with the Medicaid dental benefit.
The content of this article was written March 15, 2017. Some of the bill information included may have changed since publication.
Key Colorado Regulatory Happenings
In addition to a busy legislative session, rules on several key dental topics are currently being considered by state agencies.
The Colorado Dental Board has organized a sleep apnea workgroup to draft new rules and policies regarding sleep apnea services offered by dentists. The CDA encourages members who might be affected by these changes to participate in the workgroup, which began meeting at the end of March. Additional details are available under “Featured News” at cdaonline.org.
The Colorado Department of Public Health and Environment Radiation Program is also proposing extensive changes to x-ray regulations that apply to dental offices. Proposed changes would require some additional quality assurance activities, including equipment maintenance, integrity evaluations of protective apparel, annual evaluations of x-ray operators, tracking and reporting of certain errors, and potentially increased compliance inspections. Operators of CT systems (like dental cone beam machines) may also be subject to more stringent standards, though the CDA is working to ensure that dental CT equipment continues to be exempt from accreditation requirements. The CDA encourages members to provide input during this rulemaking process. Additional details about the process and copies of the proposed changes can be accessed at cdaonline.org.