By Jennifer Goodrum, CDA Director of Government Relations
From the Summer 2016 Journal of the Colorado Dental Association
Colorado’s 2016 state legislative session ran from Jan. 13, 2015, through May 11, 2016. As always, the CDA worked hard at the statehouse on your behalf. It was a busy – and very successful – session for the dental profession. This year, the CDA was successful in adding funding for several key dental programs and in shepherding several key cleanups to the Dental Practice Act through the legislative process. In addition, the CDA monitored more than 50 bills that had direct and indirect impacts on the dental profession.
Key priorities for 2016 included:
- Ensure the clean-up of a Colorado Dental Board rule that exempts dentists with inactive licenses from having to carry liability coverage.
- Based on small changes made in statute during the 2014 Sunset Review, the state attorney general objected to a rule exempting certain dentists and dental hygienists from carrying a full liability coverage policy. When DORA was unable to run a bill to ensure a reasonable approach for dentists and dental hygienists who are not in active practice, the CDA took the lead on this effort. The cleanup bill, HB 1327, passed with unanimous support.
- Monitor potential revisions to dental fee splitting requirements, given interest in changes by a Colorado dental support organization.
- SB 9 revised fee-sharing language in the Dental Practice Act to allow dentists to pay for practice management services. The bill originally borrowed language from the Medical Practice Act that would be rather difficult to understand. The CDA successfully proposed revisions to make the language more straightforward and ensure that payments for services would preserve the dentist’s independent professional judgment. The amended version of SB 9 passed with unanimous support.
- Protect the recently added adult Medicaid dental benefit and dental rates in Colorado amidst severe budget constraints (due to unique Colorado TABOR limits that restrict state general fund growth).
- The CDA was actively involved in discussions on HB 1405 (the long bill), HB 1409 (unclaimed property trust fund transfer for the continued funding of adult Medicaid dental benefits) and HB 1420 (enterprise fund for the hospital provider fee). During the state budget process, the CDA prevented any Medicaid rate cuts for dentists, and preserved the adult dental benefit in the midst of difficult budget negotiations.
- Improve the state loan forgiveness programs for dentists, including securing additional funding to ensure that awards are sufficient to incentivize students relative to debt load.
- The CDA more than quadrupled the amount of funding available for dental loan forgiveness candidates from $200,000 to $875,000 through HB 1408. This additional $675,000 will be available to support more dentists who qualify for loan forgiveness in Colorado, and can help incentivize more dentists to practice in rural and other underserved areas. There is the potential for a substantial amount of additional loan forgiveness funding to be made available should a statewide ballot initiative increasing tobacco taxes pass in November 2016.
- Improve incentives to dentists to participate in dental access initiatives, including expansion of dental practices in rural Colorado and Medicaid.
- The CDA helped pass HB 1142, a bill that offers a state tax credit to rural dentists who act as preceptors for dental students, as direct encounters in rural practice have shown to increase the likelihood of long-term engagement in these communities. Starting with the 2017 tax year, qualifying rural dentists may claim a $1,000 state income tax credit when acting as a preceptor to a dental student who serves a four-week aggregate rotation. The bill sets a precedent for incentivizing education pathways, and there is hope that the scope of the bill could be expanded in future years. The CDA also used HB 1212, a bill that would create a tax incentive for Medicaid providers that are not reimbursed the full cost of services provided, to further educate legislators about the differential between Medicaid rates and the cost of providing dental care. HB 1212 did not pass.
- Improve the environment for delivery of dental services to ensure access to care, including addressing insurance reforms needed to address current systemic inequities.
- The CDA engaged in discussions with the healthcare community regarding targeted reforms related to insurer payments to out-of-network providers and non-covered services. A bill addressing payments to out-of-network providers was expected during the 2016 legislative session, but no bill was introduced. The 2016 bill was expected to be narrow and focus primarily on emergency services and care at in-network facilities as a starting point. Discussions on this topic will continue in future sessions. Another bill, SB 162, would have allowed Medicaid patients to choose non-Medicaid providers and pay out-of-pocket for services. The bill would have removed current penalties for non-Medicaid providers who bill consenting Medicaid patients for services provided. SB 162 did not pass, but raises important discussions, especially related to a limited benefit like adult dental. Conversations on this topic are expected to continue over the interim months. HB 1361, a pharmacy choice of provider bill, also raised discussion about patient choice versus insurer mandates. While HB 1361 ultimately died in the Senate, it maintained viability for much longer than expected, which may indicate some level of receptiveness by insurers in addressing some of the long-standing discussions on insurance reform. The CDA will continue to engage in conversations and set the stage to address vital dental insurance reforms in coming years.
In addition to these priority topics, successful 2016 bills with potential dental impacts include:
- HB 1047 worked to streamline license portability across U.S. states for physicians through an interstate licensure compact. If this model for physicians is successful, it could potentially be explored for other professions, including dentists.
- HB 1160 continued through 2021 the regulation of surgical assistants and surgical technologists, including the existing requirement that employers check a state database to verify the registration credential before allowing the individual to perform care on patients. This requirement may impact some oral surgeons who utilize surgical assistants or surgical technicians (or dental assistants operating in these capacities) in facility operating rooms.
- HB 1432 allows private sector employees to inspect or request copies of their personnel files annually. A former employee may make one inspection of the personnel file after termination. Personnel files include any records used to determine the employee’s qualifications for employment, promotion, additional compensation, termination or other disciplinary action. Personnel files do not include certain confidential records related to previous employers, ongoing investigations, or accusations made against the employee. The requestor of records would be required to pay reasonable costs of duplication, as applicable.
- HB 1438 requires employers to make good-faith efforts toward providing reasonable accommodations for job applicants or employees for conditions related to pregnancy and childbirth. Reasonable accommodations are considered activities like more frequent or longer break periods (including restroom, food and water breaks), modification of equipment or seating, limitations on lifting, assistance with manual labor, light duty (if available), temporary transfer to a less strenuous or hazardous position if available (with return to the current position after pregnancy), job restructuring, or modified work schedules. Exceptions are provided where pregnancy accommodation would pose an undue hardship for the business. A business is not required to hire a new employee, discharge or transfer another employee, create a new position, or provide paid leave beyond regular business policies in order to comply with HB 1438. Employers are required to provide and post notice of pregnancy accommodation employment practices to all employees – either at the start of employment or by December 8, 2016. Failure to comply with these requirements is considered discriminatory and an unfair employment practice.