Four Fall Focus Areas for CDA Government Relations

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By Jennifer Goodrum, CDA Director of Government Relations
From the Fall 2017 Journal of the Colorado Dental Association

Even when the state legislature is not in session, the Capitol remains busy with post-2017-session and pre-2018-session work. This fall has been particularly busy to that end with a number of legislative interim committees and rulemaking processes affecting dentists and dental offices. 

Limitations for Opioid Prescribing 

A legislative-authorized interim task force has met through the summer to discuss Colorado’s current opioid abuse epidemic and possible solutions. Prescribing behavior has been a key focus of the task force, among numerous other topics ranging from education and prevention to treatment options. A number of possible prescriber reforms have been discussed including

  • improving the Prescription Drug Monitoring Program (PDMP) system,
  • mandating PDMP usage,
  • requiring e-prescribing,
  • limiting dosage that can be prescribed,
  • requiring concurrent naloxone prescriptions when a patient is prescribed opioids, and
  • mandating prescriber CE. 

In addition, efforts are underway to revisit a regulatory board policy on opioid prescribing developed by the state’s medical, dental, nursing and pharmacy boards in October 2014. This policy sets basic parameters for opioid prescribing and establishes some thresholds where additional patient safeguards should be applied (e.g. opioid therapy that is more than 90 days in duration, 120 MME dosages or certain high-risk formulations). The state is currently considering revisions to a number of these thresholds to align with recent policy recommendations adopted by the Centers for Disease Control and Prevention. The CDA is actively engaged in shaping policy around both provider and payer reforms related to the opioid epidemic to ensure that any solutions adopted are logical and effective from a prescriber perspective. 

Sales and Use Tax Simplification

A second legislative-authorized interim task force has met through the summer to discuss Colorado’s complicated local sales and use tax structure. Efforts are underway to simplify current systems to make compliance easier for businesses. These efforts would be particularly beneficial to small businesses, like dental offices, that often do not have the resources to track the many disparate local tax codes and associated requirements. Dental offices are responsible for paying local sales and use tax when providing certain goods to patients—ranging from consumer use goods (toothbrushes, toothpaste, teeth whitening kits, etc.) in some jurisdictions to medical devices (like orthodontic retainers) in other jurisdictions. The lack of consistency in codes and current difficulties associated with registration and remittance have been a longstanding challenge for dental offices.

Clarifications to the Dentist’s Role in Sleep Apnea 

In March, the Colorado Dental Board began stakeholder meetings on sleep apnea policy, resulting in the development of a draft rule to clarify dentists’ versus physicians’ roles in diagnosing and treating sleep disorders. A draft rule was developed by the Colorado Dental Board as part of this process, which clarified that dentists may fabricate and titrate oral appliances for treatment of sleep disorders pursuant to an order by a qualified medical provider with the medical provider responsible for final sign off on the efficacy of the device. Initial diagnosis of sleep disorders, as well as treatment planning, was the purview of the medical provider, who must also order and interpret diagnostic tools like sleep studies—though dentists may dispense sleep studies ordered by a physician. Dentists’ ability to independently use sleep studies to titrate oral appliances is a current area under debate, as well as whether accreditation requirements for durable medical suppliers should be applied to dental offices dispensing sleep study devices. Precedents set in this draft rule could have far reaching implications for future areas of overlap between dentistry and medicine.

Medicaid Program Improvements

In July and August, Medicaid solicited comments from stakeholders as they conducted a “Regulatory Efficiency Review,” which is designed to evaluate opportunities to improve the efficiency and cost effectiveness of programs for patients and providers. The CDA submitted extensive comments addressing numerous topics, from consistency of policies between adult and children’s dental benefits to current definitions of “high risk caries” in patients. Internal staff discussions of stakeholder feedback occurred in late September. Next, the Medical Services Board will consider recommendations on rule and policy changes. All stakeholder input will be shared with Medicaid’s Medical Services Board and the CDA will keep members informed of any policy changes made as a result of this process. 

The 2018 Colorado legislative session starts on Jan. 10, 2018. The CDA anticipates another very lively session and will keep members informed of important bills that will affect dentistry.