By Jennifer Goodrum, Director of CDA Government Relations
Colorado’s 2015 state legislative session ran from Jan. 7 through May 6. As always, the CDA worked hard at the statehouse on your behalf. It was a busy – and productive – session for the dental profession. This year, the CDA was successful in enacting some reforms to insurer rating systems that will help ensure dentists are treated fairly and consumers have access to accurate information. In addition, the CDA monitored nearly 50 bills that had direct and indirect impacts on the dental profession.
The CDA’s 2015 legislative priorities included:
• HB 1191, a bill that expanded existing protections to dentists related to insurer rating systems;
o Background: Cigna sent letters to dentists nationwide in August stating that they would be implementing a new dentist rating system based solely on the cost of care provided. Colorado has an existing law protecting physicians from rating systems based solely on cost, but the law did not apply to other healthcare providers. To ensure that dentists are treated fairly in light of the increase in such ratings programs, a bill was drafted to add dentists to the existing physician protection law.
o Status: The bill passed the state legislature with broad support and was signed by the governor. The bill took effect on Aug. 5, 2015, and all provider rating systems for dentists will be required to adhere to the new standards.
• Budget initiatives to increase Medicaid reimbursement rates (related bills included SB 234, SB 228 and HB 1151);
o Background: With the recent expansion of the state Medicaid program to include dental coverage for adults, the CDA has encouraged dentists to begin seeing at least 5 Medicaid patients or families in their practices. As members make this pledge, the CDA has committed to providing resources and support to dental practices that “Take 5.” A vital part of the CDA’s role is working to attain sustainable rates for dental services provided under the state Medicaid program. The CDA has pushed the state Medicaid program to evaluate rates for the dental program on many occasions. In November 2014, we asked the Medicaid program to evaluate the cost of raising rates to 65% of usual and customary rates (UCR). A bill mirroring this concept was introduced early in the 2015 state legislative session. HB 1151 was a Joint Budget Committee (JBC) bill that would have raised all provider rates to 60% of Medicare rates or usual and customary rates (UCR) as applicable to the provider population. The primary intent behind this bill was to allow the legislature to objectively review current provider reimbursement rates to see where the biggest discrepancies lie. While HB 1151 did not progress, 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 state Medicaid programs. SB 228 was introduced later in the legislative session, and created a permanent plan for state review of Medicaid provider rates on an ongoing five-year schedule. The bill requires that rates be reviewed against industry benchmarks (like UCR) and establishes an advisory committee to determine the schedule for rate review. SB 228 passed and the advisory committee created includes a dentist. Finally, SB 234, the budget bill that determines state funding for the 2015-2016 fiscal year, contained several provisions to address the adequacy of dental rates. While the bill does not offer a full fix, Medicaid rates were increased by 0.5% across the board and nearly $20M of funding was allocated to improve reimbursement for targeted rate codes, including fillings, extractions, x-rays and certain preventive services. The CDA will continue to work to improve Medicaid rates in future legislative sessions.
o Status: SB 234, the budget bill, passed and has been signed by the governor. Medicaid rate increases took effect on July 1, 2015. SB 228 passed and was signed by the governor. The committee will begin its work this fall. HB 1151 was killed at the sponsor’s request.
• HB 1309, a bill to authorize dental hygienists to place interim therapeutic restorations (ITR) subject to appropriate training, experience and supervision requirements.
o Background: Colorado’s oral health community initiated conversations about creating a Virtual Dental Home model that allows dental hygienists to perform interim therapeutic restorations to help address dental access needs in the state. To help ensure the training, experience and supervision parameters were appropriate to maintain patient safety and a high standard of care, the CDA volunteered to lead efforts on the legislative changes needed related to ITR placement by dental hygienists. Research published by the ADA and other state dental associations supports the safety and efficacy of the 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 was designed as a five-year pilot program with a focus on new telehealth 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.
o Status: The bill was received with great enthusiasm by state legislators. The bill passed the state House and Senate with nearly unanimous support, and was signed by the governor. The bill took effect Aug. 5, 2015. An advisory committee has been appointed to design curriculum standards for the training of dental hygienists performing the ITR procedure in the fall of 2015 with the advisory committee’s work expected to conclude before the end of 2015. Following development of curriculum standards, training programs for dental hygienists will need to be approved and offered. The State Dental Board is expected to begin permitting dental hygienists to perform the ITR procedure by mid-2016.
Highlights of other successful 2015 legislation with dental impacts include:
• HB 1029: a bill that exempted healthcare plans from certain network adequacy requirements by allowing them to utilize telehealth services where appropriate. The bill requires carriers to reimburse providers who deliver care through telehealth at the same rate as care delivered in person (though this requirement does not apply to Medicaid). Carriers cannot charge different copays, deductibles or impose annual or lifetime maximums for telehealth services. The definition of telehealth is very broad, and appears to include teledentistry in its scope. HB 1029 passed the House and the Senate and was signed by the governor.
• HB 1144: a bill that prohibits the manufacture or sale of personal care products containing microbeads. Some dental products, including toothpastes, include microbeads, but it appears that microbeads are being phased out of dental products. The CDA did not actively engage on this bill given the product modifications underway. The bill passed and was signed by the governor.
• SB 109: a bill clarifying that current abuse reporting requirements extend not only to the elderly, but all at-risk adults including adults with disabilities. SB 109 passed and was signed by the governor. A guide to reporting suspected abuse for children and the at-risk adults was published in the Spring 2015 CDA Journal. As dentists are mandatory reporters of abuse under current law, the guidance outlined in this article now extends to all at-risk adults, specifically including adults with disabilities.
• SB 234: the state budget bill also included some improvements to the state loan forgiveness program for healthcare providers. We will continue to evaluate the possibility of implementing a more comprehensive measure to address dental loan forgiveness in future legislative sessions. SB 234 passed and was signed by the governor.
Highlights of unsuccessful 2015 legislation that would have had dental impacts include:
• HB 1238: a bill that would have offered 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. A provider could have claimed up to $1,000 in tax credits for each student who served a four-week aggregate rotation. Medicaid providers could have claimed 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. The intent of the bill was to 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. The bill passed the House Health committee, but did not receive funding approval.
• HB 1297: a bill that would have prohibited several practices by optometry insurers considered unfair to optometrists, including prohibiting insurers from setting prices on non covered optometry services. Unfortunately, the optometry community did not negotiate with the insurance community prior to introducing this bill and there was a substantial amount of controversy associated with the testimony and discussions. The debate that occurred could be detrimental to future discussions on the non covered dental services topic. The bill expired waiting for consideration by the House.
• SB 31: a bill that 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. Concerns were also raised that this exemption could offer a competitive business 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 kill the bill.
• SB 74: a bill that 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 by the House State Affairs committee.
• SB 259: a bill that would have required certain disclosures before an out-of-network healthcare provider could offer services to a patient, as well as limit charges by out-of-network healthcare providers. The bill could have impacted the ability of oral surgeons and other specialists to provide reconstructive or trauma-related care in acute care settings. It could also have the unintended effect of limiting patient access to and choice of a provider who is not a participating provider in their insurance plan. There were additional concerns among the medical community about the bill’s potential to consolidate more power into the hands of insurers. Future conversations on this topic may offer the possibility of addressing adequacy of insurer payments to out-of-network providers. This bill was killed by the Senate Business committee.
• SB 274: a bill that would have removed state sales tax currently imposed on sales of soft drinks and sugary beverages. The healthcare community opposed this bill as higher purchase prices on soft drinks have been shown to reduce usage with positive impacts for health, specifically for oral health and obesity. The bill was killed by the House Local Government committee.
View a full bill status sheet summarizing all 2015 bills and outcomes.