By Jennifer Goodrum, CDA Lobbyist
From the Summer 2021 Journal of the Colorado Dental Association
Colorado’s General Assembly closed its regular legislative session on June 8—delayed almost a full month by the COVID-19 pandemic. The CDA tracked nearly 50 bills for the Colorado dental profession this year. Healthcare (reducing costs, expanding access and addressing gaps in health equity) was a primary focus of this year’s legislative session. COVID response and recovery was also a significant topic of conversation in healthcare circles.
A broad overview of outcomes in healthcare policy and specifically dental, follows.
Healthcare
- Polis signed the Colorado Option Bill (HB 1232) on June 16. The law requires health plans to lower premiums by 15% by 2024. The final bill removed penalties for doctors who do not comply with the mandatory participation requirement and loosened the enforcement provisions for hospitals by removing the loss of licensure provision.
- Hoping to mitigate out-of-pocket expenses for patients, the new Prescription Drug Affordability Board (SB 175) will be charged with reviewing prescription drug affordability data and creating caps on drug costs. Beginning Jan. 1, 2022, it is unlawful to purchase a prescription drug at a cost that exceeds the cap established by the board except for personal or familial use. The board is repealed five years after the first upper payment limit is established, following a sunset review.
- In the continuing effort to address substance use disorders, HB 1276 places several restrictions and requirements on insurance carriers and health benefit plans relating to opioids and alternative treatments (e.g., physical therapy, occupational therapy, chiropractic and acupuncture). The measure also imposes prescribing limitations and continues indefinitely the requirement that healthcare providers query the Prescription Drug Monitoring Program (PDMP) before prescribing an opioid. The bill adjusts the PDMP check requirement to the first prescription of an opioid and a benzodiazepine. Prescribing boards are required to issue rules to limit prescribing of benzodiazepines—likely in a format similar to restrictions imposed for opioids—by Nov. 1, 2021. Finally, the bill authorizes the Center for Research into Substance Use Disorder Prevention, Treatment, and Recovery Support Strategies at the Colorado Health Sciences Center to include in its educational activities the best practices for prescribing benzodiazepines and the potential harm of inappropriately limiting prescriptions to chronic pain patients.
- Additionally, the Legislative Audit Committee heard the report on the Department of Regulatory Agencies Prescription Drug Monitoring Program (PDMP) on June 21. Findings indicate that the PDMP is not operating as effectively as the legislature intended to help improve patient care, detect illegal activity, and prevent prescription drug abuse or misuse in Colorado. We anticipate significant statutory and regulatory changes over the next year that will include more enforcement among healthcare providers, more robust limitations on opioid prescriptions, and increased scrutiny of registration. We will continue to keep you informed as this issue develops.
Dental
- The CDA passed two dental specific measures: SB 139, preserving dental telehealth options for patients post-pandemic, and SB 102, allowing dental hygienists to continue provision of ITR and SDF procedures to patients with certain adjustments for efficiency in the practice. We had an incredible community of partners in these efforts with more than two dozen stakeholders supporting the two bills.
- We secured an aggregate increase of more than $21M in state and federal funding for the dental profession. We fought to restore funding for the state’s adult Medicaid dental benefit, as the cap for services was slated to be reduced from $1,500 to $1,000 as a consequence of the 2020 budget recession (SB 211). Medicaid rates were increased by 2.5% (beginning July 1, 2021) and planned co-pays for Medicaid patients were eliminated. We also helped to restore a cut of $1M to the state’s Low Income Senior Dental Program. Funding for a preventive dental hygiene program for patients with disabilities was continued and funding was increased for the state’s Dental Loan Repayment Program. Additional state and federal relief dollars were made available to small businesses and minority owned businesses with opportunities to pursue additional relief through summer interim processes. SB 284 also introduced some new evidence-based criteria for state budget decisions. The new standards may have an impact on future state funding requests.
- HB 1198 imposed billing restrictions for providers (including dentists) related to care provided in a hospital or facility setting for uninsured patients earning 250% or less of the federal poverty level. Hospitals remain responsible for most of the screening processes, but providers are capped on the monthly amounts they may bill a patient and must discontinue billing after 36 months of payments. There are limitations imposed on collections activities with significant fines for noncompliance. While hospitals have access to funding sources to offset the costs of uncompensated care, providers do not and creating a mechanism to at least partially reimburse providers for the financial impacts of this care will be a continued area of stakeholder discussions in coming months. We were also able to secure a complete exemption for the CU School of Dental Medicine, as the bill could have greatly constrained the charitable and reduced cost care provided by students and faculty members.
- The CDA worked to expand definitions in HB 1005 to allow providers beyond physicians and nurses to be included in state healthcare emergency response teams, particularly given the role that forensic dentistry can play in disaster response. Participating in summer task force work on this topic will be vital to future inclusion in the program.
- We worked successfully to stop SB 197, a bill that would have restructured access to dentists through the workers comp claim system. The bill would have required a physician referral for patients to see a dentist for oral injuries (as opposed to the current direct access system). These modifications could have ultimately increased costs and resulted in worse outcomes for patients. Discussions on this bill are expected to continue into future legislative sessions and we will closely monitor continued stakeholder conversation on the topic.
- A number of changes were made to telemedicine statutes. Among the most substantial was HB 1256, which gives HCPF/Medicaid the ability to develop rules on when in-person checkups should be required as part of a course of telehealth treatment. This can have an impact for industries where online, direct-to-consumer telehealth services can be abused (orthodontics, etc.).
- Another bill that impacts Medicaid providers was SB 22, which changed the requirements for provider notification with Medicaid audits to ensure that providers have full awareness and opportunity to respond to audit requests prior to any recoupments.
- Substantial changes were made to the PDMP with opioid prescribers now required to check the PDMP before writing a first (previously required at second) opioid script (HB 1276), prescribing boards directed to adopt rules on PDMP checks and tracking for benzodiazepines (HB 1275), and the pharmacy board authorized to adopt rules to expand PDMP tracking to all prescription drugs (HB 1012).
- DORA boards may see some impacts (hopefully positive) with the addition of HB 1212, which seeks to expand the diversity of Board appointments.
- We continue to watch the implementation of SB 126, which sets precedent to improve insurance credentialing timelines for physicians. If the state Division of Insurance does not require consistent credentialing for other types of healthcare providers, future legislative action may be warranted to ensure alignment.
- HB 1330 sets up a task force to review gaps in current higher education programs and opportunities for future workforce development. This process may offer a venue to raise awareness of dental hygiene and dental assisting workforce shortages and explore potential state assistance in solutions.
- HB 1232 (state plan to reduce insurance premiums) and SB 175 (board to cap the cost of high dollar prescription drugs) are intended to address affordable coverage and drug pricing as implemented over coming months and years, but also come with some concerns among providers about impacts to medical decision making and practice sustainability. These bills are not expected to have a heavy intersection for most dental practices, but it will be important to keep a close eye on rulemaking related to these policies to ensure no unanticipated adverse impacts for patients or the profession.
- Significant federal funding is anticipated to be allocated during interim session policy work and provider groups should stay engaged in these conversations to help drive funding to more programs and innovations that could improve sustainability of practices that have experienced adverse financial consequences from the pandemic, as well as health and outcomes for patient populations.
We anticipate business-as-usual moving forward with legislative interim committees occurring throughout the summer and early fall. Additionally, several legislative task forces will work through the summer to determine allocations for the remaining $2.5 million in federal funding through the American Recovery Plan Act. We anticipate these committees and task forces will begin meeting later in July or early August and are still awaiting details on committee memberships and schedules, which have not yet been announced at the time of publication.
While the 2021 legislative session has concluded, budget and policy discussions will continue over the interim with deadlines in place for fiscal year 2022-2023 department budget requests in advance of the Nov. 1 budget presentation to the Joint Budget Committee.
Jennifer Goodrum is a principal at Michael Best Strategies. She serves as the CDA’s primary lobbyist with 20 years of association management and healthcare policy experience. Contact her at jbgoodrum@michaelbeststrategies.com.