The Halfway Point: Mid-Term Legislative Update

Molly PereiraFeatured News

HB 1045 Signed into Law

Dental hygienists soon can administer silver diamine fluoride in cooperation with a dentist. 

On Thursday, March 22, Governor John Hickenlooper signed HB18-1045 into law. The bill authorizes dental hygienists, who have received appropriate training, to administer SDF when working in cooperation with a dentist.

Prior to the passage of this bill, the Colorado Dental Board had considered SDF to be outside the scope of dental hygiene practice.

To administer SDF under HB 1045, a dentist hygienist must:

have a license in good standing,

  • be covered by professional liability insurance,
  • complete training on the use and limitations of SDF, and
  • have a collaborative agreement with a supervising dentist that outlines treatment protocols, restrictions or limitations and follow up and referral mechanisms.

Under this protocol, dental hygienists may administer SDF under the direct, indirect, or telehealth supervision of a dentist. If SDF is provided at an offsite location, disclosures of the name and contact of the supervising dentist, as well as the patient’s right to consultation with the dentist, must be provided. Appropriate patient consent should always be obtained.

In coming weeks, the Colorado Dental Board must draft rules to address:

  • training requirements, including qualifications for entities offering the course;
  • appropriate indications and limitations for the application of SDF by a dental hygienist; and
  • any stipulations for the collaborative agreement.

The bill requires these rules to be adopted by June 27, 2018.

SDF is becoming much more broadly adopted and utilized by all types of dental practices. The upcoming issue of the Journal of the Colorado Dental Association will include a detailed article describing one protocol for treatment using SDF, which offers factors to consider as you evaluate how you might incorporate this emerging treatment into your practice model. Given the safety profile of SDF and its minimally invasive nature, CDA leadership welcomes its potential in helping address concerns about access in many underserved and non-traditional care settings, in addition to the benefit of offering additional treatment options for already established patients.

The Halfway Point: Mid Term Legislative Update

We are about two-thirds the way through the 2018 state legislative session, and what a ride it has been. The session has been full of hot topics and contention. Even the most amicable of groups have been caught in the cross fires at times.

But the CDA has still managed to protect and promote oral health interests during this legislative session. A few key successes so far include:

  • HB 1045, authorizing dental hygienists to administer silver diamine fluoride in cooperation with a dentist, passed and has been signed into law.
  • HB 1322, the 2018-2019 state budget bill, contains a 1% proposed provider rate increase and no other changes to the adult Medicaid dental benefit.
  • SB 115, a bill that would have expanded federal Medicare and Medicaid Stark laws to severely limit patient referrals, was stopped.

Much of our work is still under way, and there is still much to come in this legislative session. Some of our key remaining priorities include:

  • Crafting policies to address the state’s current opioid crisis that are reasonable to implement for providers. Current opioid prescribing bills include:
    • SB 22, which would restrict initial prescribing for acute conditions to a seven-day prescription. After conducting a check of the state’s Prescription Drug Monitoring Program (PDMP), a second seven-day prescription could be written. Subsequent prescriptions would be allowed as medically indicated. SB 22 would also require the PDMP vendor to make their software compatible for integration into practice management software systems (hopefully eliminating the need to login to a separate system to perform the required second prescription check).
    • HB 1279, which would require all prescriptions for opioids to be issued electronically beginning in 2020. Extensions would be provided for solo practitioners and providers in rural areas. The CDA has negotiated amendments to exclude providers who write fewer than two opioid prescriptions a month (24 per year) and to double the implementation timeline for dentists (until 2022). We are also working to identify grant funds that could be used to incentivize integration of e-prescribing into dental practice management software systems and to potentially provide low cost or free e-prescribing solutions to dentists through Medicaid and CHP. These types of incentives would be valuable in leveling the playing field, as dentists have not received the same federal incentivizes to convert to electronic systems as the rest of the healthcare community.
  • Securing an exemption for dentists from HB 1128, which would allow the state Attorney General to enforce certain consumer data privacy protections with public entities and private businesses in Colorado. Since dentists are already subject to HIPAA data privacy rules, this bill would create duplicative (and sometimes conflicting) requirements.
  • Ensuring fairness and due process for providers as the state Attorney General’s Medicaid fraud control unit is recognized in law through HB 1211. The CDA has worked to amend the bill to ensure that a very high threshold is required to prosecute providers and that administrative processes to remediate errors are preserved.
  • Monitoring efforts on fee disclosure and transparency in the wake of last year’s SB17-65, which required healthcare providers to disclose average fee data for their top 15 codes. Several 2018 statewide ballot initiatives have been submitted that, if approved for inclusion and adopted, would require disclosure of healthcare providers’ full fee schedules and increase penalties for noncompliance. A bill mirroring the ballot initiative has been anticipated this legislative session, but has not yet materialized.
  • Monitoring discussions about addressing a dentist’s role in sleep apnea diagnosis and treatment through the legislative process. There was an extensive regulatory process between the Colorado dental and medical boards on this topic in fall 2017, which ultimately failed to clarify questions about current scope for medical and dental professionals. There have been some recent rumblings about this issue being addressed on the legislative front. Scope clarifications are often better handled through regulatory processes, and the CDA will keep a close pulse on these efforts.
  • Tracking several bills aiming to improve the efficiency of state agencies, like the Colorado Dental Board, and streamline regulatory processes. Many of these bills are progressing favorably and would aim to help reduce the regulatory burden for dentists should they pass.

The CDA is always working to protect and improve the practice environment and parameters for members, as well as perceptions of the importance of dental care and oral health. To this end, the CDA has a top-of-the-line team at the state Capitol every day keeping pulse on the more than 600 introduced bills. This session, more than 60 bills have either a direct or indirect impact on your practice. View the full list of bills the CDA is monitoring in 2018.