It has been a long legislative session in Colorado for 2021. In a “normal” year, the session would end in early May. This year, Colorado’s session will end this week (prior to June 12). Throughout the session the CDA has actively monitored more than 50 bills that have an impact on the dental profession or oral health.
The CDA’s initial priorities included:
- Restoring funding for dental benefits, including the adult Medicaid dental cap and low-income senior dental program, as possible under expected state fiscal constraints.
- Reauthorizing ITR and SDF procedures by dental hygienists and making appropriate adjustments to protocols following a sunset review of the procedures.
- Ensuring payment parity for telehealth services delivered at a dental office during the COVID pandemic and beyond.
- Adding dentists to healthcare provider types that may aid in administering COVID vaccines.
- Supporting physicians in assuring ongoing confidentiality for any healthcare provider who self-refers to a peer assistance program.
As the session carried on, the CDA honed in on several specific bills. These include:
- SB 102 ITR/SDF Sunset – This bill continues the ability of dental hygienists to place interim therapeutic restorations (ITR) and apply silver diamine fluoride (SDF) until Sept. 1, 2025, to align with the next sunset review of Colorado’s Dental Practice Act. The bill has been signed by the governor and rulemaking by the Colorado Dental Board is now underway.
- SB 211 Adult Dental Cap – The Medicaid adult dental cap was restored to $1,500 in the state budget with the projected cap reduction never actually taking effect for patients. IN addition, a 2.5% community provider rate increase was secured. This bill has been signed by the governor and provider rate increases will take effect on July 1. Other notable state budget actions for dentistry included a funding increase of $1M to the state’s low income senior dental program, increased funding for the dental loan forgiveness program and continuation of a preventive dental hygiene outreach program for individuals with disabilities.
- SB 139 Dental Telehealth – This bill allows for dental telehealth services to be delivered to patients and requires each dental plan that is issued, amended, or renewed in Colorado after May 7 to cover telehealth services. This bill has been signed by the governor.
- HB 1198 Hospital Billing of Indigent Patients – This bill addresses how hospitals and providers offering services in a hospital or surgical facility may bill low income, uninsured patients. The bill requires the hospital or facility where a procedure is performed to screen all patients for income and insurance status, caps the amount that can be billed by hospitals and providers, and specifies terms of patient payment plans that must be used. This bill primarily intersects hospitals and large facilities, but it may also impact dental providers who perform procedures in hospital settings. The CU School of Dental Medicine clinic was also impacted under this bill, and the CDA was able to get the school’s clinic carved out of the bill – a huge benefit to students and faculty. This bill is still in the final stages of the legislative process.
- SB 22 HCPF Audit Notification – This bill requires the Colorado Department of Health Care Policy and Financing to notify a provider via email and another means before taking audit actions. Previously, HCPF was only required to send an email – which caused problems for some providers if emails changed or notifications were caught in junk mail filters. This bill has been signed by the governor.
- SB 18 Necessary Document – This bill provides ID document recovery for those in need. Examples include domestic abuse situations where someone flees and needs an ID or someone loses an ID and doesn’t have financial means to replace it, etc. This bill can help alleviate a significant barrier (lack of ID) in connecting patients with needed services following crisis situations, including medical care. This bill is in the final stages of the legislative process.
- HB 1232 Public Option – This bill began as a state-run health plan that would require mandatory provider participation. While routine dental services would not be expected to be covered benefits under a state plan – excluding most dentists from impacts under this bill, the bill may affect some oral surgeons and dentists providing sleep apnea services and supports. Since the bill was introduced, it has been heavily amended. The state-run health plan was eliminated in favor of a standardized benefit plan that must be offered by private carriers if they do not meet certain premium reduction targets over the next five years. Premium reduction targets were reduced. Hospital and provider payment methodologies have been adjusted. Penalties associated with the provider participation mandate were largely eliminated. The bill is through all but the final step of the legislative process and is currently waiting for the House to sign off on Senate amendments. The main provisions of the bill would begin roll out in 2023 and many additional discussions are expected to occur in the period prior to implementation.
- HB 1276 SUD Prevention (substance use disorder) – This bill permanently extends the existing 7-day limit of opioid prescribing and requires PDMP check for opioids at the first script. Limitations on prescribing of benzodiazepines will be delegated to each relevant prescriber Board. This bill is still in the legislative process.
- HB 1107 Public Health Worker – This bill prevents doxing (sharing of personal info) for public health workers. It has been signed by the governor.
Regulatory Update
- Dental Health Care Program for Low-Income Seniors – The state’s senior dental care benefit typically disqualifies individuals from coverage if they have any other dental coverage. It was brought to the CDA’s attention this year that Medicare had added extremely limited dental coverage to many of its medical plans, which was disqualifying many seniors from this more extensive care program without their choice or knowledge. The CDA brought attention to this situation and the state is now working out the process to bill Medicare first in these situations and then allowing patients to use the senior dental care benefit as the payer of last resort.
- HPSA Update – The CDA is working with the Department of Health Care Policy and Financing to remap Health Provider Shortage Areas and loan forgiveness boundaries. Original maps were drawn in 1950s.
Community Water Fluoridation
Community Water Fluoridation issues were calm in 2020 but have started making a comeback this year. The Loveland Utilities Commission was asked by Loveland City Council to re-evaluate the city’s decision to provide community water fluoridation to its residents. Anti-fluoridation proponents made claims that drinking fluoridated water reduces immunity, in addition to dated arguments that were also brought up in 2014 when Loveland last evaluated this public health practice. The CDA organized a 45-minute presentation for the Loveland Utilities Commission in late March 2021 that included speakers: Chris Manly (Larimer County Public Health), Bill Bailey D.D.S. (CU faculty and former CDC fluoride expert), Patty Braun M.D. (American Academy of Pediatrics), Katya Mauritson D.D.S. (dental director CDPHE), Eric France M.D. (chief medical officer for CDPHE). The commission unanimously voted in favor of retaining Community Water Fluoridation in Loveland.