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By Jennifer Goodrum, CDA Director of Government Relations
From the Winter 2018 Journal of the Colorado Dental Association

The CDA had a busy fall with a number of legislative interim committees and rulemaking processes, debating a number of issues that can impact dentists and dental offices. The CDA is always working to protect and improve the practice environment and parameters for members.

Several key issues were debated last fall:

  • Opioid Prescribing: A state legislative task force met through the summer and fall months to discuss changes that can be made to reduce opioid abuse and addiction. A number of changes for prescribers were discussed, including greater use of the state’s Prescription Drug Monitoring Program (PDMP) database, ePrescribing, expanded continuing education for providers, and dose and duration limitations for prescriptions. Several bills will be introduced in 2018 to address these reforms. The Colorado Department of Regulatory Agencies (DORA), which oversees the dental board, is also revising its Quad Regulatory Board opioid policy. Proposed changes to the DORA policy are more aggressive than those currently proposed on the legislative side.
  • Sales and Use Tax: A second state legislative task force met through the summer and fall months to discuss changes that can be made to simplify Colorado’s extremely complex local sales and use tax system. Each local jurisdiction has different rules on what items are taxable and different systems for licensure and tax remittance. 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. Unfortunately, it does not appear that legislative efforts will do much to streamline definitions on what dental goods are taxable. However, some progress may be made toward streamlining licensing and remittance systems during the upcoming legislative session.
  • Medicaid and CHP: Dental coverage for many of Colorado’s low income populations could be dramatically impacted by actions of the U.S. Congress in coming months. At the time of publication, congress had not yet acted to provide continued funding for CHP programs nationwide. Funding expired in September. Colorado sent notices to CHP families at the beginning of December that coverage will be discontinued in January 2018 if Congress has not acted to restore funding prior to January. Federal discussions about healthcare reform could also have dramatic impacts on the state Medicaid program. If funding to states is ultimately reduced, some dental benefits—like those currently offered for adults—could be at risk. The CDA is actively working to defend both benefits, as well as improve the efficiency and dentists’ experience in working with both programs. Dental anesthesia rates in the Medicaid program are also being scrutinized by the state’s Joint Budget Committee, which is also considering increasing funding for the state Old Age Pension Senior Dental Care program.
  • Sleep Apnea: The Colorado Dental Board worked with the Colorado Medical Board to develop guidance on the intersection between dentistry and medicine related to oral appliances provided to treat sleep apnea—a discussion that could have set precedents for other areas of overlap between the professions. These discussions were recently discontinued due to legal and process concerns, leaving some continued uncertainty but also potentially greater flexibility for dentists under the drafted policy.

In addition, some anticipated topics of interest during 2018 include:

  • Silver Diamine Fluoride: There has been uncertainty under current Colorado Dental Board rules on whether dental hygienists may administer silver diamine fluoride (SDF) treatments in any capacity. The CDA is working with the Colorado Dental Hygienists’ Association to run a bill in 2018 to clarify when a dental hygienist may administer silver diamine fluoride, along with what training, supervision and disclosures should be required for the procedure.
  • Fee Disclosure: In addition to Senate Bill 17-065, which requires all healthcare providers, including dentists, to disclose cash-pay fees for their top 15 procedures by Jan. 1, 2018, more fee disclosure bills are being proposed during the 2018 state legislative session. State assembly bills and a ballot initiative are expected and would be far more aggressive than past efforts. The anticipated bill and ballot initiative are rumored to require disclosure of healthcare providers’ full fee schedules and add compliance enforcement. A number of concerns have been raised, including points that these new bills are being pursued without even allowing implementation of prior efforts. The CDA and the healthcare provider community have grave concerns with this upcoming proposed legislation.
  • X-Ray Rule Revisions: The Colorado Department of Public Health and Environment, which oversees licensure and registration of x-ray facilities and equipment, is expected to undertake a comprehensive revision of x-ray rules in 2018. The CDA is closely involved in this process to ensure regulations that are reasonable and as minimally disruptive on practices as possible.
  • Amalgam Separators: As shared with CDA members in the Summer 2017 Journal of the Colorado Dental Association, the Environmental Protection Agency (EPA) recently reinstated a federal mandate that most U.S. dental offices must install a qualifying amalgam separator and comply with industry best management practices (BMPs) to reduce amalgam waste. Existing dental practices have until July 2020 to comply, but new practices and practices with new ownership must comply immediately. Once dental practices have complied with the standards, they must file a one-time compliance report with their local wastewater treatment authority. Dentists in most metro areas will file this compliance report directly with one of the 25 approved wastewater districts in the state. Anyone outside of these jurisdictions will file their compliance report directly with the EPA. More information on filing of these compliance reports will be published for CDA members in coming months.

2018 is an election year, and as such we anticipate a controversial legislative session marked by statement bills that legislators use to woo voters in their districts. The CDA will keep this environment in mind in its legislative strategy, and will continue to share the narrative about the critical role dentists play in the health and well-being of the people of Colorado. Protecting practice environments that ensure dentists can continue to deliver high-quality, patient-centered care is an ongoing priority.

Save the Date: Dentists at the Capitol Lobby Day 2018
Be sure to mark your calendar to join the CDA at the state Capitol on the morning of Friday, Feb 16 for the 2018 Dentists at the Capitol Lobby Day. The CDA will email more details and RSVP information to members in January. We need your voice. Join us at the Capitol.