KAPD Logo - Kentucky Academy of Pediatric Dentistry

State Advocacy

State Legislation and Regulations Access to Care Goal:

1. Develop advocacy toolkit and work to obtain state Medicaid agencies’ acceptance and private insurers use of new HCPCS code G0330, for dental OR cases. AAPD (WITH PPA NETWORK) and ADA and AAOMS AND OTHER COALITION PARTNERS Workforce and Access to Care Goal

2. Promote states’ adoption of expanded duties for dental assistants as recommended in the AAPD’s Policy on Workforce Issues and Delivery of Oral Health Care Services in a Dental Home, and assist state chapters dealing with dental therapist and other mid-level proposals.ii Provide technical assistance, via research and policy center, to state Public Policy Advocates working in collaboration with state dental associations on this issue. Work with research and policy center to identify data on national rate of EFDA use. State chapters (PPA network) and AAPD Medicaid Dental Reform Goal

3. Provide continued technical assistance to state pediatric dentistry chapters for Medicaid dental reform for their efforts with both state legislatures and state dental associations. Work closely with ADA Medicaid Task Force to develop a comprehensive model state Medicaid dental reform bill. Continue to promote states’ adoption of appropriate dental periodicity schedules consistent with AAPD guidelines, and update research and policy center dental periodicity schedule adoption map on website as appropriate. Continue to inform and educate key constituencies about reforms that work, including MSDA (Medicaid/CHIP State Dental Association), NCSL, NGA etc. Work with research and policy center and CDBP to respond to Medicaid medical movement to managed care by: (a) promoting dental managed care hybrid payment models that leave the risk with the plan contractor (or at least share it between the plan and the provider); and (b) maintaining accountable dental fee-for-service plans. (c) promoting SMA MCO dental contracting that adheres to criteria in the ADA’s 2015 guidance document Medicaid: Considerations When Working with the State to Develop an Effective RFP/Dental Contract. AAPD, state chapters (PPA network), and state dental associations 7 State Legislation and Regulations Medicaid Dental Reform Goal

4. Ensure that state Medicaid programs conducting provider audits, as well as auditors contracted by CMS, do so in an appropriate and fair manner, adhering to AAPD clinical recommendations and utilizing peer review by pediatric dentists. Work with PPA network to secure language in SMA dental provider manuals referencing AAPD clinical recommendations as the appropriate criteria for any audits of pediatric dental practices, and a dental advisory board for every SMA. Pursue dental auditor training initiative with CMS Center for Program Integrity. Assist state PPAs interested in pursuing model Medicaid audit reform legislation as passed and signed into law in Nebraska in 2020. AAPD, state chapters (PPA network) and state dental associationsiii Access to Care Goal

5. Continue to provide technical assistance to states for General Anesthesia coverage via legislation or state insurance marketplace regulations, highlighting ongoing cost analysis and using TRICARE coverage and success in 33 states to spur momentum. Utilizing research and policy center technical brief and working closely with CDBP, educate insurers and insurance regulators on necessity of this benefit and role of pediatric dentists in treating high risk children. State chapters (PPA network) and AAPD Access to Care Goal

6. Provide technical assistance to states seeking legislation for mandatory or incentivized oral health examinations or screenings prior to school matriculation, utilizing efforts in Colorado as an advocacy model. Seek support of state dental associations and other interested organizations via efforts of state Public Policy Advocates.iv State chapters (PPA network), AAPD, and state dental associations Access to Care Goal

7. Work with ADA, state dental associations, and state pediatric dental units to promote community water fluoridation, and prevent efforts to remove fluoride from currently fluoridated communities. ADA Workforce and Access to Care Goal
8. Secure or expand student loan forgiveness programs for pediatric dentists who practice in under-served areas.v State dental associations and state chapters (PPA network) Access to Care Goal

9. Ensure that state dental boards adopt regulations concerning mild, moderate, and deep sedation and general anesthesia practice and permitting that are consistent with policies, best practices, and guidelines of the AAPD. Utilize review and input from AAPD’s Committee on Sedation as needed. AAPD and state chapters (PPA network) 8 State Legislation and Regulations Workforce Goal

10. Ensure that state dental boards maintain and enforce regulations concerning appropriate advertising of specialty status and advertising guidance for general dentists treating children consistent with AAPD policies concerning Affiliate members.vi AAPD and state chapters (PPA network) Access to Care Goal

11. Support states’ adoption of TRANSPARENCY IN DENTAL BENEFITS CONTRACTING MODEL ACT adopted by the National Council of Insurance Legislators to address several vexing third party-payer issues: fair and transparent network contracting (allow dentists to accept or refuse contracts to which they would be obliged); virtual credit cards (not limiting payments to such method); and prior authorization (hold dental insurers to pay what was promised in the authorization).vii Also support medical-loss ratio (MLR) dental insurance legislation, modeled after MLR ballot initiative approved in Massachusetts in 2022. State dental associations and state chapters (PPA network)