Advocacy 2019 Recap

Serving as Your Voice on State Issues

Throughout the
year, NADP effectively represented members on a variety of state issues
as many adverse bills did not pass or were amended favorably. Key
issues included network leasing, network adequacy, non-covered services –
just to mention a few.

To keep
members informed, NADP published a 2019 State Wrap-Up in July, after the
close of state legislative sessions. This summary was posted in Dental
Interact and distributed at the Annual Business Meeting. Find this wrap-up here.

Recently the Government Relations WorkGroup has had the following issues on its radar:

NCOIL/Network Leasing:
NADP recently represented our members at the National Council of
Insurance Legislators Dec. 7-10 in Austin. NADP Executive Director Eme
Augustini submitted a testimony before the NCOIL Health Insurance &
Long-Term Care Issues Committee regarding model legislation on network
leasing, submitted by the American Dental Association.

Nebraska/Non-Covered Services:
The state dental association has sued the Nebraska Department of
Insurance (DOI) over its interpretation of the state’s noncovered
services law. Previously the DOI issued a bulletin stating that it would
allow carriers to use one of two definitions of “covered services:” 1)
services for which an insurer actually paid; or 2) services covered
under the contract but not necessarily actually reimbursed by the
insurer. In its suit, the dental association is asking the court to
mandate the use of the first definition only, which would greatly narrow
the scope of services considered “covered services” and enable
providers to charge their preferred rates without being constrained by
their contracts.

Nevada/SADPs Exempt:
In 2019, the legislature enacted AB 170, which creates the Office for
Consumer Health Assistance and requires health carriers to report to the
Office certain information relating to access to health care services.
After some confusion as to whether this provision would apply to
standalone dental plans, the Office confirmed that they will not seek to
collect data from such plans.

Washington/Credentialing:
NADP members recently provided informal comments to OneHealthPort,
Washington’s vendor for credentialing providers. The feedback included
suggestions on technical issues that could save time and improve
efficiency for users of the system.

Massachusetts/Network Leasing – A joint House-Senate committee held a hearing on a bill
that would enact new network leasing and minimum loss ratio reporting
requirements for dental plans. The leasing provisions in the bill are
more onerous than those recently enacted in states like New Jersey and
California and require dentists to affirmatively consent to each
individual leasing arrangement. NADP submitted comments in opposition, as well as joining a coalition letter opposing the bill. So far that bill has not been voted out of committee.

Ohio/Non-Covered Services – The Senate recently held a hearing on SB 148,
a bill that would enact a noncovered services law in Ohio. Ohio is one
of a minority of states that does not yet have such a law in place. The
bill uses a definition of “covered services” that is consistent with the
NCOIL Model. NADP submitted comments in opposition to the bill and as of this writing the bill has not advanced any further.

Maine/Pediatric Waiting Periods: The
State Legislature plans to introduce “LR 2910 An Act to Facilitate
Dental Treatments for Children,” which states “Except for orthodontic
treatment, a health insurance or dental insurance issuer offering
coverage in the group or individual market shall not impose a benefit
waiting period on any dental or oral health service or treatment for
enrolled individuals aged 0-18 years”

For more information on state issues, please contact NADP State Affairs Manager Artur Bagyants.

Your Advocate on Federal Issues

Serving as the
voice of the dental benefits industry, NADP represented member plans on
a wide range of federal issues this year, including:

• Dental in Medicare
• Taxes – Health Insurance and Cadillac Taxes
• Tagline Requirements
• Non-Covered Services
• Surprise Billing
• Updates from CMS and HHS
• Affordable Care Act (ACA) News

In addition,
NADP represented our members to the National Association of Insurance
Commissioners (NAIC), informed members about an Executive Order and
contributed to the 2020 U.S. Surgeon General’s Report.

Following are key 2019 highlights on these major issues and accomplishments:

Dental in Medicare

Anticipating that dental in Medicare would be a hot topic during the 2019 Legislative Session, NADP issued a press statement early in the year,
noting the association supports the initiative to add dental coverage
to Medicare and wants to serve as the resource on this issue.

During the
course of the year, NADP represented the industry on several bills on
the subject. In December, the House passed the Elijah E. Cummings Lower
Drug Costs Now Act, ” which proposes the expansion of dental benefits to
Medicare Part B. Senate Majority Leader McConnell (R-KY) said H.R. 3
will not be considered in the Senate.

In addition to
discussing this issue during face-to-face meeting at Advocacy in
Action, NADP also scrutinized these bills regarding Dental in Medicare:

1. H.R. 4650,
   the “Dental Medicare Act of 2019” adding dental benefits to Medicare
   Part B. The House Ways and Means Committee approved this bill by voice
   vote in October.
2. “The Medicare Dental, Vision and Hearing Benefit Act of 2019,” introduced by Rep. Doggett (D-TX-2) in February
3. HR 576, “Seniors Have Eyes, Ears and Teeth Act”, introduced by Rep. Roybal-Allard (D-CA-40)
4. S. 22, “Medicare Dental Benefit Act of 2019,” introduced by Sen. Cardin (D-MD)

In addition, NADP monitored “Medicare for All” proposals submitted by presidential candidates including Sanders and Biden.

• The New York Times: https://nyti.ms/2Sn0PDO
• Biden Healthcare Plan: https://bit.ly/2XZ5DAr
• Sanders Healthcare Plan: https://bit.ly/2VCeMOW

Taxes

HIT: At the direction of the Commission on Advocacy Policy, NADP urged Congress to pass HIT tax relief. NADP filed a public comment
to congressional leadership urging the immediate passage of an
extension of the Health Insurance Tax (HIT) moratorium through 2021.
NADP argued passage of the HIT moratorium is critical. Levying the HIT
increases dental premiums, and when combined with medical premium
increases, puts pressure on employers and families to drop their dental
benefits. Losing coverage for dental benefits hurts a patient’s overall
health and disrupts stable market trends that have kept dental premiums
flat for the last 5 years. Furthermore, the current uncertainty
regarding the HIT leaves dental plans in limbo, unsure of how to price
their benefits to employers and consumers. As soon as a moratorium is
enacted, NADP recommends that Congress begin work on passing a
moratorium for 2022 and beyond, which will help keep dental premiums
steady, as well as provide stability and security to plans, employers,
and families.

Cadillac Tax:
NADP continued to push for the repeal of the Cadillac Tax, which impacts
one in five health plans, according to the Kaiser Family Foundation. In
July the House approved a permanent repeal of the tax. However, the
repeal will have a longer road to passage in the Senate because of
budget concerns. Without the Cadillac Tax, the federal government will
lose more than $190 billion in revenue over the next decade.

Tagline Requirements

After review by the Government Funded Programs WorkGroup, NADP filed a public comment on the proposed rule HHS–OCR–2019–007: Nondiscrimination in Health and Health Education Programs or Activities. In these comments, NADP agreed with the Administrations’ repeal in toto
the tagline and notice requirements related to Section 1557. For
background on Section 1557, see the Advocacy Open Forum in Dental
Interact.

Non-Covered Services

The NADP Commission on Advocacy Policy renewed opposition to the “Dental and Optometric Care Act, DOC Access Act” (HR 3762).
This proposed federal approach to noncovered services, as summarized in
the first two bullet points below, was not consistent with an National Council of Insurance Legislators (NCOIL) Model Law on the topic (nor with laws in 30+ States). In addition, the list of provisions was more narrow when compared to prior versions HR 1606 (2017-18) and HR 3323 (2015-16).

HR 3762 would
have denied insureds the benefit of discounts negotiated for both
covered and non-covered services, which negates one of the primary
values of insurance. Additionally, the costs to recontract biennially,
as noted in the third bullet below would be significant and impact
premiums with no benefit to consumers. Proposed provisions would:

• Allow a
  provider to charge the consumer for services that are not “covered” by
  the health, dental or vision plan as long as the provider does not
  charge more than s/he charges to individuals that are not on a plan.
• Defines
  services that are “covered” by a plan as only those services for which
  the plan is obligated to pay an amount that is “reasonable” and is not
  “nominal or de minimis,” terms which are not defined.
• Allow that contracts to be extended for a term beyond two years with the “prior acceptance” of the extension by the provider. 
• Prohibit restrictions on choices of laboratories or suppliers.
• Create a private right of action in district courts for a violation of the Act with injunctive relief, monetary

Surprise Billing, Cost Containment, All Claims Databases

Multiple House
and Senate Committees addressed surprise billing, cost containment and
all claims databases throughout the year. NADP continued to represent
members as it monitored and commented on these bills:

• HR 2328, Reauthorizing and Extending America’s Community Health Act” (REACH), advanced by the House Energy and Commerce Committee
• S. 1895, the “Lower Health Care Cost Act,” approved by the Senate Committee on Health, Education, Labor and Pensions (HELP)

HHS and CMS Updates

NADP quickly
reviewed updates from the Centers for Medicare and Medicaid Services and
Health and Human Services for information applicable to dental plans
and distributed information and links to members including details
about:

• 2020 plan year Exchange regulations and the Notice of Benefit and Payment Parameters (NBPP)
• Final Medicare Advantage (MA) and Part D Calendar Year (CY) 2020 regulations affecting the Preclusion List
• Final health reimbursement arrangements regulations
• Repeal of Health Identifiers Requirement   (See Oct. 28  final rule).
• Review of Interoperability Rules Under OMB Review(CMS-9115-F and RIN 0955-AA01.

NADP also commented on the above list as necessary.

In addition,
NADP conducted an Intent to Offer Survey among plan members to inform
CMS about standalone dental plans that would be participating in
Exchanges.

Affordable Care Act News

While the
House explored expanding and protecting provisions of the Affordable
Care Act (ACA), the Administration asks the Courts to strike down the
ACA. In addition, lawsuits were filed that threatened to repeal the ACA.
NADP provided timely and thorough updates on all these matters.

NAIC

NADP served as
your voice concerning Minimum Standards Model regulation, discussed at
National Association of Insurance Commissioners meetings. NADP provided
members with a detailed summary of proposed revisions to the model act
via Dental Interact and the May edition of the Monthlybyte newsletter.

Executive Order

NADP promptly reviewed and updated members about the Executive Order on Price Transparency.  NADP noted only two directives have potential impacts to dental benefits:

Section 5 – “HHS,
in consultation with the Secretaries of the Treasury, Defense, Labor
and VA, and the Director of the OPM, shall increase access to
de-identified claims data. HHS shall make a list of priority data
sets and shall report to the President on proposed plans for future
release of these priority data sets and on any barriers to their
release.” 

• This language is similar to a directive from 2017 which prompted rules on increasing health data interoperability, and could potentially include dental plans (see NADP comments online here). Dental data could be considered a “priority data set” by HHS and studied for future transparency rules. 

Section 6(c) – “Treasury shall issue guidance to increase the amount of permissible FSA funds that can carry over to the next tax year.“

• An increase in the amount of funds rolled over in FSAs could allow consumers to spend more pretax money on dental procedures.

Surgeon General’s Report 2020

NADP authored a
section in the 2020 Surgeon General’s Report about the Status of Dental
Benefits and Impact on Dental Practice. NADP provided insights and
research statistics to highlight the value and contributions of dental
benefits in improving access to oral health care.

The above
summary skims the surface of the multiple issues addressed by NADP on
behalf of our members. For more information on these or other issues,
please review the Advocacy Open Forum or contact Government Relations
Analyst Owen Urech.