August 2015


Federal Legislation Seeks Dental Changes

This summer, U.S. Congressional Representatives introduced two pieces of legislation impacting insurance contracts with dentists and dental coverage in public programs.


Seniors Have Eyes, Ears and Teeth Act

Representative Alan Grayson (D-FL-9) introduced H.R. 3308, “Seniors Have Eyes, Ears and Teeth Act,” which would expand Medicare coverage to include dental services, eyeglasses and hearing aids. The bill has strong support from House Democrats (80 co-sponsored the bill) and from senior advocacy groups including the National Committee to Preserve Social Security and Medicare (NCPSSM).

In a speech on the House floor, Representative Grayson explained the services that would be covered under H.R. 3308: “We’re not talking about exotic, high-tech treatments – we’re talking about no Medicare coverage for eyeglasses, eye exams, hearing aids, and cavity fillings and dentures. We’re talking about no treatment for medical conditions that lead to blindness, deafness, lost teeth and serious gum disease, which has been strongly linked to heart disease. It is unthinkable that we deny our seniors this elementary level of care.”

It’s unlikely that legislation expanding public programs and services would pass in the current Congress, where Republicans hold the majority 247-188.


Dental and Optometric Care Access Act

Representative Buddy Carter (R-GA-1) introduced H.R. 3323, “Dental and Optometric Care Access Act” or the “DOC Access Act,” which spans several aspects of dental and vision plan contracts with providers.

In a statement on the bill’s introduction, Representative Carter explains, “this legislation is necessary to provide doctors with greater flexibility in meeting the needs of their patients. By prohibiting insurance providers from forcing doctors to participate in restrictive insurance plans or networks, doctors will be able to charge reasonable fees for the care Americans need. This legislation is a strong and necessary step in bringing free market principles back into healthcare by removing anti-competitive business practices.”

H.R. 3323 begins with a non-covered services (NCS) measure to prohibit plans from requiring providers to accept a negotiated fee set by the plan unless the plan compensates the providers for the specific service.

Since an NCOIL Model Act was finalized on the subject in 2010, state dental associations have been strong proponents of NCS bills, supporting measures in more than 35 states. The sponsor indicates H.R. 3323 would establish a national standard on the issue and apply to plans that are regulated at the federal instead of state level. NADP is looking further into whether the provisions are applicable to all plans including self-insured or just insured products.

American Dental Association president Maxine Feinberg, D.D.S., expresses support for H.R. 3323: “And I speak on behalf of the ADA’s 158,000 members in thanking Rep. Carter for introducing this legislation, which would prohibit dental insurance companies from interfering in the doctor-patient relationship by dictating prices for services they don’t even cover. State after state have passed similar laws, but federal action is necessary in order to apply the prohibition to all health care coverage products.”

Other provisions include:

  1. Duration of plan: limits provider contracts to 2 years
  2. Changes to plan: requires that changes in rates go into effect only when approved by the provider
  3. Terms and conditions: prohibits plans from removing providers from a network if they don’t agree to accept the terms and conditions under a contract
  4. Joining a network: prohibits a plan from requiring a dentist to join a network to be eligible for payment under a plan
  5. Interference with existing relationships: limits plan communication with enrollees if it “interferes with the doctor-patient relationship”
  6. Choice of laboratories: prohibits plans from directly or indirectly limiting a provider’s use of certain suppliers or laboratories
  7. Right of action: gives providers a private right of action against insurers for violations of any of this up to $1,000 a day and attorney’s fees

H.R. 3323 was referred to the Committee on Energy and Commerce (one of three House committees involved in Affordable Care Act topics) and then to its Subcommittee on Health.




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