As the nation began to take steps to address COVID-19, NADP remained committed to supporting and informing dental carriers, dentists, consumers, and various stakeholders, including federal policymakers. NADP weighed in on several issues that were critical to the dental benefits industry during the COVID-19 pandemic:

  • April 21 letter to Congressional leadership seeking federal subsidization of COBRA premiums for the newly unemployed and a special enrollment period for the Federally Facilitated Exchanges
  • April 23 joint stakeholder letter to Congressional leadership with key health and health care priorities for the next COVID-19 response legislation. NADP has partnered with more than 400 organizations, led by Families USA, to advocate for legislation that ensures American families have the ability to seek the care they need to stay healthy.
  • On May 18 NADP joined a coalition of more than 200 organizations in a joint stakeholder letter asking Congress to preserve and protect access to oral health care for millions of Americans including increasing the FMAP and establishing an oral health infrastructure fund. 
  • May 20 letter to Congressional leadership advocating for an increase to the Medicaid Federal Medical Assistance Percentage (FMAP), with a specific increase for dental benefits, in the next COVID-19 relief package
  • On July 22, NADP sent a letter of support to the sponsors of the Small Business PPE Tax Credit Act (HR 7216) which would provide a $25,000 tax credit for small businesses to purchase personal protective equipment (PPE). The tax credit would help some dental practices that are still struggling with obtaining PPE as dental care begins to resume.

NADP Responds to Congressional Investigation of Insurance Industry Profits

In August House Energy and Commerce Committee Chairman, Frank Pallone (D-NJ), announced that he would launch an investigation into health and dental insurance companies’ business practices following reports of higher profit margins, particularly for health insurance companies, during the COVID-19 pandemic. NADP has remained in close contact with the Committee staff, coordinated with individual carriers that were questioned and, in September, submitted a letter response to the Committee’s questions which provides context on the financial picture for the dental industry in 2020, highlights the myriad actions that dental carriers are taking to assist consumers and the community during this pandemic, and explains the key differences between medical and dental plans.

NADP Members Participate in Virtual Grassroots Campaigns with Congress

Due to travel restrictions and Congressional office closures related to the pandemic, NADP conducted its fifth annual Advocacy in Action (AIA) lobbying day virtually. More than 40 NADP members engaged in in-depth telephone conversations and virtual meetings with 60 Congressional offices during NADP’s virtual Advocacy in Action event, June 24-26. Most participants agreed the conference-call format was advantageous as it provided more time to cover industry issues. NADP members urged Congressional leaders to increase the Federal Medical Assistance Percentage (FMAP), direct the Centers for Medicare and Medicaid (CMS) to open a special enrollment period on the Federally-Facilitated Marketplace (FFM) and temporarily subsidize COBRA premiums. NADP members also discussed the dental benefits industry efforts to support oral health and provide access to dental services during the pandemic as well as ongoing efforts to address racial disparities in oral health.

In addition to AIA, NADP members engaged in other large-scale grassroots activities. NADP’s call to action on the FMAP increase, arguing the federal government needed to provide relief to state Medicaid programs to preserve adult dental benefits in Medicaid reached more than 300 congressional offices.

NADP Continues Push for Independent Purchase on the Exchange

NADP continued to advocate for independent purchase of dental benefits on the federal health insurance Marketplace, which provides consumers with an additional option beyond the existing private individual market through which to obtain dental coverage. In February, NADP, in partnership with kidney and transplant advocates, sent a joint letter to the Health and Human Services Secretary Alex Azar bringing to the foreground the needs of kidney and transplant patients, who require dental treatment before and after surgery. In response, NADP received a letter from Director of the Center for Consumer Information & Insurance Oversight (CCIIO), which reversed course with respect to their stance that there are no statutory barriers to independent purchase of dental on the federal marketplace. Previously the Agency had expressed that the primary barrier was simply a technical issue with, which the Centers for Medicare and Medicaid Services (CMS) was actively working to resolve. NADP reached out to Congressional supporters to explore next steps and will continue to advocate for independent purchase of dental benefits on the federal health insurance Marketplace with the new Administration in 2021.

NADP Advocates Against Federal Non-Covered Services Legislation

On Nov. 12, Sen. Joe Manchin (D-WV) introduced S.4894, the DOC Access Act, in the Senate. NADP has been actively opposed to the House version (H.R.3762) of the non-covered services (NCS) bill, which has been introduced several times in prior years (as HR 1606 in 2017-18 and HR 3323 in 2015-16 but has never passed the full House). The American Dental Association (ADA) expressed its support for federal NCS and NADP anticipates that both the Senate and House versions will likely be reintroduced after the 117th Congress is seated in January 2021. For more details on NADP’s position on this bill, please access the issue brief <here>.

NADP Election Wrap-up 2020

NADP issued a comprehensive Federal and State Election Report analyzing the potential impact of the 2020 elections on NADP members.

NADP Issues Comments on Numerous Federal Regulatory Proposals Impacting Dental in 2020

2020 presented one of the most active years with respect to federal rulemaking activity in recent memory. NADP commented to federal agencies on issues including the Medicaid Fiscal Accountability rule, value based dental plans on marketplaces, direct primary care agreements, and exchange waivers. In the waning days of the Trump Administration, a plethora of rules impacting the dental benefits industry have emerged.

  • Medicaid Fiscal Accountability Rule

On Jan. 31 NADP filed comments with the Centers for Medicare and Medicaid Services regarding the Medicaid Fiscal Accountability Rule (MFAR). NADP opposed the proposed expansion of the definition of permissible classes of health care items and services for the purpose of imposing Medicaid-related taxes. The letter also highlights that the proposed class of health insurance would be substantially more broad than existing classes under Medicaid statute. This fall Center for Medicare and Medicaid Services (CMS) Administrator Seema Verma issued a press release that the rule was being withdrawn, but it has not been officially removed from the regulatory docket and could potentially still be finalized.

  • 2021 Exchange Notice of Benefit and Payment Parameters

On March 2 NADP commented on the annual notice of benefit and payment parameters for the Affordable Care Act exchanges. The rule specifically requested comments on potential future developments of value-based insurance designs (VBID) for dental plans. In response, NADP provided insight from members on the state of value based dental care, including that fee-for-service remains the primary reimbursement method for the industry. Furthermore, NADP recommended that any future VBID developments should follow the frameworks created through the Healthcare Payment Learning & Action Network, bringing together dental payers, providers, and patients.

  • 2022 Exchange Notice of Benefit and Payment Parameters

The Notice of Benefit and Payment Parameters (NBPP) for Plan Year (PY) 2022 introduces an option for states to end the use of centralized exchanges and rely only on direct enrollment entities such as brokers or carriers. The plan follows the implementation of a similar 1332 innovation waiver in Georgia, which NADP opposed for its potential to cause a decline in dental coverage. Comments for the rule are due Dec. 30.

  • CMS Delays Implementation of the Interoperability Rules

In April CMS announced a six-month delay in implementation of the Interoperability and Patient Access final rule (CMS-9115-F). The rule, which would require Medicare Advantage, Medicaid, and the Children’s Health Insurance Program (CHIP) dental plans to develop provider registry and patient data APIs will not be enforced until July 1, 2021. In May 2019, NADP commented in opposition to the inclusion of dental plans in the rule’s requirements, citing cost concerns for plans, the likely lack of dental data utilization by patients, and privacy issues. This argument was in line with the Administration’s own reasoning for exempting Standalone Dental Plans (SADP)s on federally facilitated exchanges (FFEs) from the rule. CMS has also proposed a new rule to expand the requirements for Medicaid/CHIP plans; comments on the rule are due January 4, 2021.

  • 1557 Tagline Repeal

On June 12, the Health and Human Services (HHS) Office of Civil Rights finalized “Nondiscrimination in Health and Health Education Programs or Activities: Delegation of Authority” (RIN 0945-AA11), which permanently repeals tagline requirements under section 1557 of the Affordable Care Act, effective Aug. 18. In August 2019, NADP filed comments supporting the repeal of 1557 tagline requirements, citing the substantial financial burden to dental plans. NADP reiterated that dental plans would continue to provide meaningful access for limited English proficiency enrollees without the tagline requirements.

  • Direct Primary Care

On Aug. 7, NADP filed a comment with the Internal Revenue Service (IRS) on the proposed rule regarding “Certain Medical Care Agreements” (RIN 1545-BP31) that would expand the definition of “medical care” under section 213(d) of the IRS Code, to include health sharing ministries and direct primary care arrangements. This would allow both arrangements to be reimbursable under employee Health Reimbursement Arrangements (HRAs). In the proposed rule, the IRS requested comments on potentially further expanding the definitions in section 213(d) to include “an agreement between a dentist and a patient to provide dental care.” NADP responded by reiterating the stability and affordability of the dental benefits market and raising concern that of allowing direct dental care agreements to be reimbursable by Health Reimbursement Accounts (HRAs) could lead to a false assumption of comprehensive coverage by enrollees.

  • Price Transparency Rule

In October the Trump Administration announced the publication of the final rule on “Transparency in Coverage” (CMS-9915). Under the final rules, plans and issuers that offer excepted benefits, such as limited scope dental or vision benefits, along with their major medical coverage are not required to disclose the information required by the final rules regarding their provision of those excepted benefits. While embedded dental benefits could be required to report as part of the final rule in the future, dental care and billing codes are not currently included in the list of 500 services plans must report beginning in 2023.  

  • Final Rule on Medicaid Managed Care

On Nov. 9, the Centers for Medicare and Medicaid Services (CMS) released the final rule “Medicaid Program: Medicaid and Children’s Health Insurance Program (CHIP) Managed Care” (CMS 2408-F), which finalizes changes to Medicaid and CHIP managed care plan requirements alongside other alterations. In January 2019, NADP filed comments on the proposed rule, voicing support for changes in tagline requirements, grievance/appeals support, and asking for a carve-out for dental benefits in the existing MMC medical loss ratio reporting requirements. Both the information reporting requirements and grievance changes were finalized; however, the rule keeps the existing MLR framework in place. More information can be found here.

  • SUNSET Rule

NADP submitted comments on the proposed rule “Securing Updated and Necessary Statutory Evaluations Timely” (SUNSET). The proposed rule would require that regulations deemed “economically significant” undergo an impact review after 10 years. Any regulations older than 10 years old would be reviewed in the first 2 years after the SUNSET rule’s enactment. If a review is not completed before the 10-year deadline, the regulation would automatically expire. The comments focus on the uncertainty the rule creates in the regulatory environment and the detrimental effects of the potential elimination of regulations without proper review, and NADP encourages HHS to reconsider the repeal of regulations after the 10-year mark if a review is not completed.

  • Interim Final on COVID-19

As part of NADP’s continued advocacy to preserve adult dental benefits in Medicaid, comments were filed in opposition to portions of the Nov. 6 interim final rule on COVID-19 (CMS-9912-IFC), which reversed policies established in April by CMS requiring states to maintain dental benefits for Medicaid enrollees in order to receive enhanced FMAP dollars under the Families First Coronavirus Response Act (FFCRA). NADP argued that the reversal, as well as language in the rule using dental as an example of an acceptable benefit to cut under the Interim Final Rule (IFR), put the oral health of Medicaid enrollees across the country at risk and posed a threat to public health during the pandemic. The comments were also sent alongside a letter to members of congress encouraging them to pass an expansion of the FMAP and reinstate the maintenance of effort requirements on dental benefits from the April guidance.

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