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2019

Surprise Billing

States continue to investigate ways to legislate away the “surprise billing” issue that has sprung up as insurers continue to narrow their networks. Because OMSs provide services at hospitals, they will likely be disproportionately affected by these bills compared to the rest of the dental community. Proposals have been introduced that require out-of-network providers to be reimbursed at a specified percentage of the usual and customary rate for the geographic area, require providers to accept assignment of benefits, prohibit balance billing or require specified patient notification before a provider can balance bill a patient. This is by far the most prevalent issue among the bills being tracked by AAOMS in 2019.

Midlevel Providers

With the enactment of dental therapy bills in Arizona and Michigan in 2018, we have seen several states propose similar legislation this year. As of 2018, eight states authorize the practice of dental midlevel providers either in a limited capacity (such as on tribal lands) or on a statewide basis. Of concern to OMS, many of these midlevel proposals authorize the performance of irreversible procedures – including the extraction of badly diseased and highly mobile permanent teeth – by inadequately trained providers. Proponents of this model argue such extractions are “uncomplicated extractions,” but as a profession we know that what may at first appear simple may indeed be quite complex. AAOMS continues to oppose allowing midlevel dental providers from diagnosing a patient or performing irreversible procedures.

E-prescribing

As states continue to develop ways to address the nation’s opioid epidemic, many are proposing legislation that would mandate electronic prescribing of controlled substances. Eight states currently require e-prescribing with an additional four states’ laws scheduled to take effect by 2020. While e-prescribing can be helpful to states’ tracking of controlled substance prescriptions, it can also be burdensome to implement. Providers and pharmacies need adequate time to incorporate the technology into their systems and account for any implementation waivers granted to providers unable to meet the requirement. Past history has shown that states that fail to take these facts into account result in chaotic roll outs, delayed patient care and a rush to implement corrective legislation.

Craniofacial coverage

While states generally mandate health insurance coverage for the treatment of craniofacial anomalies in young children, procedures performed later in life – particularly related to dentistry – are frequently denied coverage. Several states instituted insurance mandates for such treatment and AAOMS is seeing an uptick in similar proposals for 2019, mainly in the northeast. AAOMS supports efforts to require health insurers to cover procedures that correct craniofacial anomalies – including associated dental and orthodontic treatment. At the federal level AAOMS is working with a coalition of patients and providers to address national legislation that would require such coverage.