In 2020, the COVID-19 pandemic dominated all aspects of life, including state legislative activity. The start of the outbreak interrupted or delayed many state legislative sessions in a scheduled abbreviated legislative year due to the elections. This necessitated executive and public health orders issued by the states, including many – particularly in the spring – that placed a temporary hold on all elective medical and dental procedures. Orders also were issued to expand access to care, including telehealth, and broaden scope of practice, particularly for midlevel providers, such as CRNAs. It is unclear how many of these broadened provisions will remain after the pandemic. With the pandemic occurring for much of the year, states addressed little else legislatively in 2020.

Surprise billing

States continue to investigate ways to legislate away the surprise billing issue as insurers continue to narrow their networks. Because OMSs provide services at hospitals, these bills will likely disproportionately affect them compared to the rest of the dental community. Proposals have been introduced that would prohibit balance billing or require specified patient notification before a provider can balance bill, out-of-network providers to be reimbursed at a specified percentage of the customary rate for the geographic area or providers to accept assignment of benefits.


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. Currently, 12 states require e-prescribing. While e-prescribing can be helpful to states’ tracking of controlled substance prescriptions, it also can be burdensome to implement. Providers and pharmacies need adequate time to incorporate the technology in their systems and account for any implementation waivers granted to those unable to meet the requirement. History has shown states that fail to take these facts into account experience chaotic rollouts, 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 has seen an uptick in similar proposals for 2019-20, 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 legislation that would require such coverage.