State Issues Summary
States continue to investigate ways to legislate away the “surprise billing” issue that has sprung up as insurers continue to narrow their networks. Despite the adoption of model legislation by the National Conference of Insurance Legislators in 2017, only a handful of states have introduced similar language. 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.
Nearly 25 percent of all of AAOMS’s legislative tracking centers on opioid abuse, indicating the prevalence of the legislation in the states. Prescription limitations continue to be a popular trend, with most states proposing a three-, five- or seven-day cap. More proposals are requiring ICD-10 or CDT codes to be included on prescriptions, and AAOMS is aware of several private pharmacies that have begun to require the disclosure of this information. A new trend for 2018 is requiring prescribers to have a specified discussion on the risk of opioid use with their patients prior to issuing a prescription for an opioid. E-prescribing mandates also are popular proposals this year, with several states seeking to institute the practice by 2020.
Midlevel Dental Providers
States continue to consider a number of midlevel dental provider bills, mainly for dental therapists. 2018 was the first time Arizona, Florida, Mississippi and Wisconsin had to face this type of legislation. Prior to this year, only three states – Maine, Minnesota and Vermont – authorized statewide practice by dental therapists. An additional three states – Alaska, Oregon and Washington – allowed midlevel dental providers to practice on Native American tribal lands. While Alaska and Washington allow this statewide, Oregon is currently only allowing such practice through a pilot project. In the end, Arizona enacted a dental therapy proposal that restricts dental therapy practice to low access areas, such as tribal lands and Federally Qualified Health Centers. Similar legislation was also enacted in Michigan.
The Texas advertising case ruling in favor of non-ADA recognized dental specialties threw the question of what is a dental specialty wide open. The Dental Boards and legislatures have reacted by amending their current specialty advertising language in a few ways. In the past, many states included language that essentially deferred the ability to determine specialties to the ADA or CODA. This practice has served as the basis of many lawsuits, so AAOMS is seeing states amend their laws to grant the determination of what constitutes a dental specialty to either the legislature or the Dental Board explicitly. AAOMS also is seeing laws amended to require those who wish to advertise as a specialist to meet specified educational thresholds.