Entering a New Decade

Entering a New Decade

Edward J. Vigna, D.D.S.*:

I hope by now everyone has settled in to the routine of a new decade and that each of you is remembering to write 2010 rather than 2009. The start of a new year is always a good time for reflection and new beginnings. Entering my second year on the ADA Board of Trustees, my energy and enthusiasm are as high as ever. A year of great change is behind us; however, each day presents new challenges and more change. This is the case in any dynamic organization, and the ADA is a dynamic organization. Previously I have referred to the relevancy of the organization. The importance of membership is critical as we face reform, continued interference from third parties, and workforce models, all of which I will address later in this report.

I must first acknowledge that the ADA has experienced some internal discord in the wake of discussions that took place in preparation for and during the 2009 ADA House of Delegates. I will be talking about this and other ADA happenings when I meet with MDA leadership in early March. I want you to know that although we are experiencing some unrest, it can be resolved if everyone involved will set aside their agendas and take the high road. I can assure you that I will follow what I feel is the ethical (high) road. That is what ADA members deserve, and I will honor the trust the 10th District has placed in me. I need to hear from you if you have specific questions or concerns.

Now for an update on some pressing issues.
Health care reform. As health care reform moves along, some points of interest are as follow.

The ADA has not supported nor endorsed either version of the bill. We have supported and opposed several sections or provisions within the proposed legislation.

ADA policy (Res. 60H)passed by the 2009 House of Delegates states the Association shall advocate for any health care reform proposal that maintains the private health care system and assures that insurance coverage is affordable, portable, and available without regard to preexisting health conditions. ADA policy (Res. 33H) passed by the Association’s 2009 House of Delegates also directs the ADA to seek application of consumer protections that would apply to ERISA plans that are exempt from state consumer protection laws. ADA policy (Res. 59H) passed by the 2009 House of Delegates states the Association shall advocate for any health care reform proposal that opposes any third party contract provisions that establish fee limits for non-scheduled dental services.

Anti-trust. The ADA is on record supporting the provision in H.R. 3962, (House bill), which essentially repeals the McCarran-Ferguson Act. The ADA has actively lobbied in support of an amendment of the health care reform legislation to repeal the McCarran-Ferguson federal antitrust exemption for the “business of insurance” because it would boost competition in the health care marketplace. The ADA is also on record supporting several pieces of legislation that would repeal the McCarran-Ferguson federal antitrust exemption for the health insurance industry.

The Senate bill has no antitrust provision.

Public Health Infrastructure.
ADA supports adequate funding of the public health infrastructure, which fosters public-private collaboration, necessary to help break the cycle of oral disease in our country. The ADA supports the establishment of a core public health infrastructure program within the Centers for Disease Control and Prevention and the Public Health Investment fund, which will provide additional appropriations for a number of public health programs.

Regarding H.R. 3962 (House bill) reauthorization of Title VII, the ADA is pleased the legislation established new funding opportunities and a separate section for the dental program. The Title VII sections also, for the first time, support teaching programs that address the oral health needs of vulnerable populations. In general, the ADA supports the infrastructure provisions in H.R. 3962 (House bill) and is very pleased to see the improvements in the NHSC loan repayment program and the granting of liability protection to volunteers at health centers.

Eliminating the taxation of NHSC and state loan repayments and expanding NHSC funding are very significant steps toward addressing the access to care problem, as such change will enable the funding of many more positions.

Workforce issues. The House version calls for the Secretary to establish a Public Health Workforce Corps and a Public Health Workforce Scholarship Program for graduate school programs in public health, dental public health programs, and others.

There are also Health Resources and Services Administration grant programs. One program provides grants (fellowships, etc.) for schools and other entities engaged in increasing the number of individuals in the field of public health workforce, including dental. The ADA supports the provision in the House bill increasing the number of dentists in the public health services.

The Senate bill calls for an Alternative Dental Health Care Providers Demonstration Project whereby the Secretary is authorized to award grants to 15 entities to establish demonstration programs to train “alternative dental health providers”, including community dental health coordinators (CDHC), advance practice dental hygienists, independent dental hygienists, supervised dental hygienists, primary care physicians, dental therapists, dental health aides, and any other professional the Secretary determines is appropriate. Entities eligible to receive grants include institutions of higher education, community colleges, FQHCs, IHS facilities, a state or county public health clinic, a public-private partnership, or a public hospital or health system. The program must be accredited by the Commission on Dental Accreditation or within a dental education program in an accredited institution. Each entity receiving a grant under this section shall certify it is in compliance with all applicable state licensing requirements. Nothing shall prohibit a dental health aide training program approved by the IHS from being eligible for a grant.

The ADA feels the Alternative Dental Health Care Providers Demonstration Project provision should be amended to preclude the funding of mid-level dental providers who could perform surgical procedures.

Wellness and prevention. This provision is consistent with Res. 60H passed by the ADA’s 2009 House of Delegates that states the ADA shall advocate for any health care reform proposal that develops prevention strategies that encourage individuals to accept responsibility for maintaining their health and which may reduce costs.

The ADA is pleased more emphasis is being put on prevention, which has always been a key component of oral health care in the United States. The ADA supports the establishment of a Prevention and Wellness Trust Fund in the House bill and the oral health prevention provisions in the Senate bill.

Dentistry must be represented in a preventive services task force. Rather than the ambiguous statement that the task force will be composed of “individuals with appropriate expertise”, this provision should expressly require individuals be appointed to the task force with expertise in medicine, dentistry, mental health, and other providers of primary preventive or pediatric services.

The ADA supports the oral health prevention education provisions in H.R. 3962. The Association’s proposal for a new dental team member, the Community Dental Health Coordinator (CDHC), meets the needs identified in these provisions for a health care professional with the ability to work in the community providing necessary outreach and education.

Tort reform. The ADA does not support the provisions in either version. Neither the House nor the Senate bill provides meaningful tort reform, which should include limits on non-economic damages and reasonable limits on attorneys’ fees.

The section of the reform legislation that includes the Indian Health Care Improvement Act has been the source of much of the controversy I mentioned earlier regarding our conference call, Dr. Tankersley’s testimony before the Senate committee, and newspaper articles. The House bill incorporates many provisions of the IHCIA, including the ADA-agreed language that limits the scope of practice of a Dental Health Aide Therapist (DHAT) and that precludes DHATs from being part of the Community Health Aide Program (CHAP) beyond Alaska if the CHAP program is nationalized by the Secretary.

The Senate bill, by reference, includes the IHCIA as reported by the Senate Committee on Indian Affairs in December 2009 (S. 1790). The bill also contains a number of key amendments to the IHCIA. Similar to H.R. 3962, the Senate IHCIA includes the ADA-agreed language that limits the scope of practice of a Dental Health Aide Therapist (DHAT) and contains the general prohibition that precludes DHATs from being part of the Community Health Aide Program (CHAP) beyond Alaska if the program is nationalized by the Secretary.

However, unlike the House bill, the Senate bill contains an exception to the general prohibition of DHATs practicing outside of Alaska under the CHAP program. Specifically, DHATs will be permitted in the CHAP program if requested by an Indian tribe or tribal organization located in a state in which the use of DHAT or mid-level provider services is authorized under state law to supply such services in accordance with the state law. This the language submitted by Senator Franken. There is also a general statement that nothing shall restrict the ability of the Service, an Indian tribe, or tribal organization from participating in any program or to provide any service authorized by any other federal law. The bill also states the Secretary shall not fill any vacancy for a dentist with a DHAT.

The ADA supports the provisions noted in the House bill, H.R.3962.

I have highlighted some of the longstanding positions we (ADA) have maintained in the debate over reform.

Another issue of concern is the fee limitation on non-covered procedures imposed by third parties. Virginia has introduced legislation similar to Rhode Island stopping that activity in their state. Delta Dental of Virginia has undertaken a very aggressive campaign directly with patients against this legislation. I guess you could say they learned from the Rhode Island situation. I will forward all the documentation on this activity to the MDA office.

I look forward to continued service to all of you in Minnesota, and to the entire 10th District. Please contact me with any questions you many have, and STAY WARM!

Always Available
Much more to come next year, so stay tuned. As always, please contact me with your concerns and comments: vignae@ada.org or (402) 770-7070.

*Dr. Vigna is the Trustee to the Tenth District of the American Dental Association, representing Iowa, Minnesota, Nebraska, North Dakota, and South Dakota.