With the Minnesota State Legislature recently adjourned for the year, we are pleased to report that the MDA's lobbying efforts were very impactful in successfully affecting the outcomes of several initiatives on behalf of dentistry in Minnesota
It was a long, grueling year at the Capitol. In a short session (Feb - May) that was intended primarily for bonding issues, this year we were again faced with a looming budget deficit as well as the question mark regarding the Governor’s $2.7 billion unallotment. And, in typical legislative fashion, it all boiled down to the final days of the session and the need to call a one day special session to wrap everything up.
MDA Legislative Priorities:
Critical Access Dental Payment Program: The Governor unalloted $6.2 million in 2009 and had proposed cutting another $3 million this year from this program that increases dental reimbursements for dentists who see substantial numbers of public program patients. Despite a huge state budget deficit, we worked diligently to restore the program. Language was incorporated in the Omnibus HHS bill, but it was vetoed. We were then successful in getting it into a second omnibus budget bill, but that was also vetoed. Finally, during the special session, the critical access language was included in the omnibus budget bill that passed and will be signed by the Governor.
The language calls for critical access funding to be made available for Medical Assistance patients and focuses on non-profit community dental clinics with language giving DHS discretion to designate a dentist or dental clinic as a critical access dental provider if the dentist or dental clinic would significantly increase access to dental care in a service area.
Critical Access Dental Provider Program Eligibility: The Minnesota Department of Human Services maintains there is substantial “fraud” amongst dentists seeing low-income patients under the critical access program and, as a result, was seeking authority to dismiss dental clinics from the critical access program, including the right to use dental plan audit findings for such dismissals. We had been working with legislators to ensure that this language was as acceptable as possible and that the Department used a fair process in determining eligibility for the critical access program. However, in the end, we supported Senator Linda Berglin’s position to not adopt the language at all preventing DHS from having special authority to remove dental clinics from this reimbursement program.
Adult Benefit Set: Minnesota has always provided a comprehensive dental benefit set for public program adults. Due to budget shortfalls, the adult dental benefit set was restricted substantially by the legislature in 2009. The MDA created a video with the assistance of ADA State Public Affairs financing that has helped to illustrate the problems created by a partial benefit set and that has convinced many legislators that some dental benefits need to be restored. We were successful in getting the House to pass language to restore or increase the frequency of coverage for full-mouth radiographs, molar root canals, relines and repairs of dentures, adding teeth and clasps to dentures, limited periodontal scaling and root planning, and some general anesthesia. Regrettably, this language did not make it into the final Conference Committee report and will not become law. We will continue to fight on into the future to improve the dental benefit set for adults.
State Operated Services Dental Clinics: The state operates five dental clinics that serve developmentally disabled patients. As part of a budget cutting plan, the Minnesota Department of Human Services had proposed closing those clinics. The MDA was successful in fighting to prevent these developmentally disabled patients from being abandoned - the law that will be signed by the Governor will restore the funding for these dental clinics and will prevent the state from closing them. In addition, this new law establishes an advisory group made up of a variety of stakeholders, including the MDA, to recommend how these services can be provided more efficiently in the future.
Donated Dental Services Program: The Governor had proposed eliminating funding for the DDS Program. The MDA successfully fought to maintain DDS Program funding in the final bill, arguing that for every state dollar spent, $15 of free dental care is provided by dentists to very needy patients.
Provider Tax: It has long been our goal to prevent increases to the provider tax and to ensure that revenues from the tax go toward dental programs. With this year’s budget crunch we were very concerned that the tax could be increased and the Health Care Access Fund (to which the tax is dedicated) would be raided to help balance the state budget. We are pleased to report that this did not happen. However, a looming concern would be if the next Governor were to choose an early opt-in of the new federal Medicare program, the HCAF would be used to offset the state’s costs.
Dental Therapist Law: The MDA successfully worked to prevent an effort to remove important quality controls regarding the education and licensure of dental therapists in Minnesota. The MDA had worked hard in 2009 to establish such quality controls in order to ensure quality care and safety for patients. The last minute effort by some senators was an unwelcome effort to undo important pieces of the 2009 dental therapist legislation. The vote to remove the unacceptable language was 40 to 21. To see how your state Senator voted, click here.
Dental Loan Forgiveness Programs: Despite the budget problems, a new dental loan forgiveness program was created to encourage new dentists to practice on the Iron Range. This new program will be funded with a small percentage of the taconite tax.
Emergency Preparedness Entity Liability Protection Law: Legislation was successfully passed this year to address a gap in liability protection and to create incentives for private and non-profit entities to join with government agencies as they prepare for, and respond to, the next public health emergency. The fundamental concept of this law is to provide liability protection for business and non-profit organizations who act in good faith to voluntarily assist government agencies during such emergencies.
Non Covered Services: An MDA bill that would have prevented rates on non-covered dental services from being capped. The MDA saw a number of successful votes in the House, but ultimately did not become law this year. The MDA was able to pass the bill out of two House committees and amend the language onto the House omnibus HHS bill. However, when the bill went to conference committee, Delta Dental worked very hard to expand the language to other dental payers or to defeat it even though they had originally supported the concept. The Senate conferees ultimately chose to not include it because they either felt that the bill had not passed out of a Senate committee because of anti-consumer concerns or because the amended language only applied to Delta Dental and not to all of the state’s dental insurers. This will remain one of our top priorities for the 2011 legislative session.
Third Party Payer Audits: The MDA had introduced legislation requiring dental third-party payers to provide due process to dentists who they audit. As a result of discussions with Delta Dental and the introduction of a retrospective audit bill to establish due process for dentists who are audited, Delta Dental has indicated that it will amend its Policy and Procedures Manual to clarify the rights and opportunities a dentist has in the audit process. Once Delta provides dentists the opportunity to see those changes in the Manual, the MDA will assess the need for a renewed legislative strategy in the 2011 session.
Retail Teeth Whitening: The MDA supported legislation sponsored by the Minnesota Board of Dentistry to officially define tooth whitening as the practice of dentistry. This legislation was defeated in a committee hearing because there was not a clear ability to show that harm has been caused at these facilities.
Dental Caries: A new law was passed “encouraging” medical assistance primary care providers to perform primary caries prevention services as part of the child and teen checkup program. Such services consist of a visual exam of the mouth without using dental instruments or radiography equipment, a risk assessment and the application of a fluoride varnish beginning at age 1 to those children assessed by the provider as being high risk.
Advisory Group on Administrative Expenses: For some time we have been concerned about the administrative expenses that health plan payers were charging for publicly funded programs. New legislation will create an advisory group to make recommendations to the legislature on developing consistent guidelines and reporting requirements for these organizations.
Fair Contracting Bill: The MDA is a member of the Minnesota Provider Coalition which passed legislation to address grievances providers have with their third-party payers. This legislation was an extension of provider contracting legislation the MDA and others got passed in 2004. Delta Dental Plan of Minnesota sought to be exempted from this legislation; however, the MDA was able to defeat much of that effort.