1. Current Legislative Issues Update Jonathan D. Shenkin, DDS, MPH 1 st Vice President, American Dental Association Clinical Associate Professor of Health Policy, Health Services Research and Pediatric Dentistry Boston University

2. Boston University Slideshow Title Goes Here Disclaimer The following opinions are my own and do not represent those of the American Dental Association.

3. Boston University Slideshow Title Goes Here  ADA Legislative staff  State Issues  State Public Affairs (SPA) program  Mid levels  Maine  Other issues  Federal Issues  ADPAC  Regulatory-EPA separator mandate  Legislative

4. Boston University Slideshow Title Goes Here American Dental Association  DC and Chicago staff devoted to state and federal issues  DC staff includes 8 lobbyists  Chicago office heads state government affairs with 5 active staff members assisting states.

5. Boston University Slideshow Title Goes Here State Issues  State Public Affairs program (SPA)  Mid-level legislation  Dental Benefits (Minimum Loss Ratio)  Group Practice Regulations  Expanding Dental Board oversight of Corporate practice

6. Boston University Slideshow Title Goes Here State Public Affairs program  $2.8 million allocated for 2014  Dispersed by an ADA committee of volunteers and staff  Program assists states in need of public affairs financing and staffing on a broad array of topics.  So far this year 23 states have received funds.

7. Boston University Slideshow Title Goes Here  Arizona – Native American program, CDHC;  California – Minimum Loss Ratio legislation;  Colorado – Workforce, Medicaid, Community Water Fluoridation, ER Referral, RAC Audits;  Connecticut – Workforce and RAC Audits;  Florida – Workforce and Action For Dental Health (ADH) implementation;  Idaho – Workforce, Medicaid;  DC – Workforce;  Kansas – Workforce and ADH Implementation;  Maine – Workforce and RAC Audits;  Michigan – one lump grant for a Community Water Fluoridation project;  Missouri – Medicaid, ADH Implementation;  Montana – Denturism, Dental Board Structure; RAC Audits;  New Hampshire – Workforce and ADH Implementation;  New Mexico – Native American, workforce, ADH Implementation including a new CDHC education program

8. Boston University Slideshow Title Goes Here  North Dakota – Native American and workforce;  Pennsylvania – Community Water Fluoridation, amalgam, non-covered services;  Puerto Rico – Mandatory dental exams for school enrollment legislation;  Rhode Island – Modifying the Dental Practice Act to provide due process and guidelines pursuant to Dept. of Health dental office inspections;  South Dakota – Native American and CDHC implementation;  Vermont – Workforce, Medicaid, Single-payer issues in the state, ADH Implementation;  Virginia – Long-term care pilot implementation/ADH Implementation;  Washington – Native American and Workforce;  Wisconsin – ADH Implementation, Community Water Fluoridation, Loan Forgiveness

9. Boston University Slideshow Title Goes Here Mid-Level Legislation  Maine  In the hands of BODEX  Expected states with legislation this year  VT, CT, ND, NM, WA, KS, and CO.

10. Boston University Slideshow Title Goes Here What happened in Maine?

11. Boston University Slideshow Title Goes Here Aroostook County Aroostook County6,829 sq miles 71,870 population10.7/sq mi Connecticut 5,543 sq miles 3.6 million739/ sq mi

12. Boston University Slideshow Title Goes Here Maine’s Oral Health Stats  NOHSS-2012  3 rd graders Untreated decay-14.6% 2 nd lowest in nation Caries experience 32.7% Lowest overall in nation Sealants 68.5% Highest in the nation

13. Boston University Slideshow Title Goes Here  Access to preventive services for kids with Medicaid is low in Maine.  But decay levels are among lowest in the nation, and access to appropriate treatment appears to be among the best in the nation for children.  Answer should be that we improve availability of basic prevention for children, not more treatment.

14. Boston University Slideshow Title Goes Here What did Pew do to win?

15. Boston University Slideshow Title Goes Here AHRQ, 2006 AHRQ 2009 ER use in the US, 2006-09

16. Boston University Slideshow Title Goes Here ER spending for Dental in Maine

17. Boston University Slideshow Title Goes Here Number of actively practice dentists in Maine, 1997-2009

18. Boston University Slideshow Title Goes Here Entities that paid registered lobbyists the most in Maine, 2013 Source: Maine Commission on Governmental Ethics and Election Practices

19. Boston University Slideshow Title Goes Here California A.B. 1962 Medical Loss Ratio Legislation  Some dental plans spend as little as 38% of dental premiums for reimbursement of care  Goal is for 80% of premiums to be used for reimbursement of services  This legislation requires reporting back to the legislature actual percentage spent on dental services, which will enable the legislature to develop a medical loss ratio requirement for dental plans.

20. Boston University Slideshow Title Goes Here Group Practice Regulation  Washington State v Pacific Dental  Complaint filed that PD was practicing dentistry without a license  Also filed a complaint against an owner dentist, stating that aiding and abetting practice of dentistry without a license

21. Boston University Slideshow Title Goes Here Small Smiles  Multiple lawsuits filed against dentists  Small Smiles bankrupt and had no insurance  Insured employed dentists, who are now targets  Lawsuit in NY found Small Smiles dentists guilty of malpractice, but with no financial judgment.

22. Boston University Slideshow Title Goes Here Federal Issues  ADPAC  RAC audits  Federal Regulatory Issues  Students loans  Affordable Care Act  Action for Dental Health campaign  GME funding

23. Boston University Slideshow Title Goes Here ADPAC  In 2012 cycle, $3.6 million collected  2 nd largest Healthcare PAC after Anesthesiologists.  Successfully have kept 2 dentists in Congress and likely to elect a 3 rd in November.  Donate now as a student.  http://www.ada.org/en/advocacy/adpac/

24. Boston University Slideshow Title Goes Here June 22, 2012

25. Boston University Slideshow Title Goes Here RAC Audits  Mandated under ACA  States given great latitude on how they implement audits  Louisiana and CT have passed legislation will limit and control audit processes  Nebraska recently had an ADA member testify before Congress about RAC audits.

26. Boston University Slideshow Title Goes Here Federal Regulatory Issues  4 full time lobbyists  Full spectrum of federal agencies  Rulemaking that impacts infection control to Medicaid policies  Outside of the realm of Congress

27. Boston University Slideshow Title Goes Here EPA Amalgam Separator Rule  Hearing on November 10 th  Will mandate amalgam separators in dental offices  Follows ADA best management guidelines  Currently only 12 states mandate separators

28. Boston University Slideshow Title Goes Here Student Loans  Federal Student Loan Refinancing Act  S 1066  Enable students to consolidate or refinance Direct Unsubsidized Stafford Loans at 4%  Student Loan Interest Deduction Act of 2013  HR 1527  Would allow interest deductions and allow them regardless of income

29. Boston University Slideshow Title Goes Here Affordable Care Act

30. Boston University Slideshow Title Goes Here Increase in Medicaid since ACA CMS 2014

31. Boston University Slideshow Title Goes Here ADH campaign consists of many initiatives such as: - ER Referral - Community Dental Health Coordinator - Fluoridation - MoMs programs and GKAS - Long-term Care - Medicaid Reforms

32. Boston University Slideshow Title Goes Here GME funding  Critical in funding of post graduate residencies in dentistry  HRSA is planning on eliminating the funding for Children’s Hospital  Appears DOA

33. Boston University Slideshow Title Goes Here Title VII  Funds GPR and Pediatric Dental Residencies  Senate just included expanded funding for Title VII funding  $9 million will go to each program.

34. Boston University Slideshow Title Goes Here Conclusions  A constant flow of new and evolving legislation  Most issues arise and are solved in the states  Being active early in your career is critical  Be a part of ADPAC now, and tell a friend  Start local

35. Boston University Slideshow Title Goes Here Questions? shenkinj@ada.org