2010 LEGISLATIVE ISSUES SHEET -- Back to GAO Home
(As of March 10, 2010 - subject to change)
The Florida Dental Association’s (FDA) Governmental Action Committee, in collaboration with the FDA Board of Trustees and the FDA House of Delegates, prepares for each legislative session by developing an issues sheet outlining dental-related priorities to be addressed during session. The following is a list of dental issues for the 2010 Session:
• Prohibiting Maximum Allowable Charges for Non-Covered Services SUPPORT
• Dental Workforce Survey SUPPORT
• Health Care Clinic Establishment Permit Legislative Fix SUPPORT
• Addition of a Dentist on the Florida Healthy Kids Board of Directors SUPPORT
• Scope of Practice Expansion by Dental Hygienists OPPOSE
• Maintain the Adult Dental Medicaid Program SUPPORT
• Increase Medicaid Dental Provider Reimbursement Fees SUPPORT
• Dental Student Loan Repayment Program Funding SUPPORT
• Internationally Trained Dentists Educational Opportunities SUPPORT
• Medicaid Reform MONITOR
• Dental Managed Care Pilot Project Expansion OPPOSE
• Protect the Florida Dental Licensure Exam SUPPORT
PROHIBITING MAXIMUM ALLOWABLE CHARGES FOR NON-COVERED SERVICES
(HB 291 by Rep. Clay Ford, SB 302 by Sen. Dennis Jones)
SUPPORT
HB 291 and SB 302 will prohibit Florida insurance preferred provider organizations (PPO) (chapter 627), health maintenance organizations (HMOs) (chapter 641), and pre-paid limited health service organizations (PLHSOs) (chapter 636, part I) from forcing contract provisions on health care providers for services not covered by the plan. It basically will prohibit artificial price controls by big insurance companies thereby protecting many small Florida businesses.
Some insurance companies are strong-arming health care practitioners to agree to artificial price controls (maximum allowable charges) for non-covered services. These insurance companies are sending contract addendums to health care practitioners forcing them to agree to steep discounts on services not covered by the insurance plan that was initially negotiated.
This insurance company practice mixes an insurance product with a discount medical plan and they should be two distinct and separate entities. According to s. 636.202 (1), Florida Statutes, which defines discount medical plan, “The term “discount medical plan” does NOT include any product regulated under chapter 627, chapter 641, or part I of this chapter.” Therefore, current law clearly implies that insurance companies should not mix these two products.
This latest insurance company practice, if not stopped, could negate many long established patient / practitioner relationships. Potentially, these new contract provisions could diminish access to specialty care by the consumer, while discouraging health care practitioners from being innovative in their approach in outlining alternative treatment options for their patients. Instead of allowing the health care practitioner the ability to negotiate these contract addendums, it is presented as a take it or leave it – leaving the provider with not being highlighted in the insurance network provider directory as an available provider.
While we all agree reducing health care costs is an important part of health care reform, artificial price controls by huge insurance companies will only further complicate the system.
These bills have no fiscal impact to the state of Florida’s budget.
DENTAL WORKFORCE SURVEY
(HB 537 by Rep. Ken Roberson, SB 970 by Sen. Garrett Richter)
Public Record Exemption Bills
(HB 539 by Rep. Ken Roberson, SB 972 by Sen. Garrett Richter)
SUPPORT
The FDA has been working closely with the Department of Health (DOH) and the Florida Board of Dentistry (BOD) in an attempt to gather additional information on the dental workforce in Florida. The product of this work is a voluntary survey that will be included in the 2010 renewal cycle for both dentists and hygienists. Dentists and hygienists have until February 28 to renew their license. Questions include geographical practice locations, number of hygienists and assistants employed, areas of specialty practice, pro bono hours provided, Medicaid and other special needs availability, etc. This exercise was implemented for the physicians in 2007 and resulted in a high percentage of physicians completing the voluntary survey – over 90% completion rate. This survey is now a mandatory requirement for physicians during their renewal cycle.
The FDA is educating member dentists about the voluntary survey that will appear in their 2010 renewal and is encouraging them to comply. However, it is voluntary and cannot be required without a legislative change.
This legislation will make the voluntary survey a requirement as a part of licensure renewal during the 2012 renewal cycle. Additionally, there is a public records exemption bill filed to protect the dentists and hygienists personal identifying information. The FDA supports gathering this information in an attempt to properly address the access to care problems in Florida.
SB 970 and SB 972 passed unanimously out of the Senate Health Regulation Committee. The bills will now go to the Senate Governmental Oversight and Accountability Committee.
HEALTH CARE CLINIC ESTABLISHMENT PERMIT LEGISLATIVE FIX
(HB 537 by Rep. Ken Roberson, SB 970 by Sen. Garrett Richter)
SUPPORT
The 2008 Legislature passed a bill that established a new permit called the health care clinic establishment permit, which costs $255 every two years. The section of law that created this permit is associated with the "pedigree papers" or the tracking of all prescription drugs from manufactures to end-users.
The idea of the new permit was to allow corporate entities to purchase prescription drugs/supplies if they had a “qualified practitioner” who then became responsible for all legal and regulatory requirements related to the purchase, recordkeeping, storage and handling of the prescription drugs. Wholesale drug suppliers faced a criminal penalty for sending prescription drugs to unauthorized entities and this was an attempt to address that problem.
The 2009 Legislature passed a glitch bill that attempted to fix many problems with the legislation; however, it did not address dentist’s specific concerns. Most dental practices are incorporated for liability and tax purposes, so even though the law allows dentists to purchase prescription drugs without this new permit due to their licensure as dentists, if they pay for the drugs with their corporate check as most do, the DOH has interpreted this as the corporation being the owner of the drugs, therefore, a permit is required. The FDA does not agree with the DOH’s interpretation and will be seeking legislation to allow dentists to continue the same procedures and process that they’ve used previously to purchase their prescription drugs.
The FDA is supporting additional language making it clear that this permit is not required as a condition of ordering prescription drugs, but that it is optional.
SB 970 and SB 972 passed unanimously out of the Senate Health Regulation Committee. The bills will now go to the Senate Governmental Oversight and Accountability Committee.
ADDITION OF A DENTIST TO THE FLORIDA HEALTHY KIDS BOARD OF DIRECTORS
(HB 537 by Rep. Ken Roberson, SB 970 by Sen. Garrett Richter and
HB 1545 by Rep. Juan Zapata, SB 2082 by Sen. Nan Rich)
SUPPORT
During the 2009 Legislative Session, the FDA was able to get a dentist representative on the Florida Healthy Kids Board of Directors with the passage of HB 185 by Rep. Matt Hudson (R-Naples). However, on the last day of session, SB 918 by Sen. Nan Rich (D-Sunrise) passed and added a representative from the Department of Children and Families (DCF) to serve on the Florida Healthy Kids Board. Since the statute designates a certain number of members to serve on the Board, SB 918 needed to amend the statute to reflect 12 members instead of 11 members. Because SB 918 passed last, it bumped the FDA representative out of the statute. To fix this glitch, the FDA has filed an amendment to HB 537 and SB 970.
SB 970 has passed its first committee of reference and is now scheduled to be heard in the Senate Governmental Oversight and Accountability Committee.
HB 1545 and SB 2082, the KidCare bills, also contain language that would add a dentist to the Florida Health Kids Board of Directors.
SCOPE OF PRACTICE EXPANSION BY DENTAL HYGIENISTS
(HB 1469 by Rep. Pat Patterson, SB 490 by Sen. Chris Smith)
OPPOSE
The FDA opposes HB 1469 and SB 490. These bills are an attempt by dental hygienists to expand their scope of practice in “health access settings” without the presence of a dentist. While HB 1469 and SB 490 are not identical, both bills attempt to do the following:
• Allows dental hygienists to go into health access settings without the supervision, prior authorization or presence of a dentist to provide remedial services.
• Broadens the definition of “health access settings” to include school-based prevention programs.
• Allows dental hygienists in health access settings under public health supervision (no supervision) the ability to perform all of their private office duties and dental charting. In other words, hygienists are allowed to do procedures that they are now doing in private offices in a health access setting without any supervision or presence of a dentist.
• Allows dental hygienists, without supervision, to do fluoride treatments including fluoride varnish applications and instruct patients in oral hygiene care and provide other services that do not involve diagnosis or treatment of dental conditions.
The FDA believes that all Floridians should have a dental home and this includes seeing a dentist no matter what the setting. While dental hygienists are an integral part of the dental team, only a dentist has the education and qualifications to diagnose and establish a treatment plan. This is done under the scope of practice for dentists not hygienists.
We all agree that access to care is an on-going challenge; however, it is not a simple solution that a scope of practice expansion will solve. It will take an investment of financial resources that are presently lacking to adequately address this access to care issue.
At this time, the FDA is working with the FDHA on compromise language that will allow dental hygienists to practice in health access settings and maintain the protections of having clearance involvement by a dentist or physician.
MAINTAIN THE ADULT DENTAL MEDICAID PROGRAM
SUPPORT
Florida’s current adult dental Medicaid program, which is optional and subject to elimination, provides minimal services to Medicaid recipients. Adults can only receive emergency dental services, which include extractions and partial/full dentures. As part of the state agencies exercise to make budget reduction recommendations, this program could potentially be up for elimination.
Even though the adult dental Medicaid program is not comprehensive, it provides necessary treatments to individuals who would otherwise be without any access to dental care. By eliminating this program, these Medicaid recipients will end up in the emergency room for treatment at a much higher cost. The FDA urges the state to maintain the adult dental Medicaid program.
Additionally, the FDA urges the Legislature to continue the policy of allowing partial dentures for adult Medicaid patients when appropriate. AHCA recently suggested that this benefit be eliminated. Partial dentures, when appropriate, are the proper standard of care for certain individuals who are missing teeth. Prior to partial dentures being an option, Medicaid dental providers were forced to pull healthy teeth, which act like an anchor against jaw bone loss, to place a complete set of dentures. Pulling healthy teeth or “slicking the mouth” required dentists to practice sub-standard dentistry to comply with a Medicaid policy that would only pay for a full set of dentures. This option is critical for Medicaid recipients who want to keep their natural teeth intact.
INCREASE MEDICAID DENTAL PROVIDER REIMBURSEMENT FEES
SUPPORT
Extremely low reimbursement rates for Medicaid dental providers have been a significant barrier for increasing the number of dentists willing to participate in the Medicaid program. In a comprehensive study of Medicaid dental reimbursement rates by the Lewin Group, Florida has ranked 38th among 45 states. The study also cites that Florida has the lowest Medicaid reimbursement schedule when compared to its immediate surrounding states. These levels range from about 150 percent to as much as 391 percent below the fees paid for similar procedures in states such as Georgia and North Carolina. When compared to the usual and customary rates within the state, Medicaid reimbursement is as low as 15 percent of the 50th percentile fee for some procedures.
Florida has not increased Medicaid dental reimbursement fees in over 10 years, while the cost of the actual dental service has nearly doubled in some areas. Dentists participating in the Medicaid program are passionate about working with the underserved population group. However, current reimbursement levels are creating a problem attracting dental providers to the Medicaid system and are creating additional barriers as efforts move forward to improve access to dental care for children.
DENTAL STUDENT LOAN REPAYMENT PROGRAM FUNDING
SUPPORT
Current law provides for the state to implement a dental student loan repayment program, which would allow dental graduates the opportunity to get their student loans repaid based on their commitment to provide services to federally designated dental shortage areas. This program has been very successful in many other states, such as California, Massachusetts and Washington. Florida participated in the student loan repayment program in years past, but had to forego its recurring funding in June 1996, because of budget shortfalls. As the state continues to tackle access to care problems, it is anticipated that this program will help provide the much needed access to dental care in these underserved areas.
The statutory authority needed to implement the student loan repayment program is currently in law under the Florida Health Services Corporation statute in s. 381.0302, F.S. Therefore, no legislation needs to be filed to reinstate this program. The FDA is requesting that the Legislature provide adequate funding for the program.
During the 2007 Legislative Session, the Legislature appropriated $700,000 to reinstate the funding for the program, with proviso language to implement marketing strategies at both dental schools. Unfortunately, the Governor vetoed the appropriations. The FDA will continue to pursue funding for this program.
INTERNATIONALLY TRAINED DENTISTS EDUCATIONAL OPPORTUNITIES
SUPPORT
The FDA supports the opportunity for internationally trained dentists to have access to supplemental educational training in Florida before sitting for the Florida clinical exam. The University of Florida College of Dentistry (UFCD) is in the process of opening the new 2-year Advanced Education in General Dentistry Program for Internationally Trained Dentists at the UF Hialeah Dental Clinic, located in Miami-Dade County. This clinic is committed to both providing community based clinical learning opportunities for dental residents and improving access to dental care for underserved populations. This new program will accept 12 residents per year and will double the number of resident dentists currently being educated at the facility. To handle this increase of residents, renovations to the existing facility are needed, as well as equipment upgrades. The total cost estimate is approximately $750,000.
This new program will continue to be closely aligned with the main UFCD campus in Gainesville, utilizing a state of the art interactive distance learning system and sharing administrative support. Locally, the program will continue to draw on the expertise of the clinical faculty, staff and volunteer dentists that have made the Hialeah Clinic training programs a success during the past 14 years.
The FDA supports the funding request to help prepare the existing facility for its new class and the UFCD efforts to successfully train internationally trained dentists to become licensed dentists in Florida.
MEDICAID REFORM
MONITOR
The Agency for Health Care Administration (AHCA) has implemented Medicaid reform in two urban counties, Broward and Duval Counties and three rural counties, Baker, Clay and Nassau counties. A report by the Office of Inspector General (OIG) clearly states that AHCA has encountered major challenges in Broward and Duval Counties. The Agency lacked adequate resources to meet set timelines, staffing levels were inadequate to undertake Medicaid reform, limited access to specialists continued to be a problem, Medicaid fraud and abuse continued under the managed-care model, and the list goes on. Another report released by the University of Florida provided contradictory differences in ways that make it hard to draw conclusions.
Many groups have expressed their concerns and opposition to Medicaid reform expansion. The Legislature must approve any expansion of the reform project before being implemented. The FDA will continue to monitor Medicaid reform and the potential impact it will have on access to dental care.
DENTAL MANAGED CARE PILOT PROJECT EXPANSION
OPPOSE
The AHCA has encouraged the Legislature to restructure the Medicaid system from a fee-for-service (FFS) payment schedule to a capitated payment methodology. One major example of this shift in Medicaid is the managed-care pilot project in Miami-Dade County for children dental services. Despite the FDA’s request for the pilot project to be discontinued and the reported reduced levels of access to dental care outlined in an evaluation done by the University of Florida (UF), the Agency negotiated a new two-year contract for managed-care dental services in Miami-Dade County. Many of the Medicaid dental providers who participated under FFS stopped participating in the Medicaid program and refused to accept the low capitated payments. The FDA opposes any attempts by the Legislature or the Agency to expand Medicaid managed-care dental services outside of the pilot area.
As the state continues to move health care services to a capitated payment system, many issues related to dentistry will need to be addressed and resolved before this mechanism will work to benefit all parties involved. In the meantime, the FDA remains opposed to expanding Medicaid managed-care dental programs.
PROTECT THE FLORIDA DENTAL LICENSURE EXAM
SUPPORT
The DOH is working on a legislative proposal this year to eliminate the Florida dental licensure exam. It is unclear what specific issue the DOH is trying to resolve with this extreme measure.
The FDA strongly supports the present Florida dental clinical exam. The FDA has worked with both the DOH and the Board of Dentistry over the last several years to improve this exam and it has been noted that Florida has one of the best, if not the best, exam in the country.
The FDA believes passing the Florida exam is crucial to patient protection and the state should not allow other regional exams to determine what is best for Florida. The Legislature, through statute, determines the requirements for the Florida exam. If the DOH is allowed to get rid of the Florida exam, the Legislature will lose control over the contents of the exam.
