WSDA Legislative Efforts In Review
The Washington State Legislature adjourned its regular 105-day session on April 23, 2017. Because the philosophically divided legislature did not finish their work on the state operating or capital budgets, nor agree upon a resolution to the McCleary education funding lawsuit, Governor Inslee immediately called them back into a 30-day special session and then directly into a second 30-day special session. With a shutdown of state government looming if the legislature did not pass an operating budget by the end of June, a third special session was necessary. They passed the operating budget on the 10th day of the third special session - the last day possible to avoid the shutdown.
Most of the policy work, however, was completed during the regular session. With a focus on ensuring that issues of import to organized dentistry remained in the forefront of the legislators’ minds, WSDA was able to obtain key victories during the 2017 regular session.
Protecting patient safety
WSDA achieved a major success this year with the passage of Senate Bill 5322. Some companies, known as dental support organizations (DSOs), provide administrative support services to dental practices, but experience in Washington and other states has shown that those services sometimes cross the line into the corporate practice of dentistry, with non-dentists calling the shots on patient care. WSDA supports choice in how dentists manage their practices, as long as proper patient safeguards are in place. Dental care decisions should be left to a patient and his or her dentist’s independent judgment.
With competing bills introduced by WSDA and the DSOs, legislators called on both parties to reach a compromise solution. WSDA honored the legislators’ requests, engaged in discussions with the DSO representatives, and found a productive solution that will allow dentists to utilize the services of dental support organizations subject to the limits of important patient safety protocols and oversight by the Department of Health. Senate Bill 5322 takes effect July 23, 2017. Funding for enforcement was included in the state operating budget.
Dental residents are part of WSDA’s strategy to reach more low-income patients and are a superior alternative to lesser-trained dental therapists. This year, WSDA supported capital budget requests to help fund facilities and infrastructure needed to expand dental residency programs. Providence Health & Services is looking to expand in Spokane and Olympia. In addition to the capital request, WSDA supported House Bill 1411, which expands opportunities for dentists to forego the licensure examination by completing a postdoctoral dental residency program to include general practice, pediatric, or advanced education in general dentistry residency program options. This bill expands residency settings to include hospitals and should encourage the creation of new programs. House Bill 1411 passed unanimously and takes effect July 23, 2017.
Rep. Michelle Caldier, the only dentist in the Legislature, prime sponsored House Bill 1314, which will create safeguards to ensure fair and transparent Medicaid audit processes. WSDA fully supported her efforts to direct the Health Care Authority to meet standards regarding auditing practices related to the recovery of payments, auditing timelines, the use of statistical sampling, and the submission of records as well as establish requirements related to expertise and reporting for contractors performing the audits. The bill passed unanimously and takes effect on July 23, 2017.
Funding was provided in the operating budget for the Oral Health Connections Pilot Program in Yakima, Adams, and Cowlitz Counties. The pilot will include enhanced reimbursement rates for participating dental Medicaid providers and an increase in the allowable number of periodontal treatments. Medicaid clients who are diabetic and/or pregnant and who are receiving dental care within the pilot regions are eligible.
Opioids and suicide prevention
The overuse and abuse of opioids have become a crisis nationwide, and Washington’s legislature has reviewed a number of bills related to opiates. WSDA successfully defended against onerous infringements into the dentist-patient relationship such as hard limits on prescribing practices and worked toward more well-rounded legislation that requires the health care provider disciplinary committees, like the Dental Quality Assurance Commission, to develop rules establishing requirements for prescription opioid drugs. The bill will also enhance the use and availability of data through the Prescription (Drug) Monitoring Program (PMP) and will update opioid treatment programs. Funding was provided in the operating budget for the analytical work and increased reporting associated with the expansion of organizations eligible to receive information from the PMP.
WSDA also supported bills that would address legislators’ concerns in different ways, such as House Bill 1612, which adds dentists and dental hygienists to the long list of healthcare providers who must receive training in suicide assessment and referral. While WSDA would generally oppose such a government mandate, the prime sponsor of the bill worked well with WSDA leadership to address our concerns. As amended based on those conversations, the bill that passed includes a three-year delay in implementation, and will allow WSDA to work with the University of Washington School of Dentistry to develop the curriculum. The operating budget provided one-time funding for rulemaking regarding training for licensed dentists and dental hygienists.
Opportunities for future success
Even with the successes of the regular legislative session, much work remains for WSDA members and staff both this year and in 2018.
First and foremost, the Legislature is still in their third special session, which runs until July 20 unless they adjourn early. While the operating budget must be passed by June 30, it is still possible for them to pass a capital budget or engage in further policy work. Thus, WSDA remains vigilant regarding projects that are still pending during this legislative session.
2017 Capital budget
As mentioned above, the Washington State Dental Association teamed up with Providence Health & Services to request funding for residency projects in Olympia and Spokane. Both the House and Senate drafts of the capital budget include funding for these programs. Thus, we remain hopeful that a capital budget will pass before the end of the third special session and will include the $2.8 million in infrastructure funding necessary to make these programs a success.
Both drafts of the capital budget also include funding requested by the Community Health Network for construction and equipment directly associated with dental facilities in local communities.
2017 Operating budget
Following a budget provision last year that required the Health Care Authority to report on how the administration of dental Medicaid could be contracted to an outside company, a proviso was included in this year’s operating budget that requires the Health Care Authority to contract with two dental managed care organizations. Funding is reduced by $6.1 million to reflect savings achieved through reduced emergency department utilization anticipated as a result of managed dental care. The proviso also requires that any additional savings incurred shall be used to increase dental provider reimbursement rates. As directed by the proviso, the Health Care Authority must now develop and implement a competitive procurement process with the idea that two managed care organizations will be under contract by July 2018. WSDA will remain fully engaged in this process to ensure the best possible process and contract going forward.
WSDA also supported the House budget’s inclusion of the UW School of Dentistry’s $1.96 million request for infrastructure and personnel to expand the capacity and footprint of the Regional Initiatives in Dental Education (RIDE) program, which trains providers in rural and underserved areas. Unfortunately, this funding did not make it into the final operating budget bill.
Speaker of the House Frank Chopp convened a dental “one-table” process to learn about what issues mattered to dental stakeholders this year. Several of the bills and funding provisions pending before the legislature this year were discussed in this setting. One such policy bill may still have the opportunity to pass this year. House Bill 2143 would expand the Washington State Opportunity Scholarship to students in eligible advanced degree programs in health professions who commit to a required service obligation. The bill passed the House during the regular session, and has been passed again in both the first and second special sessions, keeping it alive as budget negotiations continue. It remains to be seen whether the bill will pass before the legislature adjourns for good this year.
Additionally, because 2017 was the first year of the biennial legislature, all of the bills that were introduced this year will automatically be reintroduced next year along with all of the new legislation that will be introduced in the 2018 legislative session. Thus, we already know some of what will be on the agenda for next year.
House Bill 1316, prime sponsored by dentist Rep. Michelle Caldier, would have required carriers to maintain a utilization review program description and written criteria based on the prevention of dental disease and chronic disease implications. It also would have prohibited a carrier from retrospectively denying coverage for care that had prior authorization, and would have prohibited carriers from subjecting providers to additional oversight based on the provider filing an appeal or grievance on behalf of a patient.
Finally, the bill would have required the Office of the Insurance Commissioner to convene a workgroup to examine current practices related to explanations of benefits. While this bill did not pass, WSDA supports ensuring patients have the same protections when accessing dental care as when accessing medical care and supports eliminating the unfair insurance practices of some dental insurance companies. We will continue to look for opportunities to improve insurance practices in Washington State.
The National Association of Dental Laboratories proposed legislation to address supply chain accountability through dental laboratory registration and disclosure. WSDA believes House Bill 1782 will enhance patient health and safety, and that a state-maintained registry will assure dentists that their dental laboratory is compliant and operating under high standards. Unfortunately, this bill did not pass the legislature this year and will remain on WSDA’s agenda for support next year.
Defending against midlevel providers
While a bill authorizing the practice of dental health aide therapists on tribal reservations in Washington State did pass the legislature this year, the bills relating to general midlevel providers that were introduced this session did not pass. House Bill 1364 and Senate Bill 5224 would have created a new licensed health profession called “dental therapists.” These dental therapists would only need about three years of post-secondary school education, but would be allowed to do many procedures a dentist (with eight-plus years of education) is authorized to do, including drilling and extracting teeth. WSDA-member dentists testified in opposition to both bills, and WSDA successfully prevented these bills from passing. However, the bills will be reintroduced in the 2018 legislative session.
Advocacy work has become a year-round endeavor, and legislators enjoy hearing from their constituents even when they are not in session. WSDA member dentists are encouraged to reach out to their legislators to talk about how the legislature can improve the practice of dentistry in Washington State. WSDA staff will continue to work with legislators on behalf of WSDA members and stand ready to assist members in developing relationships during the interim that will improve our opportunity for success during session. Next year’s advocacy agenda will be developed at the House of Delegates meeting in September.