February 25, 2013
The Washington State Legislature is nearly two months into its 105-day session. This session has been a very active one for organized dentistry. WSDA has been tracking more than 30 bills related to dental workforce, loan repayment, dental access, dental insurance, licensure, and several other issues. The 2013 legislative session is scheduled to end in late April.
On February 22, the session reached its first significant milestone: the policy cutoff date for all non-fiscal or transportation related bills. This means that all policy bills that were not voted out of their committee of origin are dead for the session. However, all legislation introduced during the 2013 legislative session is automatically reintroduced during the 2014 legislative session.
Here is a breakdown of some of the bills and fiscal issues that WSDA has been involved in:
New Dental Workforce Legislation
All new dental practitioner bills died in their committees of origin. HB 1516 and SB 5433 were nearly identical to dental therapist legislation that was considered during the 2012 legislative session. Both bills were supported by the Children’s Alliance, the Washington State Dental Hygienists’ Association, and other members of the Washington Dental Access Campaign. WSDA opposed both bills as they would have created dental practitioners with the ability to diagnose and perform irreversible procedures without the supervision of a dentist.
HB 1514, legislation patterned after WSDA’s HD-13-2012, was introduced in the House by Representative Eileen Cody (D-Seattle). WSDA opposed HB 1514 as did the Children’s Alliance, the Washington State Dental Hygienists’ Association, and other advocates for dental therapists. Prior to the 2013 legislative session, WSDA’s leadership decided to not support legislation based on HD-13-2012. This decision was based upon further review of existing dental therapist models, new research on the cost-effectiveness of dental midlevel providers, the increased viability of expanding dental residency positions across the state, and the rejection of the model by the Children’s Alliance and other advocacy organizations.
The House Health Committee held a hearing on HB 1514 and HB 1516 in early February. At the hearing, over a dozen dentists, lobbyists, and citizen advocates spoke in support and against the dental therapist model. WSDA’s panel of dentists questioned the viability of creating a new workforce member and spoke in support of better alternatives including dental residency programs and reinstating adult dental Medicaid funding.
Residency Expansion and Loan Repayment:
WSDA is working with the Yakima Valley Farmworkers Clinic and the Columbia Basin Health Association to expand Community Health Center (CHC)-based dental residency positions in Eastern Washington. WSDA and these partners are requesting capital matching funds to expand dental clinics in Toppenish, Othello, and Walla Walla. These expanded clinics will allow for up to six new dental residency positions in rural parts of Eastern Washington. CHC and hospital-based residency positions continue to expand in Washington state. There are currently 33 CHC/hospital based residency positions; nine additional positions will be added this July.
SB 5615 is a bill sponsored by Senator David Frockt (D-Seattle) which aims to reinvigorate the health professional loan repayment program for primary care practitioners who work in rural and underserved areas. This legislation was voted out of the Senate Health and Senate Higher Education committees. SB 5615 would require the state program to solicit and seek grants and donations from public and private sources. WSDA testified in support of SB 5615 and will continue to work on improvements and enhancements to loan repayment programs for newly licensed dentists. According to the American Dental Education Association, the average student debt load for 2011 dental school graduates is $203,374.
Adult Dental Medicaid Funding
In 2011, dental coverage for most Medicaid-insured adults was eliminated. As a result, nearly 450,000 low-income adults, including many people with disabilities and 130,000 seniors, were left with only access to emergency dental care. The WSDA and the Coalition to Fund Dental Access are fighting to restore the dental safety net and ensure that the state’s most vulnerable have access to comprehensive dental care. WSDA and the coalition are asking that the legislature do the following:
• Restore comprehensive dental coverage for Medicaid-eligible adults. Today, only 38,000 Medicaid-eligible adults have comprehensive coverage; leaving 450,000 adults without comprehensive dental care. Reinstating adult dental Medicaid coverage will cost the state $28.7 million for the biennium.
• Include dental coverage in Medicaid expansion benefits. The Affordable Care Act provides states with a 100% match to expand Medicaid coverage to all adults who live at or below 138% of the federal poverty level. Adding dental coverage for this vulnerable population will not impact the state’s operating fund in this biennium.
The Washington State Dental Association is a founding member of the Coalition to Fund Dental Access, a coalition created in 2007. Other coalition members include: University of Washington School of Dentistry, Solid Ground, Washington Association of Community & Migrant Health Centers, Poverty Action Network, Washington Dental Service Foundation, Children’s Alliance, Washington State Dental Hygienists Association, and many other organizations.
WSDA/WSDHA Joint Legislation
WSDA and the Washington State Dental Hygienists’ Association jointly authored and support HB 1330. HB 1330 would allow dental hygienists to provide preventative services to homebound patients under general supervision. The legislation also fixes a DOH legal interpretation that has prohibited dental hygienists from placing topical anesthesia under general supervision and prohibited dental assistants and EFDAs from placing topical anesthesia altogether. HB 1330 was voted out of the House Health Committee.
Washington Physicians Health Program
HB 1534 would increase the dental license surcharge for the Washington Physicians Health Program (WPHP) from $25 to $50. WPHP helps dentists, physicians and other health care practitioners recover from impairing illnesses such as addiction or other physical and mental conditions. WPHP is a non-profit organization and is not affiliated with the Department of Health. The program is funded by practitioners enrolled in the program, donations and the license fee surcharges on health care practitioners. The surcharge on dental licenses has been $25 for over ten years while the surcharge for physicians and physician’s assistants has been $50 for the last four years. HB 1534 was voted out of the House Appropriations Subcommittee on Health and Human Services and is supported by WSDA.
Licensure Grace Period
WSDA has worked with Representative Mike Hope (R-Lake Stevens) on HB 1603. HB 1603 would establish a 30-day grace period for expired dental licenses and require all health carriers to reimburse dentists with expired licenses for services performed within 30 days of their license expiration date. While the license would remain active for an additional 30 days under HB 1603, all applicable late fees would still be imposed. HB 1603 was not voted out of the House Health Committee in 2013. However, HB 1603 will automatically be reintroduced in the 2014 Legislative Session.
HB 1270 would provide the Board of Denturists with the authority to handle denturists’ disciplinary cases. HB 1270 was voted out of the House Health Committee.
HB 1271 is based on legislation that passed in Oregon a few years ago and would expand the scope of practice of denturists. In 2012, the Department of Health conducted a sunrise review on a denturist scope of practice expansion that would have permitted denturists to make and place all “nonorthodontic removable devices.” DOH and WSDA both agreed that there was substantial risk of patient harm if denturists were permitted to make and place “nonorthodontic removable devices.”
WSDA testified against HB 1271 and the use of this vague definition. HB 1271 was amended to allow denturists to make and place sports mouth guards, bruxism devices, whitening trays, removable cosmetic appliances, and snoring devices after a physician has ruled out snoring associated with sleep breathing disorders. Substitute HB 1271 was voted out of the House Health Committee.
Health Care Reform Legislation
HB 1846 is legislation supported by Washington Dental Service and would require that stand alone pediatric dental plans be offered both inside and outside of the health benefit exchanges. The Affordable Care Act requires that pediatric dental coverage be included as an “essential health benefit” and is required to be included in all small group and individual health insurance starting in 2014. Currently, all pediatric dental plans offered inside of the exchange are required to be priced and offered separately. It is unclear if HB 1846 would prohibit medical insurance providers from embedding pediatric dental coverage into their medical insurance outside of the exchange. HB 1846 was voted out of the House Health Committee and WSDA is closely monitoring the legislation.