Below you will find proposed legislation and rules that affect orthodontic practices in California.
Legislative Updates, Status Reports & Proposed Legislation
Red Flags Rule - Senate Votes to Exclude Dental Practices from Red Flags Rule
Earlier this week, the U.S. Senate passed legislation to amend the "Red Flags" Rule to remove certain businesses, including dental practices, from being regulated under the rule. Introduction of a similar measure has been planned in the House of Representatives, reportedly under a "suspension of the rules" vote, which is a procedure used for passing non-controversial laws by a two-thirds vote. It is expected that President Obama will sign the measure once it has been passed and reconciled, if necessary.
The AAO and other dental organizations have worked together during the past year to secure exclusion of dental practices of all types from the Red Flags Rule. The Red Flags Rule was designed to extend the definition of a creditor to any entity that provides a service under a payment plan agreed upon by the provider and the customer, and to require creditors to develop and implement written identity theft programs.
Update on the Form 1099 - Reporting Requirement
In September, the AAO announced its opposition to the 1099 reporting requirement included in the Patient Protection and Affordable Care Act and encouraged each U.S. member to join in asking legislators to repeal the requirement. A Senate amendment repealing the 1099 reporting requirement, which is scheduled to take effect January 1, 2012, did not pass.
The law will require a 1099 form to be issued to all vendors from whom $600 or more of goods or services are purchased in a year, with the completed form to be filed with the IRS. The AAO has been working with the American Dental Association and other dental specialty groups to enact repeal of this law because it will impose a tremendous burden on small businesses.
AAO members will again be asked to write to their legislators if the possibility of repeal re-emerges. It is uncertain when that opportunity will occur. If the requirement has not been repealed by January 24, 2011, the issue will be at the forefront for AAO members during the Professional Advocacy Conference, scheduled January 24-26 in Washington, D.C. In the meantime, please look for further updates on the issue and please take action when asked to do so.
Fee-Cap Ban Signed Into Law
Governor signs CDA-sponsored legislation that prohibits fee caps
CDA successfully sponsored legislation, AB 2275 (Hayashi), that prohibits dental plans from capping fees dentists may charge for non-covered services.
The bill, which was signed into law by Governor Schwarzeneggeron September 30, 2010 allows dentists to reasonably cover their costs of providing non-covered services by enabling them to charge up to their usual and customary fees that would apply to most private-pay patients. It also requires dental plans to provide a disclosure statement in their enrollees' evidence of coverage document explaining the law and encouraging them to contact their plan or insurance broker for further information.
The law, which goes into effect Jan. 1, 2011, is the result of a resolution passed by the CDA House of Delegates in November 2009 that directed CDA to consider options, including legislation, to ban these fee restrictions on non-covered services.
Healthcare Reform - Health Care Reform Timeline
Your Guide to Understanding the Reform Provisions and Timeline <Read More>
Infection Control Requirements - Good news...
The Dental Board of California confirmedon Friday, February 26, 2010 that, under the new dental assisting law created by AB 2637 (Eng) two years ago, dentists must ensure that only newly hired dental assistants that are unlicensed must complete aboard-approved, eight hour infection control course within their first year of employment in that office.
Initially it was thought that this section of the law applied to all dental assistants, making compliance almost impossible for course providers.
The California Dental Association and the California Association of Orthodontists – Partners in Advocacy
Michelle Rivas
Legislative Advocate &
Manager, External Affairs
California Dental Association
Members of the California Dental Association and the California Association of Orthodontists have worked together over the years for the benefit of all dentists in the state.
Legislation is introduced every year in Sacramento that has a direct impact on the dental profession and the patients you treat. The CDA Public Policy department has staff that reads every bill introduced by the Legislature, analyzes it for any impact it may have on dentistry and provides that information to the CDA Government Affairs Council which then decides what position the organization will take and gives direction to staff.
Additionally, we have been directed by the membership to be more proactive in dealing with third-party payer issues. CDA has sponsored legislation the past few years to deal with specific issues as they relate to insurance issues of concern to the membership.
Our advocacy efforts are truly a team effort – our team includes professional legislative advocates, policy experts and of course, individual members of CDA and CAO. Participation by individual dentists is more important than ever before. Organized dentistry understands that and has worked as closely with the members of CDA and CAO to move our legislative agenda forward.
Here are a few examples of our successes:
Advertising Restrictions: Legislation was introduced in 2008 as an attempt to help health care consumers verify the licensure status of their providers, by requiring providers (including dentists) to include in all “public communications” their license number, the web site and telephone number of their licensing agency, and a notice that the consumer can contact that agency for more information. While sympathetic to the author’s and sponsor’s intentions, CDA expressed serious concern that the bill’s definitions were overly broad in scope and impractical, potentially requiring, for example, dentists to include their license number and the Dental Board’s web site and telephone number on toothbrushes that they provide at community health fairs. Although CDA offered several amendments to modify the bill’s practical impact on providers, agreement was not reached with the author and sponsor as the bill moved through the Assembly, and CDA was forced to actively oppose the bill on the Assembly floor, where it was defeated on May 29th by a vote of 16-36.
Mercury/Dental Amalgam Regulation: In 2008 legislation was introduced which was intended to allow the state Department of Toxic Substances Control to begin regulating “chemicals of concern” that are potentially hazardous to health. Mercury was included as a chemical of concern that could be regulated by the state. Because mercury is one of the elements contained in encapsulated form in dental amalgam fillings, CDA was concerned that this bill could result in duplicative state regulation of dental amalgam that could needlessly drive up the cost of restorative materials to patients. Because chemicals such as mercury already are regulated by the federal Food and Drug Administration, CDA opposed the legislation unless it was amended to exempt all dental restorative materials. In response to CDA’s opposition, when the bill was taken up for a vote on the Assembly floor, the author pledged to amend the bill in the Senate to exempt dental restorative materials. That amendment was made on June 17th, at which point CDA removed its opposition to the bill, which then passed both houses and was signed by the governor in late September.
Dental Practice Ownership Transition: California’s Dental Practice Act specifies that only a licensed dentist can own and operate a dental practice, including hiring other dentists. This law is rightly intended to prevent the corporate practice of dentistry, but it had significant, arguably unintended consequences for families and patients when a dentist owner dies unexpectedly or becomes incapacitated and his or her spouse or estate wishes to keep the practice operating while they attempt to sell it permanently, were prohibited from doing so. To remedy this unique and temporary situation in a way that encourages continuity of care for patients, CDA sponsored legislation to allow an estate, trustee, or other legal representative to employ or contract with dentists and otherwise operate the practice of a deceased or incapacitated dentist for up to 12 months, while assuring that patients are appropriately notified and assuring that the temporary operator of the practice does not interfere with a contracting dentist’s professional judgment. As the bill moved through the legislature, amendments were adopted to clarify the legal authority for dentists to place their practices into trusteeships as a way to prepare in advance for such an eventuality. The legislation passed by both houses with unanimous votes and was signed by the governor on October 10th.
Denti-Cal Orthodontic Billing: In 2007 CDA met with members of CAO to discuss the issue of Denti-Cal coverage for medically necessary orthodontic services and the requirement of submission of claims based only on monthly patient visits, which is inconsistent with the standard of care. The requirement for monthly claim submittals forced orthodontists to schedule Denti-Cal patients for monthly visits that do not fit within the ideal sequence of treatment, which created a significant disincentive for orthodontists to participate as Denti-Cal providers. CDA/CAO therefore sponsored legislation, to allow orthodontists to be reimbursed on a quarterly basis. This gave participating orthodontists the ability to “bundle” a series of treatment visits into a single quarterly claim submittal, enabling them to schedule their patients’ treatment visits on a schedule fully consistent with the standard of care.
Dental Plan Coordination of Benefits Policies: “Coordination of benefits” is the means by which two insurance plans determine their relative responsibilities when a patient has dual coverage. In recent years, CDA’s members and their patients had seen increasing instances in which dental plans that are the secondary payers were using “non-duplication” clauses and other similar policies to deny any additional reimbursement beyond what the primary plan has already paid. CDA believed that these policies unfairly short-change patients and employers who have paid premiums to the secondary payer with the expectation that benefits will in fact be provided. Therefore, CDA sponsored legislation requiring dental plans, when they are secondary payers, to provide supplemental reimbursement for the patient’s out-of-pocket costs under the primary plan for benefits covered by the secondary plan and require all dental plans to clearly disclose their coordination of benefits policies in the evidence of coverage documents they provide to their enrollees. The legislation passed through both houses of the legislature with unanimous votes and was signed by the Governor.
In the crowded hallways of the Capitol, lobbyists compete for legislator's time and attention and a chance to discuss their issues. Your involvement is encouraged and very much appreciated. To be truly successful, we all must continue to work together for the benefit of the profession of dentistry.
Summary of CDC Guidelines for Infection Control in Dentistry
The Center for Disease Control and Prevention (CDC) released guidelines for infection control for dentistry on December 19, 2003 - 10 years after the previous update of such guidelines.
You can view the full 68 page guideline at: http://www.ada.org/sections/publicResources/pdfs/guidelines_cdc_infection.pdf
More on the Status of Legislation
Status of proposed changes in laws which would impact dentistry and specialties: www.dbc.ca.gov/laws.cfm
Status of proposed laws from either a business or general citizen perspective: www.leginfo.ca.gov
Additional Information
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