The
years-long efforts to ensure strong oral health provisions in health care reform
were realized when the House of Representatives passed the Senate version of
health reform on March 22, 2010 and the President signed it into law the next
day. The final law includes a host of oral health provisions advanced by
several key members of Congress, including Senators Jeff Bingaman (D-NM), Chris
Dodd (D-CT) and Representatives Henry Waxman and Diana DeGette. CDHP is deeply grateful to our Congressional
champions and many others for their leadership as well as the grassroots
community that worked with us to secure this unparalleled federal investment in
oral health.
1. Coverage:
a. Oral Health Services for Children: Requires that all insurance plans
that are made available through state Exchanges to the uninsured and to small
groups include oral health services for children. Bars insurance plans
operating under the Exchanges from charging out of pocket expenses for
preventive services, including preventive pediatric oral health services. [SEC.
1302(b)(4); SEC. 1001]
b. Stand-alone
Dental Plans: Allows stand-alone dental plans to participate in the Exchanges. Purchasers
will have the option of buying pediatric dental coverage directly from
standalone dental plans or through medical plans.
c. Medicare
Advantage: Requires Medicare Advantage Plans to use rebates to pay for dental
coverage, and other services. [SEC. 3202]
2. Provider
payments:
a. Charges
the Medicaid and CHIP Payment and Access Commission with
review and report to Congress on payments to dental professionals. [SEC 2801]
3. Access
provisions
a. School-based
Health Centers:
Provides grants to school-based health centers and includes oral health
services in qualified services to be provided at those centers. [SEC.4101]
b. Dental
Medical Diagnostic Equipment: Establishes standards for accessibility of
medical and dental diagnostic equipment for persons with disabilities. [SEC.
4203]
4. Preventiona. Public
Education Campaign: Requires the Secretary to establish a 5-year, evidence based public education
campaign to promote oral health, including a focus on early childhood caries,
prevention, oral health of pregnant women, and oral health of at-risk
populations. [SEC. 4102]
b. Dental
Caries Disease Management: Establishes a grant program to demonstrate the effectiveness
of research-based dental caries disease management. [SEC. 4102]
c. School-based
Dental Sealant Programs: Requires that all states, territories and Indian tribes receive grants for
school-based dental sealant programs. (Note: Currently only 16 states benefit
from these grants.) [SEC. 4102]
5. Infrastructure
a. Cooperative
Agreements to Improve Oral Health Infrastructure:
Requires
CDC to enter into cooperative agreements with ALL 50 states, territories and
Indian tribes to improve oral health infrastructure through leadership and
program guidance, data collection and interpretation of risk, delivery system
improvements, and science-based population-level programs. [SEC. 4102]
b. Oral
Health Care Surveillance Systems: Requires that the Secretary update and improve national oral
health surveillance by:
i. requiring the inclusion of oral health reporting on pregnant
women through the Pregnancy Risk Assessment Monitoring System( PRAMS). (Note: currently the oral health component of PRAMS is
optional);
ii. retaining the current National Health and Nutrition Examination Survey (NHANES) "tooth-level" surveillance
(Note: This reverses plans to drop tooth-level analysis in NHANES and replace it
with "person-level" analysis and allows ongoing longitudinal analysis of
American's oral health status);
iii. requiring the Medical Expenditure Panel Survey (MEPS) findings be validated through a
"look back" procedure (Note: currently MEPS conducts this validation for
medical expenditures but not for dental expenditures);
iv. requiring all states to participate in the CDC's National
Oral Health Surveillance System. (Note: currently only 16 states are required
to participate.) [SEC. 4102]
6. Workforce
a. Alternative
Dental Health Care Providers: Establishes five-year, $4 million 15-site demonstration program
beginning within two years to "train or employ" alternative dental health care providers.
Defines "alternative dental providers" to include currently proposed new dental
professionals (by the American Dental Association, American Dental Hygienists'
Association, and others) and others to be determined by the DHHS Secretary.
Charges the DHHS Secretary to contact with the Institute of Medicine in
evaluating this program. [SEC. 5304]
b. National
Health Care Workforce Commission: Establishes a National Health Care Workforce
Commission, for which oral health care workforce capacity is a designated high
priority area for review. The Commission will: support national, state and
local policymaking; coordinate workforce issues across agencies; evaluate the
education and training of health professionals with regard to demand for
services; facilitate coordination across levels of government, and encourage
workforce innovations. [SEC. 5101]
c. Public
Health Workforce: Establishes through the Surgeon General a multidisciplinary
health professional training program for select individuals committed to public
health and safety. The program supports stipends and loan repayments as well as
grants to institutions (including dental schools) and obligates trainees to
service in the National Health Service Corps proportional to the years of
training support. Requires that Track trainees tailor their pre-doctoral
education and postdoctoral training to disciplines pertinent to public health
and safety and that educational preparation involve community based experiences
in multidisciplinary teams. Establishes "Elite Federal Disaster Teams"
comprised of Track faculty and students to respond to national emergencies
(public health, natural disaster, bioterrorism, and other emergencies). [SEC.
5315]
7. Training
a. Workforce
Development: Establishes a unique appropriations line-item for training of
general, pediatric, and public health dentists and appropriates $30M for FY2010
to train oral health workforce. (Note: currently dental and medical training is
appropriated in a single lump sum.)
b. Expands
"Title VII" dental workforce training program to include training of dental
students and practicing dentists as well as residents (Note: currently the
program supports only the training of dental residents); providing financial
assistance to dental trainees (including dental hygienists); developing new
training programs; expanding faculty capacity through traineeships and
fellowships for dentists committed to teaching; grants for faculty development;
and faculty loan repayment programs; advancing pre-doctoral training in primary
care dentistry; providing technical assistance to pediatric dental training
programs in population and public health issues. [SEC. 5303]
c. Faculty
Loan Repayment Program: Establishes a dental faculty loan repayment program
for faculty engaged in primary care dentistry to include general dentistry,
pediatric dentistry, and public health dentistry. Priorities are established
for eight categories of faculty who collaborate with medical care providers;
demonstrate retention of trainees in primary care and public health dentistry;
demonstrate training of rural, disadvantaged, and minority dentists;
collaborate with Federally Qualified Health Centers (FQHCs) and other safety-net providers; teach in programs that
target underserved populations of all ages and medical and social conditions;
teach cultural competency and health literacy; succeed in placing graduates in
underserved areas or in the service of underserved populations; intend to
establish training programs for special needs populations (inclusive of
disabled, cognitively impaired, medically complex, physically limited, and
vulnerable elderly).
d. Primary
Care Residency Programs: Establishes three-year, $500,000 grants to establish
new primary care residency programs, including dental programs. [SEC. 5508]
e. Graduate
Medical Education: Provides funding for new and expanding graduate medical
education, including dental education. [SEC. 5508]
In the coming weeks and months, CDHP will keep you informed regarding the impact of each of these important provisions as well as the implementation process.