State Update

Kansas Bill Seeks to Increase Access to Dental Care

State Policy | Permanent link

Since 1943, Kansas law has required dentists with satellite practices to be “physically present” for at least half of the time that “dentistry is performed” at each location. 

States File Teledentistry Bills

State Policy | Permanent link

For states with large rural and/or underserved populations, telehealth has developed as a cost-effective alternative to traditional face-to-face consultations or examinations between a provider and a patient. According to the National Conference of State Legislatures (NCSL), the most common path being taken by states is to cover telehealth services in the Medicaid program. In fact, 43 states and the District of Columbia now provide some form of Medicaid reimbursement for telehealth services. States also are evaluating whether to require private insurance plans to cover telehealth services. According to NCSL, 19 states and the District of Columbia now require private insurance plans to cover telehealth services. Although most states provide some form of Medicaid reimbursement for telemedicine or telehealth, many states have not yet begun to explore teledentistry as a way to tackle the growing oral health needs in their communities. Below are some examples of state legislation related to teledentistry. California A.B. 318 has been introduced by Assembly Member Dan Logue (R-CA). The bill provides that, to the extent that federal financial participation is available, face-to-face contact between a health care provider and a patient shall not be required under the Medi-Cal program (California’s Medicaid program) for teledentistry by store and forward. The bill defines “store and forward” as an asynchronous transmission (1)  of dental information to be reviewed at a later time by a licensed dentist at a distant site, where the dentist at the distant site reviews the dental information without the patient being present in real time. The bill would also provide that dentist participation in services provided at an intermittent clinic shall be considered a billable encounter under Medi-Cal. Additionally, the bill requires that on or before January 1, 2017, the State Department of Health Care Services must report to the Legislature regarding the number and type of services provided, and the payments made related to the application of teledentistry. Hawaii H.C.R. 2014 16 and a similar resolution, S.C.R. 2014 14, have been introduced. Both resolutions note the following: This new care delivery model [teledentistry] can provide a much needed community-based “virtual dental home” for the state’s most vulnerable and underserved populations, who will access dental services in their own communities. It also will remove some of the barriers to receiving care in a traditional dental office setting. This model allows dentists and dental hygienists working in community sites to connect with a dental home in private dentist offices and in public health settings; The State of Hawaii has a unique geographic topography that includes five main islands, where the majority of oral health professionals, including specialists, reside and work on the island of Oahu; and Teledentistry can be an effective way to improve access to oral health care. The resolutions request that the Department of Health establish a task force to study the potential benefits of teledentistry for the vulnerable and underserved populations, such as access to dental care and cost efficiencies, and to identify the barriers to the practice of teledentistry in Hawaii. The resolutions have been introduced on behalf of the governor. On February 26, the House Committee on Health recommended that H.C.R. 2014 16 be passed as amended by a vote of 7-0. To date, the amendment language has not been released to the public. H.B. 2411 and its companion bill, S.B. 2469, have also been introduced in Hawaii. Both bills require reimbursement for services provided through telehealth to be equivalent to reimbursement for the same services provided via face-to-face contact between a health care provider and a patient. The bills also clarify that a health care provider of telehealth includes primary care providers, mental health providers and oral health providers, such as dentists. H.B. 2411 is currently moving through the committee process. On March 4, S.B. 2469 passed the Senate by a 23-0 vote with an amendment changing the effective date and making some nonsubstantive changes to the bill. S.B. 2469 has been transmitted to the House for further consideration. Virginia Sen. Richard H. Black (R-VA) has introduced S.B. 647. The bill defines teledentistry as the delivery of dental services through the use of interactive audio, video or other electronic media used for the purpose of diagnosis, consultation or treatment. Teledentistry does not include audio-only telephone, email or facsimile transmission. Specifically the bill requires the Department of Medical Assistance Services (DMAS) to establish a pilot program providing dental services to school-age children who are eligible to receive pediatric dental services through the Smiles for Children program. Dentists participating in the program must provide supervision to licensed dental hygienists through teledentistry. Additionally, the bill requires DMAS to enter into a memorandum of understanding with the Virginia Dental Association to establish protocols for the administration of the program. Further, DMAS, in consultation with stakeholders including the Virginia Dental Association, the Virginia Dental Hygienists' Association, the Virginia Association of School Nurses, the Mid-Atlantic Telehealth Association and the Virginia Oral Health Coalition, must develop metrics to be used to evaluate the plan. The bill also directs DMAS to report to the Secretary of Health and Human Services and the Chairmen of the House Appropriations and Senate finance committees on the benefits of teledentistry by November 1, 2016. On February 7, the bill passed the full Senate 40-0 and was transmitted to the House. On February 27, the bill passed the House Committee on Health, Welfare and Institutions with amendments by a vote of 22-0. S.B. 647 has been referred to the House Committee on Appropriations for further consideration.   1. The U.S. Centers for Medicare and Medicaid Services defines asynchronous or store and forward as follows: The transfer of data from one site to another through the use of a camera or similar device that records (stores) an image that is sent (forwarded) via telecommunication to another site for consultation. Asynchronous or store and forward applications would not be considered telemedicine but may be utilized to deliver services.   

California Debates a Warning Label on Sugary Drinks

State Policy | Permanent link

California may become the first state in the country to require warning labels on the front of all beverage containers with added sweeteners that have 75 or more calories in every 12 ounces. Sen. Bill Monning (D-CA) has sponsored S.B. 1000

States Tackle Community Water Fluoridation

State Policy | Permanent link

According to the Centers for Disease Control and Prevention, more than 204 million people in the United States are served by public water supplies containing enough fluoride to protect their teeth. However, approximately 100 million Americans still do not have access to fluoridated water. Listed below are several bills currently pending in state legislatures which capture the public’s sentiment both for and against community water fluoridation. Kansas H.B. 2372, sponsored by the Committee on Federal and State Affairs, would require that all Kansas cities and other local governmental units providing artificially fluoridated water notify the consumers of treated water that the latest science confirms that ingested fluoride lowers the I.Q. in children. The bill would permit the notice to be included with, or printed on, water bills or by any other means that the city felt would adequately make the consumers aware of the findings. The bill has been referred to the Committee on Health and Human Services for consideration.   Missouri H.B. 1078 is sponsored by Rep. Donna Lichtenegger (R-MO), a dental hygienist with more than 30 years of experience. The bill requires any public water system or public water supply district intending to permanently cease fluoridation of its water supply to notify the departments of Natural Resources and Health and Senior Services and its customers of its intentions at least 30 days before any vote on the matter. In addition, the system or district must notify its customers by mail at least 30 days before any meeting at which the vote will occur. The Tourism and Natural Resources Committee voted to pass the bill on February 13, and the bill has since been referred to the Committee on Rules. New Jersey Sen. Joseph F. Vitale (D-NJ) has sponsored S. 1180, titled the “New Jersey Public Water Supply Fluoridation Act.” The bill requires the fluoridation of all public community water systems in New Jersey for the purpose of promoting public health through the prevention of tooth decay. Also, the bill provides that the Commissioner of Environmental Protection, in conjunction with the Commissioner of Health and Senior Services, must adopt rules and regulations relating to the fluoridation of public community water systems. The bill has been referred to the Senate Health, Human Services and Senior Citizens Committee for consideration.

California May Expand Health Coverage to all Residents

State Policy | Permanent link

S.B. 1005, the Health for All Act, sponsored by Sen. Ricardo Lara (D-CA), along with 16 co-sponsors, would use California state funds to expand eligibility in Medi-Cal (California’s Medicaid program) to those who meet financial requirements of less than $15,000 per year but cannot obtain insurance because of their legal status. Additionally, the bill would create a new health exchange where undocumented immigrants can purchase coverage. The bill also would require the governing board of the new exchange to provide premium subsidies and cost-sharing reductions to eligible individuals that are the same as the premium assistance and cost-sharing reductions the individuals would have received through the current exchange. Sen. Lara has stated that he balances the expense of expanding health care to all residents, regardless of their legal status, against the approximately $1.4 billion spent on emergency services each year for those who are not covered and do not have legal status. Of the estimated 2.3 million undocumented persons in California, some one million are without coverage. The estimated annual tax contributions of undocumented immigrants in California is $2.7 billion and 92% of this population live in working families, according to Sen. Lara. The bill has been referred to the Committee on Health for consideration.

Gubernatorial Elections Will be Held in 36 States in 2014

State Policy | Permanent link

According to the National Governor’s Association (NGA), gubernatorial elections will be held in 36 states and three territories in 2014. Additionally, there are 31 incumbent governors eligible to run for reelection and eight incumbent governors who are term-limited or have announced they will not seek reelection. The primary elections will be held in most states between March and September 2014. To learn if your state will have a gubernatorial election during 2014, click here.

ADEA United States Interactive Legislative Tracking Map March 2014

State Policy | Permanent link

For additional information on state legislation affecting academic dentistry, please visit the ADEA United States Interactive Legislative Tracking map. The map is updated daily and will allow members to view: The current status of bills, Upcoming hearing dates, and Current bill text and bill author/sponsor information. To use the interactive map, visit www.adea.org/legislativemap.

Dental Amalgam Bills Filed in Maryland, New Jersey and Vermont

State Policy | Permanent link

On November 14, Delegate Alfred C. Carr, Jr. (D-MD) pre-filed H.B. 47. The bill requires the Department of the Environment to create a fact sheet on dental amalgam on or before January 1, 2015. 

ADEA United States Interactive Legislative Tracking Map February 2014

State Policy | Permanent link

For additional information on state legislation affecting academic dentistry, please visit the ADEA United States Interactive Legislative Tracking map. The map is updated daily and will allow members to view: The current status of bills, Upcoming hearing dates, and Current bill text and bill author/sponsor information. Please be advised that the ADEA United States Interactive Legislative Tracking map has been refreshed for the 2014 legislative session. Meaning, all legislation for the calendar year 2013 session, and the 2012-2013 session has been removed, except for final governor action which has not been completed and carryover bills (some states allow measures that were not final enacted during the last session or year to be carried over to the next session for consideration). However, newly filed and introduced legislation for the 2014 session will remain on the map. And of course, as new bills relevant to academic dentistry are introduced, the bills will be added to the map. To use the interactive map, visit www.adea.org/legislativemap.

Des Moines, IA, Discusses Water Fluoridation

State Policy | Permanent link

At the December 3 Board of Water Works Trustees’ Planning Committee meeting, Des Moines Water Works (DMWW) staff announced the utility, which serves approximately 500,000 customers in Central Iowa, will continue community water fluoridation at the current level of 0.7 mg/L. The issue was opened up for public comment at the October committee meeting and DMWW staff solicited comments, research and studies on fluoridation. According to DMWW, approximately 650 comments were received. The Board of Water Works Trustees held their regularly scheduled meeting, which includes a public comment period, on December 17, but took no action on the issue of community water fluoridation.