State Update

New Mexico Governor Approves Funding to Increase Number of Dental Students

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On March 11, Gov. Susana Martinez (R-NM) approved S.B. 313, the state budget (FY15 appropriations). The approved budget allocates sufficient funding to add six additional New Mexico dental slots to the Western Interstate Commission for Higher Education (WICHE).   In 2013, New Mexico had 21 WICHE certified applicants with offers, but only 12 received support. The approved FY15 state budget will increase the number of New Mexico dental slots to 18.  Sen. Mark Moores (R-NM), WICHE Commissioner and New Mexico Dental Association Executive Director played an integral role in ensuring that funding for additional dental slots remained on the forefront during budget negotiations.  According to information provided by the Department of Health (DOH), New Mexico is experiencing a dental healthcare professional shortage. All New Mexico counties, except one, are federally designated as Health Professional Shortage Areas and Medically Underserved Areas/Populations. Additionally, New Mexico ranks 49th among the 50 states in per-capita income for dentists. Access to dental healthcare and preventive services is challenging in many communities throughout New Mexico, thus increasing the number of dental students will have a significant impact on the state. 92% of dentistry graduates supported by WICHE return to New Mexico and serve.

Mississippi Looks to Issue Bonds for Higher Education

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Rep. Jeffrey C. Smith (R-MS), Chair of the House Ways and Means Committee, sponsored H.B. 787. The bill as introduced would have authorized the issuance of bonds, up to $31 million, to be used for the construction of a new School of Medicine building at the University of Mississippi Medical Center. However, after successfully passing through the House as is, the Senate Finance Committee adopted new bill text similar to S.B. 2975. S.B. 2975, as introduced, authorized the issuance of bonds for the purpose of making capital improvements for state institutions of higher education. The bill initially included $62.9 million in bonds to state universities, and an additional $1 million in bonds to be used for the construction of a new School of Medicine building at the University of Mississippi Medical Center. However, as S.B. 2975 was making its way through the legislative process in the House, the bill was laden with amendments unrelated to capital improvements for state institutions of higher education. Both H.B. 787 and S.B. 2975 went to conference committee. The conference report for H.B. 787 was adopted by both chambers on March 31 and currently authorizes $92.8 million in bonds to its state universities, including $30.5 million to be used for the construction of a new School of Medicine building at the University of Mississippi Medical Center. To view the conference report for H.B. 787 click here.   The conference report for S.B. 2975 was adopted by both chambers and is unrelated to capital improvements for state institutions of higher education.

Community Colleges to Offer Four-Year Degrees in Colorado

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On February 27, Gov. John Hickenlooper (D-CO) signed S.B. 4. The new law permits the State Board for Community Colleges and Occupational Education (SBCCOE) to establish technical, career and workforce development bachelor of applied science degree programs at state-supported community colleges. The new law provides that the SBCCOE may not establish bachelor of arts or bachelor of science degree programs. Additionally, all new bachelor of applied science degree programs must be approved by the Colorado Commission on Higher Education (CCHE). Prior to approving new degree programs, the CCHE must consider whether:   The SBCCOE can provide data demonstrating workforce and student demand for the degree; The accreditation requirements for the new program can be met by the college; The new degree program is cost-effective for the student and the community college system; andThe new degree program can be provided through an existing statewide transfer agreement with an accredited four-year institution in the community college’s geographical service area, or with a four-year institution that has a statewide service area.   In addition, the CCHE must determine if the degree program requested by the SBCCOE is sufficiently distinguishable from: An existing degree program at a state four-year institution of higher education, or A degree program that has been successfully offered previously in conjunction with a state four-year university and which will be reinstated sooner than the newly proposed degree program can be offered by the community college. Dental hygiene and culinary arts are the two programs farthest along in the development process, according to a senior official at the Colorado Community College System (CCCS). CCCS hopes that, within the next two or three years, a four-year dental hygiene program will be established. Under current Colorado law, a dental hygienist licensed to practice in the state may be the proprietor of a dental hygiene practice. CCCS staff believes that S.B. 4 will allow more dental hygienists to practice independently in the state. Offering bachelor of applied science degrees in high-demand fields is important to meeting local economic development needs and critical to reducing the educational attainment gap between urban and rural areas, according to the legislative declaration linked to the new law. Additionally, the new degrees will provide an opportunity for underserved and first-generation students to continue their educational pathways in a familiar community college setting, thus making it more likely these students will persist and complete their degrees.

States Debate Offering Free Tuition

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A few states have been considering offering free tuition at community colleges, as the cost of higher education continues to rise across the country. Below are examples of what some states are doing to tackle the high cost of higher education. Mississippi H.B. 424, called the “2014 Mississippi Promise Community College Tuition Gap Pilot Program,” passed the House but failed to pass out of a Senate committee. The bill would have made tuition free at all 15 Mississippi community colleges for students who graduated from high school within 12 months of enrolling in college. According to the bill text, Mississippi would pick up the tuition costs only after all other federal, state, institutional and private aid resources had been exhausted. Tennessee During his State of the State address before the Tennessee General Assembly, Gov. Bill Haslam (R-TN) introduced the “Tennessee Promise.” The proposal commits to providing on a continuing basis two years of community college or a college of applied technology (TCAT) free of tuition and fees to graduating high school seniors.  “Through the Tennessee Promise, we are fighting the rising cost of higher education, and we are raising our expectations as a state,” Gov. Haslam said during his State of the State address. “We are committed to making a clear statement to families that education beyond high school is a priority in the state of Tennessee.” It is estimated that the cost of the program will be $34 million annually. In order to make the Tennessee Promise sustainable, the governor hopes to transfer approximately $300 million in excess lottery reserve funds and join it with a $47 million endowment created by the General Assembly to fund the program in perpetuity. H.B. 2491 and S.B. 2471 were filed on behalf of the governor and would enact the Tennessee Promise Scholarship (TPS) Act of 2014. The TPS is for Tennessee residents who are seeking an associate degree, certificate or diploma from an eligible postsecondary program. To be eligible for the TPS, a student must be admitted and enrolled as a full-time student for the fall term following graduation or obtaining a GED. The TPS amount shall be the cost of tuition and mandatory fees at the eligible postsecondary institution attended, once all other gift aid is subtracted from the total cost. The amount of a TPS for students who seek a two-year degree at an eligible four-year public or private postsecondary institution shall be the average cost of tuition and mandatory fees at a public two-year postsecondary institution. Gov. Haslam is actively advocating for the legislation as a way to fuel his "Drive to 55,” a plan to bring the percentage of Tennesseans with college degrees or certifications to 55% by the year 2025; currently only 32% of Tennesseans have college degrees or certifications. Both H.B. 2491 and S.B. 2471 are pending in committee. Oregon On March 11, Gov. John Kitzhaber (D-OR) signed S.B. 1524. The new law directs the Higher Education Coordinating Commission to examine the viability of allowing students who graduated from high school in the state, or completed grade 12, to attend community college for a specified period without paying tuition and fees.  

North Carolina Teeth Whitening Case Goes to the U.S. Supreme Court

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On March 3, the U.S. Supreme Court agreed to hear North Carolina Board of Dental Examiners v. FTC during its October 2014 term. In this case, the North Carolina Board of Dental Examiners is challenging a lower court ruling and an order by the Federal Trade Commission (FTC), which said that the board engaged in unfair competition in the market for teeth-whitening services by excluding individuals not licensed to practice dentistry from the market for teeth-whitening services. According to court documents, beginning in the 1990s, dentists began providing teeth-whitening services in North Carolina. In about 2003, non-dentists also began offering the services, often at a reduced price. The board became aware of the performance of teeth whitening services by persons not licensed to practice dentistry, and also began receiving complaints from dentists. Several consumers suffered from adverse side effects, including bleeding or “chemically burned” gums, after receiving teeth whitening from non-dentists. In addition, consumers complained that the non-licensed individuals performing services were doing so without gloves or masks, thereby increasing the risk of side effects. As a result of the board receiving a number of complaints, an investigation was conducted and more than 40 cease-and-desist letters to non-dentist teeth-whitening providers were issued.  The FTC’s original complaint against the board was issued on June 17, 2010, alleging that the board was harming competition by preventing non-dentists from providing teeth-whitening services in North Carolina.  The board appealed, arguing that the FTC overstepped its authority. Specifically, the board argued that it is exempt from the federal antitrust laws under the “state action” doctrine. Under this doctrine, the antitrust laws “do not apply to anticompetitive restraints imposed by the states ‘as an act of government.’”   The board has lost several appeals of the FTC’s decision, including a 2013 ruling by the U.S. Court of Appeals for the Fourth Circuit, which upheld the right of non-dentists to offer teeth-whitening products and services in the state. Click here to view documents associated with the board’s appeals to the FTC. Justice Barbara Keenan, of the U.S. Court of Appeals for the Fourth Circuit, stated in her concurring opinion, that “the fact that the board is comprised of private dentists elected by other private dentists, along with North Carolina’s lack of active supervision of the board’s activities, leaves us [the court] with little confidence that the state itself, rather than a private consortium of dentists, chose to regulate dental health in this manner at the expense of robust competition for teeth whitening services. Accordingly, the board’s actions are those of a private actor and are not immune from the antitrust laws under the state action doctrine.” The question before the U.S. Supreme Court is whether, for purposes of the state-action exemption from federal antitrust law, an official state regulatory board created by state law may properly be treated as a “private” actor simply because, pursuant to state law, a majority of the board’s members are also market participants who are elected to their official positions by other market participants. According to an April 2013 report by the Institute for Justice, since 2005, at least 14 states have changed their laws or regulations to exclude all but licensed dentists, dental hygienists or dental assistants from offering teeth-whitening services. As a result, the U.S. Supreme Court’s decision could have far-reaching implications. 

Michigan Seeks to add Dentists to an Existing Health Provider Loan Repayment Program and Minority Grant Program

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S.B. 648 has been introduced by Sen. John Moolenaar (R-MI) and is tie-barred with S.B. 649, which was introduced by Sen. Jim Marleau (R-MI). Each bill has twelve co-sponsors. S.B. 648 would expand the Michigan Essential Health Provider program to include loan repayment for dentists who chose to work in health resource shortage areas.

Kansas Bill Seeks to Increase Access to Dental Care

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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

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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

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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

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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.