Legislative efforts on Medicaid, non-covered services continue

The ODA’s advocacy team and leadership continue their efforts at the Ohio Statehouse to push for a statute that would prohibit dental insurance companies from setting fees for services the insurers do not even cover and to increase dental Medicaid reimbursements. ODA President Dr. Tom Paumier, a general dentist from Canton, said that he is “pleased to report to the membership that progress is being made on both of our legislative priorities, but more needs to be done to get both proposals through the General Assembly and to the governor’s desk.”

Non-covered services – House Bill 95

On March 3, Rep. Anthony DeVitis (R-Green) introduced House Bill 95, which would prevent dental insurance companies from setting the prices that dentists charge for non-covered services.

On March 18, ODA Executive Director David Owsiany and West Chester general dentist Dr. Steve Moore testified before the Ohio House Health and Aging Committee in favor of House Bill 95. Moore explained that the dental insurance companies’ tactics in dictating prices for services they don’t even cover have forced some of his patients to accept less optimal treatment options.

Moore told the committee that by setting prices for non-covered services, the insurers are unnecessarily interfering with the dentist- patient relationship. During testimony, Moore provided a specific example of a patient having to choose a treatment plan that was other than one she wanted because of the insurance company’s tactic of setting the fee for the non-covered service at a rate that was below Moore’s overhead to perform the procedure. The patient offered to pay Moore’s regular fee, but accepting the patient’s proposal would have put Moore in violation of the insurer’s non-covered services policy and would have potentially jeopardized his standing as a contracted provider.

Owsiany testified that once dental insurers began setting fees for non-covered services several years ago, the National Conference of Insurance Legislators recognized the unfairness of these tactics and adopted a model act for states to consider that would ban these insurance company practices. Thirty-five states have now enacted laws that prohibit dental insurance companies from setting fees for non-covered services. Owsiany explained to the committee that none of these states have experienced any disruption to their dental insurance marketplace or higher prices for dental services. Owsiany concluded “these states continue to have thriving insurance marketplaces, have experienced no change in overall dental fees and are protecting against insurers interfering with the dentist-patient relationship.”

Several entities testified and wrote letters in opposition to House Bill 95. Delta Dental’s chief lobbyist testified that House Bill 95 “will eliminate a consumer cost protection measure” and will “increase the cost of dental care for Ohioans.” The Ohio Chamber of Commerce sent a letter to the Health Committee claiming that House Bill 95 “represents an unnecessary government intrusion” into private contracting by rewriting “the terms of a contract freely entered into by dentists and dental insurance companies.”

Other interest groups that oppose House Bill 95 include the Ohio Education Association, Ohio AFL-CIO, Westfield Insurance, America’s Health Insurance Plans (AHIP), AFSCME Ohio, National Association of Dental Plans, Ohio Association of Health Plans and United Concordia.

On May 13, 2015, the House Health and Aging Committee favorably passed House Bill 95 out of the committee by a 12-7 vote. The legislation will likely now go to the full House of Representatives for its consideration.

Dental Medicaid

In February 2015, when introducing his budget proposal for state fiscal years 2016-17, Gov. John Kasich noted that “Medicaid rates for dental providers have not increased since January 2000” and that “the current average maximum dental fee in Ohio Medicaid is approximately 36 percent of the average charge of the 2011 American Dental Association survey of fees.” Kasich’s proposed budget would “increase dental provider rates one percent,” effectively adding a total $4.5 million to the dental Medicaid program over fiscal years 2016-17.

On March 18, 2015, Owsiany testified before the Ohio House Finance Subcommittee on Health and Human Services expressing appreciation for the governor’s proposed rate increase and for bringing attention to the issue of poor reimbursements in Ohio’s dental Medicaid program. He then explained that “after more than 15 years of neglect, more needs to be done in order to make Ohio’s dental Medicaid program viable.” Owsiany pointed out that Ohio’s dental Medicaid reimbursements are 41st out of 50 states (10th from the bottom) and that, at a rate of less than 40 percent of a dentist’s regular fee, current reimbursements do not even cover most dentists’ overhead when treating Medicaid patients.

Owsiany testified that reimbursing at closer to market rates would allow more dentists to participate in the Medicaid program, keep the doors to Ohio’s dental safety net clinics open and dramatically improve access to dental care for Ohio’s most vulnerable patients.

On April 22, 2015, the Ohio House of Representatives passed its version of the state budget. The House included a provision adding approximately $16 million over the two fiscal years for “the purpose of establishing a demonstration pilot project which pays Medicaid dental providers” in 16 Appalachian counties at “65 percent of the American Dental Association survey of fees for dental services.”

The state budget is now under consideration by the Ohio Senate and must be passed by June 30, 2015.

Paumier congratulated the ODA’s advocacy team and member dentists for their work on these important issues. “We had over 150 dentists and dental students discussing these issues with legislators during ODA’s Day at the Statehouse on March 4,” he said. Paumier concluded, “we need to continue our grassroots efforts to get these initiatives passed, so I urge every member dentist to reach out to his or her legislators on these two important issues.” For more information on House Bill 95, the dental Medicaid program and how to contact your legislators, call the ODA’s government affairs department at (800) 282-1526.