Just two weeks are left in the 2020 Legislative Session, and IDA is happy to report another “win!” After weeks of zealous advocacy by IDA Director of Governmental Affairs Ed Popcheff, dentistry was finally removed from HB 1008, the problematic licensure bill. As mentioned previously, the bill would have presented a danger to our current licensure system by requiring the Indiana State Board of Dentistry to issue dental licenses to potentially unqualified foreign and out-of-state applicants. See more information below.

HB 1008: Occupational Licensure Reciprocity

Status: Dentistry Removed from Bill

HB 1008 was heard yesterday morning in the Senate Commerce and Technology Committee, where Senator Mark Messmer introduced an amendment to the bill that exempted the board of dentistry and several other licensed professions. IDA Executive Director Doug Bush testified in favor of the amendment—and reiterated our initial position on the bill as one with potential threats to patient safety. After the introduction and passage of the amendment, the bill was voted out of Committee 8-1 and will continue onto the Senate for a voice vote as early as Monday. The IDA wants to thank everyone who took the time to contact their legislators about the dangers of the unamended bill—your voices were certainly heard!

SB 455: School Accreditation

This bill, originally introduced Senators Brian Buchanan and Dennis Kruse, addresses a variety of education matters and was recently amended to include allowing a school corporation to enter into an agreement to provide free, annual dental screenings to students and stipulates that the agreement: (1) must provide for a free, annual dental screening to be offered to each student enrolled in the school corporation in grade 1; and (2) may, at the election of the governing body, provide for a free, annual dental screening to be offered to each student enrolled in the school corporation in kindergarten through grade 12. The bill also provides that the parent or guardian of a child is responsible to the dentist or dental group for the cost of services other than a dental screening.

This last-minute amendment to an otherwise innocuous bill is a revival of HB 1149, which died early in session and required school corporations to enter agreements for dental care. SB 455 makes these agreements optional, not required, but we are working in conjunction with the ADA to modify the language of this bill to make it more dental- and patient-friendly.

HB 1006 and SB 1: Regulation of Tobacco Products

Status: Hearings next week

Both SB 1 and HB 1006 passed out of committee in the second house this week. The bills—high on the list of the governor’s priorities and a step in the right direction for public health—raise the legal age to purchase tobacco from 18 to 21, triple the monetary penalties for retailers selling people who are underage, and revoke a tobacco license from repeat retail offenders. In addition, the bills prohibit a tobacco business from locating within 1,000 feet of a school (after June 30, 2020), and require a seller of tobacco products to verify the age of a purchaser who appears to be less than 30 years of age. Both bills are set to be heard in their respective full houses next week, and we will continue to update you on their progress.

The IDA thanks you for being an informed advocate for your profession. As we’ve seen with the amendment to HB 1008, your voice (and actions) really do matter.

It’s been quite a busy week. On Monday, the IDA hosted the annual Dental Day at the Capitol, an event attended by over 150 dentists and dental students. The event educates and trains current and future dentists about the importance of advocating for the profession, and even includes a visit to the statehouse. This year, several of our attendees got a chance to meet and take a photo with the governor, and others were able to meet with their representative to discuss important legislation. The IDA would like to thank all who participated this year, and we look forward to reviewing your feedback on the event and improving the structure going forward.

On Thursday, the IDA-sponsored HB 1067 passed out of the second house, and is now headed for the governor’s desk. (Talk about a busy week!) As the session winds to a close, we will continue to update you on the progress of relevant bills and we look forward to any suggestions you might have about future legislation.

HB 1067: Dental Hygienists
HB 1067 passed out of the Senate yesterday by a unanimous vote. The bill clarifies under what circumstances hygienists and assistants can administer nitrous oxide, restates restrictions on use of a laser by a dental hygienist, and provides that a dental hygienist may administer topical local dental anesthetics, other than nitrous oxide or similar analgesics, without supervision. This bill is a result of diligent work amongst the IDA, the IDHA, and the Indiana Society of Indiana Society of Anesthesiologists. We would like to thank Dr. Chuck Poland and Dr. John Roberts for testifying in support of the bill at committee and house hearings. Their direct engagement in the politics of their profession sets a great example for all IDA dentists, and we are very grateful to have such politically-engaged members.

HB 1006 and SB 1: Regulation of Tobacco Products
HB 1006 successfully passed out of the House and was assigned to the Senate Health and Provider Services Committee for the second half of session. The bill, originally brought by Representative Cindy Kirchhofer, now has over 30 co-authors and will be sponsored by Senator Ed Charbonneau in the Senate. HB 1006 raises the legal age to purchase tobacco from 18 to 21, triples the monetary penalties for retailers selling people who are underage, and revokes a tobacco license from repeat retail offenders. In addition, the bill prohibits a tobacco business from locating within 1,000 feet of a school (after June 30, 2020), and requires a seller of tobacco products to verify the age of a purchaser who appears to be less than 30 years of age. As of this publication, HB 1006 is scheduled to be heard in committee on Wednesday February 26 at 9 a.m. The companion bill SB 1 (brought by Senator Ed Charbonneau) was heard in the House Public Health Committee on Wednesday but was never brought to a vote—here’s hoping HB 1006 is.

HB 1008: Occupational Licensure Endorsement
Our position on HB 1008 has not changed, but neither has the status of the bill. HB 1008 would eliminate barriers to licensure for regulated professions, including dentistry and would require a board to issue a license to an individual who: (1) is licensed in another state or jurisdiction in the regulated occupation; (2) has established residency; (3) has passed a substantially equivalent examination as determined by the appropriate board. The bill passed out of the House and was assigned to the Commerce and Technology Committee, but has yet to be scheduled for a hearing. We will continue to watch this bill and update you if anything changes.

With just three weeks left in the 2020 Legislative Session, there is still much to do and much to make sure doesn’t happen. As your action team down at the statehouse, we are grateful for the opportunity to represent the IDA and its members; especially those who are willing to advocate for their profession.

By Dr. Valerie Martinsen Seifert 

Medicare covered dental services are few and far between, perhaps nonexistent for many dentists, so the changes in Medicare rules have not felt very important until they got more complicated.

In 2015, The Centers for Medicare and Medicaid Services (CMS) announced a new rule to combat fraud and abuse in Medicare Part D. At that time, dentists and other physicians and practitioners were presented with a mandate to either Opt Out or enroll in Medicare so that prescriptions or lab tests ordered for their patients with Medicare would be covered. If a dentist were to choose either option, Medicare patients would receive their benefits.

By April 2018, CMS released the final version of this rule that revised the regulations on dentists who might provide dental care or prescriptions for patients with Medicare Advantage (Part C) or Prescription Drug Benefits (Part D). Under the new rule, dentists no longer needed to take any action to provide Medicare Advantage services or have prescriptions they order be covered under Medicare Part D. In fact, a dentist who is Opted Out is not eligible to be reimbursed by Medicare Advantage plans. However, if ordering or referring laboratory or imaging services, a dentist is still required to Opt Out or Enroll for Medicare patients to receive their benefits.

If you were proactive when the rule was first proposed and did not delay in Opting Out of Medicare (because you don’t provide dental services covered under traditional Medicare or order/refer lab or imaging services), then you may be surprised to find that due to the rule change announced in 2018, you have spent the last few years Opted Out of Medicare without any benefit. In addition, you’ve been unable to be reimbursed by Medicare Advantage plans, nor could your patients file their own claims. If you chose to Opt Out after June 2015, your Opt Out status has been automatically renewed every two years.

According to CMS, a practitioner must submit their written notice to each Medicare Administrative Contractor to Opt Out or to cancel their Opt Out status at least 30 days before the renewal date. There are 120 dentists in Indiana who have Opted Out but may not want to maintain that status. If you are a dentist who has been Opted Out and orders or refers patients for laboratory or imaging services, you may want to enroll in Medicare in order to receive reimbursement for these services as well as Medicare Advantage services. If you do not provide Medicare services or referrals, you may now benefit more from having no Medicare status rather than being Opted Out. Your patients with Medicare will have their prescriptions covered and be able to use their Medicare Advantage benefits for dental care. For more information, see the informative flow chart from the ADA.

If You Need to Take Action 

If you are unsure of your Medicare status, you can view the list of Opt Out Affidavit practitioners by “view data” then “filter” to your name or other details here.

To rescind your Opt Out status, contact each Medicare Administrative Contractor that you initially filed with in writing. In Indiana, Medicare is administered by Wisconsin Physicians Service Government Health Administrators:

WPS GHA Provider Enrollment Unit
P.O. Box 8248
Madison, WI 53708-8248

To enroll as a full Medicare Provider (form CMS-855i) or a Medicare Ordering/Referring Provider (from CMS-855O), visit www.CMS.gov or follow this link.

Sources 

https://www.ada.org/en/publications/ada-news/2018-archive/may/ cms-finalizes-rule-rescinding-parts-c-d-enrollment-requirements 

Dr. Valerie Martinsen Seifert is a general dentist in LaPorte. She currently serves as President-Elect of the Northwest Indiana Dental Society and on the IDA Dental Benefits Subcommittee. She also is a graduate of the IDA AIR Program.

The second half of the 2020 Legislative session began Monday, and things are off to a quick start. While the number of bills to be heard in committee has decreased, the same fervor is found in the hallways. Over 50 percent of the total bills filed died during the first half of session and will be joined by those unable to get through the second half. The long road ahead to bill passage is paved with potholes.

HB 1067: Dental Hygienists
Status: in Senate, passed out of Health and Provider Services Committee

This dental hygienist “cleanup” bill clarifies under what circumstances hygienists and assistants can administer nitrous oxide, restates restrictions on use of a laser by a dental hygienist, and provides that a dental hygienist may administer topical local dental anesthetics, other than nitrous oxide or similar analgesics, without supervision. HB 1067 passed unanimously out of the Public Health Committee and the House; during the vote Representative Dr. Brad Barrett commented on the IDA-IDHA joint effort, stating, “I think it’s refreshing that both entities have come together and worked this out prior to it coming to committee… its very refreshing that the stakeholders have agreed on this and brought it to us in such a nice fashion.”

That same feeling of cooperation followed this bill into the Senate, where it passed unanimously out of the Health and Provider Services Committee on Wednesday. Senators Jean Leising and Ronald Grooms have signed on to the bill as sponsors, and our own Dr. Chuck Poland testified at the committee hearing in favor of the bill. While there was originally some opposition to the nitrous oxide provisions by the Indiana Society of Anesthesiologists, Dr. Poland and Ed Popcheff were able to assuage and address their concerns about the bill. HB 1067 will be eligible for a second reading as early next week. We will continue to update on its progress.

HB 1008: Occupational Licensure Endorsement
Status: in Senate, assigned to Commerce and Technology Committee

Our position on HB 1008 has not changed. The bill would eliminate barriers to licensure for regulated professions, including dentistry and would require a board to issue a license to an individual who: (1) is licensed in another state or jurisdiction in the regulated occupation; (2) has established residency; (3) has passed a substantially equivalent examination as determined by the appropriate board. In our opinion, HB 1008 sidesteps important safeguards put in place to protect patients—the bill errs by focusing on licensure and examinations, with little regard for education. The bill passed out of the House with an 85-6 vote and has been assigned to the Commerce and Technology Committee for the second half of session. However, as of today, the bill has yet to be scheduled for a hearing. Expect to receive a “legislative alert” on this bill in the near future.

As always, thank you for being an advocate for your profession.

The 2020 Legislative Session is well underway, and quickly reaching a critical point: the final votes on bills before they are “flipped” to the other house. (From the House to Senate, or the Senate to House.) The Legislature will not meet on Thursday as it transitions into the second half of session, resuming Monday, February 10. We’ve seen a lot of bill movement in the last few weeks and here’s where we stand now:

HB 1008: Occupational License Endorsement
Status: referred to Senate

While the IDA has taken a firm position against this bill, HB 1008 was voted out of both the Employment, Labor, and Pensions Committee and the House. The bill seeks to eliminate barriers to licensure for regulated professions, including dentistry. The bill, introduced by Representative Martin Carbaugh and coauthored by Representatives Robert Morris and Timothy Wesco, would require a board to issue a license to an individual who: (1) is licensed in another state or jurisdiction in the regulated occupation; (2) has established residency; (3) has passed a substantially equivalent examination as determined by the appropriate board. HB 1008 has been referred to the Senate, where it will be carried by Senators Mark Messmer and Justin Busch.

HB 1067: Dental Hygienists
Status: referred to Senate

This dental hygienist “cleanup” bill, carried by our own Representative Dr. Dennis Zent, clarifies under what circumstances hygienists and assistants can administer nitrous oxide, restates restrictions on use of a laser by a dental hygienist, and provides that a dental hygienist may administer topical local dental anesthetics, other than nitrous oxide or similar analgesics, without supervision. The bill passed unanimously out of the Public Health Committee as well as the House and has been referred to the Senate for the second half of session, where Senator Jean Leising will sponsor the bill.

1110: Health Workforce Student Loan Repayment Program
Status: dead

Representative Ethan Manning’s bill would have created (1) the health workforce student loan repayment program, (2) the health workforce council, and (3) the health workforce student loan repayment program fund. The bill was assigned to the House Public Health Committee, but was never scheduled for a hearing. The IDA hopes to revisit this issue next session.

HB 1149: Dental Screenings and Services in Schools
Status: dead

This bill would have required each school corporation to enter into one or more agreements with one or more dentists or dental groups to: (1) provide a free, annual dental screening to each student enrolled in kindergarten through grade 12 in the school corporation; and (2) make comprehensive dental services available at each school in the school corporation for students in kindergarten through grade 12. The bill was referred to the Education Committee but was never scheduled for a hearing.

SB 41: Definition of Dentistry
Status: dead

This IDA-sponsored bill carried by Senator Merritt would have amended current language to more closely mirror that of the ADA. Specifically, the new language would have dictated that a person “practices dentistry if the person offers to diagnose, professes to diagnose, treats, or professes to treat any lesion or disease of the oral and maxillofacial region or associated and adjacent structures.” The bill was assigned to the Senate Health and Provider Services Committee but—even with the help of our many Contact Dentists—was unable to get a hearing. The IDA looks forward to continued efforts on this issue going forward.

SB 427: Provisional Occupational License
Status: likely referred to House.

This bill, authored by Senator Brian Buchanan and coauthored by Senator Mark Messmer, allows a person who is the spouse of an active duty member of the armed forces assigned to Indiana to be issued a provisional license for the regulated occupation at the same practice level allowed by the license held by the person in the other state. The bill originally was applicable to all out-of-state applicants, but was amended in Committee to limit the potential applicants to just military spouses. The bill has passed out of Committee and will likely be referred to the House during the second half of session.

There is still so much ahead: the second half of session should prove to be as tumultuous and rapidfire as the first. We will continue to update you on the status of these bills and any others that may become relevant. Thank you for being an informed advocate for your profession.