together and discuss priorities while enjoying decadent appetizers in an elegant venue … all less than a block from the Capitol building. In addition to highlighting our 150th anniversary celebration, it was an evening of camaraderie among our members and various legislators in a much more intimate setting than our statehouse allows. While our agenda is much the same as last year, we still rely on this recep- tion to further discuss our priorities with the individuals who have the ability to ensure that our legislation passes … or fails.
Once again, the MDA’s eyes will be fixated upon the budget and whether or not it will include limited adult dental benefits within the Medicaid appropriations. Although the funding was in the core of the Medicaid budget in 2014, it was withheld by the Governor this past June for the 2015 fiscal year. Until Governor Nixon recognizes the immediate need for Medicaid providers to be reimbursed for emergency dental services as was outlined in the state’s 2013 budget, Missouri will fall even further behind in implementing statewide dental policies.
Although we have numerous oral health advocates in our corner within the 98th General Assembly, we still look to our members to remain vigilant and informed on the issues. To do my part, I endeav- or to see that adult dental services will remain intact in the budget this year, that key legislation regarding the reform of specific insur- ance provider information moves forward, and to maintain the out- standing, professional reputation the MDA has preserved throughout the course of its 150 successful years. f
CONTACT KATIE REICHARD, MDA Legislative & Regulatory Director, at katie@
modentalmail.org or call the MDA office.
Be careful what you wish for
Consequences of a new law, how to deal with it by MERLE NUNEMAKER, DDS
L
ast year as part of the MDA legislative agenda, SB 884 was introduced for us by Sen. Wayne Wallingford and was suc-
cessfully passed into law. The provisions of that bill, termed “silent PPO legislation” call for dental insurance companies with a network of practitioners to inform contracted dentists when the network is utilized by a third party. In other words, the insurance company is now obligated to let us know if we may be recognized as a provider by a company we did not actually sign a contract with, and we can make an informed decision as how best to proceed with that information.
Recently, one insurance company sent out a communication with an amendment to their provider agreement that gave the dentist 30 days to respond with objections—or else this amendment would become part of the provider agreement:
“ACCESS – DENTIST acknowledges that ******** may sell, assign, or otherwise give access to the services of the DENTIST to third party Payors, including network plans.”
Sometimes Defeat = Success
Throughout the course of its 150 years, it comes as no surprise that the MDA has seen many a successful legislative agenda pass during any given session of the General Assembly. What might surprise some to know, though, is that what is termed “successful” isn’t only legisla- tion that is drafted for the MDA and passed by the legislature—it sometimes also includes language that the MDA finds harmful in a manner of respects, and therefore endeavors to defeat it.
One such bill to include potentially harmful language for the MDA is HB 459, introduced this session by Rep. Sue Allen of St. Louis County. This bill seeks to grant dental hygienists extended access to patients, and establishes their ability to work “within or outside the usual location of the partnering dentist”, and thereby only necessitat- ing an “annual referral to a dentist for the determination of additional dental treatment”, no longer requiring an annual exam.
The MDA’s lobbying team is keeping a close watch on this bill and hopes to work successfully and amicably with the MDHA to ensure we continue to do what’s in the best interests of patients for another 150 years.
Should you agree with being a provider for another unknown (silent PPO) network, no action is necessary. If you do not want that to happen, a written objection needs to be filed with that company.
At this point, the MDA is not exactly sure what might occur. Insurance companies may say “fine, you may opt out, and you as a provider will not be part of any network they may give others access to.” Or, depending on how the contract is written, the company possibly would have grounds to terminate the entire agreement with you.
Remember the ADA has the Contract Analysis Service for its members should you desire additional assistance. Learn about it at
www.modental.org/contracts (log in to members only). It is hosted on the MDA website because you must work with your state dental association to submit a contract for analysis.
The MDA got legislation passed that it wanted, but passage is just a first step. We all need to be aware of consequences of this new law and how to deal with it. f
DR. NUNEMAKER is the MDA Immediate Past President and prior to this was the Legislative and Regulatory Committee Chair. In both these leadership positions, he worked extensively with Silent PPO legislation.
ISSUE 1 | JAN/FEB 2015 | focus 17
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