{ legislative & regulatory }


Assignment of Benefits: Readdressing the Issue


by HALIE PAYNE S


ince starting with the MDA in June 2022, the most common phone call or email I get from members is about assignment of benefits, or lack thereof, when it comes to pre- paid dental plans.


That same year, MDA passed legislation to include pre-paid dental plans under Missouri’s Assignment of Benefits (AOB) statute. Previously, Missouri’s AOB law did not apply to pre- paid dental plans. However, even with this passage, pre-paid dental plans continue to claim exemption from assigning benefits agreed upon by patients directly to providers. Insurers should be required to adhere to the law and stop the difficulty this brings to both patients and providers by the refusal to assign benefits to the provider.


Some of this exemption is claimed under ERISA, the Employee Retirement Income Security Act of 1974. ERISA is a federal law that regulates employee benefit plans, including dental care. In general, dental coverage is separated into plans that are either “self-funded” or “fully insured.” How the plan is regulated depends on how the plan is funded.


Missouri requires patients’ insurance cards to state if a plan is fully insured or self-funded. Self-funded plans are regulated by ERISA, whereas fully insured plans are regulated by state laws. Unfortunately, a majority of pre-paid dental insurance plans are self-funded.


Some carriers administering ERISA plans argue that because ERISA is a federal law, it supersedes or “preempts” state insurance laws that protect patients (like ours in Missouri). Historically ERISA has been difficult to amend, but there was a recent U.S. Supreme Court case that limits preemption. These findings in a pharmacy insurance case determined that pharmacy insurers’ claim of state law exemption under ERISA was wrong. This is good news for us, but we need your help to turn that good news into action.


We must show lawmakers the magnitude of the problem and keep the momentum going to create real change. The ADA has information and resources about ERISA to help you become informed and take action at ada.org/advocacy/advocacy-issues/erisa-plans.


If you experience assignment of benefit problems in your practice, I ask you to please share the details with me via email. The only way we are going to create effective change is through firsthand experiences from members to continue building the case against these burdensome, exemptions.


Stay updated on this and other advocacy issues at modental.org/advocacy. Contact Halie Payne, Professional Affairs Director, at halie@modentalmail.org.


Get up-to-date information on all agenda items for the 2024 session at MODENTAL.ORG/SESSION


16 focus | WINTER 2023 | ISSUE 4


A Year of Medicaid Progress: More Providers Will Help To Keep Momentum


T


he 2022 session was a big year for Dental Medicaid in Missouri. Be- cause of decades of advocacy efforts


and keeping a place at the table, Missouri’s Dental Medicaid reimbursement rates increased to 80 percent of the 50th per- centile of the UCR. After the rates officially took effect July 1, 2022, we knew there was still work to be done. Through a grant with the Missouri Foundation for Health and Missouri Forward Health Foundation, the MDA collaborated with the Missouri Coali- tion for Oral Health to create the Dental Medicaid Facilitator. This person was to work closely with the MDA, MOHealthNet and other appropriate entities to help re- cruit and serve dentists providing Medicaid.


Jessica Emmerich serves in this facilitator role and has made incredible strides to strengthen positive relationships between MOHealthNet, providers and the man- aged care organizations. Not only has she increased communications in this role, but hosts several Medicaid webinars, discussing common Medicaid topics like enrolling and credentialing, audits and billing.


There were 184 new providers enrolled in FY2023 compared to 101 in FY22. This is a great improvement; however, the work is not done. While this increase in provid- ers is a great start, Missourians with dental Medicaid are still struggling to find a dental home, especially in rural Missouri.


We encourage every provider to have a dis- cussion with Jessica about becoming a Med- icaid provider. As for 2024, we will work to ensure these increased rates are here to stay and keep advocating for better access to dental care in Missouri. To learn more about these webinars and other resources, visit the website noted below.


ORALHEALTHMISSOURI.ORG/ MO-HEALTHNETMEDICAID


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