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American Dental Education Association


Biden Administration Proposes Rule to Include Adult Dental Coverage as an Essential Health Benefit on the ACA Exchanges
 
On Nov. 24, the Department of Health and Human Services (HHS) published in the Federal Register a proposed rule [ [link removed] ] that would allow states to include adult dental services as an “essential health benefit” (EHB) that Affordable Care Act (ACA) health plans must cover without annual or lifetime limits. The rule governs issuers offering qualified health plans through federally facilitated exchanges and state-based exchanges on the federal platform, and it would allow adults who buy health insurance on the ACA exchanges to receive dental coverage as part of their medical care plan. Plan participants would still have to pay co-payments and/or co-insurance. The rule would become effective in the 2025 health insurance coverage year.
 
In the proposed rule, HHS intends to remove the regulatory prohibition at § 156.115(d) of its regulations governing the ACA. This section currently places a regulatory prohibition on health insurance companies from including routine non-pediatric dental services as an EHB. Removing the regulatory prohibition would allow states the option to add routine adult dental services as an EHB.
 
In most incidences, health insurance plans offered by private sector employers mirror those offered by the ACA exchanges.
 
HHS asserts that the purpose of this proposed change is to narrow a long-standing coverage gap in the 2010 health care law and to help advance health equity and mitigate health disparities as lower income populations and minority groups have limited access to dental care. Limited access impacts positive health outcomes.
 
Additionally, as part of its justification for the proposed rule change, HHS acknowledges the connection between oral health and systemic health, noting that, “oral health and overall health are inextricably linked; untreated oral health conditions can increase risk for and complicate the management of other chronic conditions. For example, studies have shown that periodontal disease and tooth loss are strongly associated with heart health, and oral health care can reduce the risk for cardiovascular disease, atrial fibrillation, and heart failure.”
 
Comments on the proposed rule are due on Jan. 8, 2024. The final rule will likely be released in the late spring or early summer of 2024, with implementation to follow in 2025. However, it is important to note that if HHS is able to include adult dental care as an EHB in the final rule, each individual state would still have to choose adult dental care as an option that they wanted to offer on their particular state’s ACA marketplace. If a respective state does not choose the adult dental care option, then that service will not be covered as an EHB on the state’s ACA exchanges.

Senate and House Return From Break
 
The U.S. Senate and the House of Representatives return this week from a weeklong Thanksgiving break. Both chambers will only be in session simultaneously for 12 legislative days before recessing for Christmas break. While they are in session, discussions will continue to focus on funding the government as the first of two appropriations deadlines will be on Jan. 19, 2024, followed closely by the Feb. 2, 2024 deadline.
 
Congress returns from its Christmas break during the week of Jan. 8, 2024.

California Set to Expand Medicaid to All Adults Regardless of Immigration Status and Eliminate All Asset Limits
 
On Jan. 1, 2024, California will extend eligibility [ [link removed] ] for its Medicaid program to income eligible adults aged 26-49, regardless of immigration status. The state had previously expanded eligibility to include adults in other age groups, and this expansion was required under legislation [ [link removed] ] passed in 2022.
 
Additionally, the state will also eliminate asset tests [ [link removed] ] . Legislation [ [link removed] ] passed in 2021 required the state to initially raise the asset limit and then eliminate limits altogether.

Dentist and Dental Hygienist Compact Introduced in Wisconsin
 
The Dentist and Dental Hygienist Compact has been introduced in Wisconsin through companion bills in the Assembly [ [link removed] ] and Senate [ [link removed] ] .
 
Once enacted by seven states, the compact will create a pathway to licensure portability for dentists and dental hygienists who are licensed in member states. Licensees who live in states that are compact members can apply for a “compact privilege” that will allow them to practice in another member state. Under the model compact [ [link removed] ] that was written by The Council for State Governments, license holders will be granted the opportunity to apply for compact privilege if they do the following:
 • Hold a license as a dentist or dental hygienist;
 • Graduate from a Commission on Dental Accreditation-accredited program;
 • Successfully complete a clinical assessment for licensure, with “clinical assessment” currently defined as an examination or process required for licensure as a dentist or dental hygienist, as applicable, that provides evidence of clinical competence in dentistry or dental hygiene;
 • Have passed a National Board Examination of the Joint Commission on National Dental Examinations or another examination accepted by rule as a requirement for licensure;
 • Meet any jurisprudence requirements;
 • Complete a criminal background check;
 • Submit an application and pay applicable fees; and
 • Comply with requirements to submit specified information for administrative purposes.

Iowa [ [link removed] ] became the first state to join the compact on April 27. Washington [ [link removed] ] state and Tennessee [ [link removed] ] became the second and third states, respectively. To date, the bill has also been introduced in six additional states [ [link removed] ] .

ADEA Advocacy in Action
This appears weekly in the ADEA Advocate to summarize and provide direct links to recent advocacy actions taken by ADEA. Please let us know what you think and how we might improve its usefulness.
 
Issues and Resources
 • ADEA report [ [link removed] ] on teledentistry
 • ADEA report [ [link removed] ] on the Impact of the COVID-19 Pandemic on U.S. Dental Schools
 • ADEA policy brief [ [link removed] ] regarding overprescription of antibiotics
 • For a full list of ADEA memos, briefs and letters click here [ [link removed] ] .

Key Federal Issues [ [link removed] ]

ADEA U.S. Interactive Legislative and Regulatory Tracking Map [ [link removed] ]

Key State Issues [ [link removed] ]

The ADEA Advocate [ [link removed] ] is published weekly. Its purpose is to keep ADEA members abreast of federal and state issues and events of interest to the academic dentistry and the dental and research communities.
 
©2023
American Dental Education Association
655 K Street, NW, Suite 800
Washington, DC 20001
Tel: 202-289-7201
Website: www.adea.org [ [link removed] ]

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B. Timothy Leeth, CPA
ADEA Chief Advocacy Officer
 
Bridgette DeHart, J.D.
ADEA Director of Federal Relations and Advocacy
 
Phillip Mauller, M.P.S.
ADEA Director of State Relations and Advocacy
 
Varsha Menon
ADEA Program Manager for Advocacy and Government Relations
 
Contact Us:
[email protected] [ mailto:[email protected] ]

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