By Andrew Smith, Executive Director, ADSO
At a time when the shape of healthcare is changing across the nation, the need for significant reform to existing laws governing the dental industry has never been greater. The industry is currently at a crossroads, facing rising costs, a workforce that cannot adequately meet demand, and a system that often serves insurers over patients. The issues at hand will define the future of dentistry. Fortunately, the Association of Dental Support Organizations (ADSO) has been able to join the dental community in celebrating a series of legislative victories in states across the country that will improve outcomes for dental professionals and patients alike.
Throughout the past year, the ADSO helped lead the push for the passage and enactment of legislation addressing some of the most pressing issues facing the industry. From the introduction of Medical Loss Ratio via ballot initiative in Massachusetts to the passage of interstate licensure compacts in Iowa and Washington, the ADSO has taken part in a number of legislative reform efforts aimed at resolving challenges like the workforce shortage and suboptimal practices on the part of insurers.
Different states have, of course, required different types of reform.
In Arkansas, Wisconsin, and Pennsylvania, we looked to Assignment of Benefits (AOB) legislation, which requires insurers to follow a patient’s request to pay their dentist directly for services rendered. In states where these laws don’t exist, insurers often pay the patient instead of the dentist, creating confusion and additional hurdles for patients.
In Iowa and Washington, we saw the enactment of licensure compact laws for dentists and dental hygienists, which streamline recognition of licenses from providers in the participating compact states with the goal of increasing the supply of dental professionals and thus expanding access to care for patients.
Spurred along in part by our ballot initiative victory in Massachusetts, Colorado and Nevada passed critical legislation focused on Medical Loss Ratios (MLR). This refers to the share of premiums paid to a plan spent on treatment and activities that improve the quality of care, where the remainder is the share spent on administration, fees, and profits earned. These laws regulated how much of premium payments must be spent on actual patient care, reducing costs for patients.
Finally, Illinois, Minnesota, and Missouri passed laws relating to both Network Leasing and Virtual Credit Cards. In the case of the former, a preferred provider organization (PPO) rents its dental network to other PPOs, such that the first PPO’s in-network dentists must unknowingly accept patients and terms as an “in-network” provider with other PPO, which harms dental practices. For the latter, the laws addressed the not uncommon problem of dental plans and third-party administrators (TPAs) paying dental offices with a credit/debit card as the only payment option. Dentists have reported that the card may carry a higher processing fee than a traditional debit or credit card transaction, which results in lower reimbursement for the care provided. In some cases, insurance companies even share in the revenue generated from these fees.
At each stage, collaboration with our dental organization partners, dentists, dental hygienists, and legislators who understand the importance of our proposed reforms has been absolutely essential. Together we confidently pushed ahead with the knowledge that coordinated efforts from within the industry to achieve change on these critical issues will determine the coming decades of dental care.