From ADEA <[email protected]>
Subject ADEA Advocate - February 4, 2020
Date February 4, 2020 3:00 PM
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American Dental Education Association
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Volume 1, No. 47, February 4, 2020

CMS Unveils Medicaid Block Grant Proposal
 
On Jan. 30, the Centers for Medicare & Medicaid Services (CMS) released a guidance [ [link removed] ] that could result in a drastic shift in the way portions of state Medicaid programs are funded. Under the guidance, CMS outlined terms it would use for approving voluntary state waiver [ [link removed] ] applications for demonstration programs that would use block grant funding to provide coverage for limited adult Medicaid populations who are not disabled, not in long-term care or not eligible under a state plan.
 
Regular readers of the ADEA Advocate may recall that block grants [ [link removed] ] are an arrangement between states and the federal government under which the federal government provides a fixed amount of annual funding to administer a state-run program. Medicaid is currently funded without fixed limits as an entitlement program under which the federal government pays a percentage of the state’s Medicaid costs based on per-capita income. In exchange for receiving a fixed amount of funds, states would be granted greater flexibility in administering the program.
 
Dubbed the Healthy Adult Opportunity (HAO), Trump administration officials are touting the new guidance as an opportunity for states to rein in costs and design innovative approaches to delivering health care. A demonstration approved under HAO guidance would be required to provide essential health benefits [ [link removed] ] that apply under the Affordable Care Act, and would also be required to meet additional standards [ [link removed] ] intended to protect beneficiaries. Among the possible changes that could result in cost savings would be the ability to design formularies for prescription drugs. States may also be permitted to implement new enrollment criteria for covered populations, such as work requirements, new income standards for eligibility, and premiums and cost-sharing arrangements that would be capped at 5% of a beneficiary’s income. If a state is able to save federal funding, CMS would permit the state to reinvest a portion of the savings back into the state’s Medicaid program.
 
The guidance also encourages states to reexamine laws that limit a provider’s scope of practice or that impose “unnecessarily restrictive supervisory requirements.” All states approved under the HAO would be expected to review these recommendations, and CMS will prioritize applications that demonstrate a state has or is taking steps to address “state barriers to competition.”
 
Congressional Democrats have criticized block grants [ [link removed] Medicaid Block Grant Letter.pdf ] and have stated they will result in restricted enrollment, cuts to provider reimbursement, and limited eligibility. It’s also unclear if CMS has the authority [ [link removed] ] to alter federal funding for Medicaid. Waivers approved under the program will also likely be challenged in courts on the grounds that they do not further the goals of the Medicaid program, a requirement for all waivers granted by CMS for demonstration projects.
 
Several states have already shown interest in receiving Medicaid funding through a block grant. Near the end of 2019, Tennessee [ [link removed] ] submitted a waiver request, asking that all of the state’s Medicaid funding be provided through a block grant. Alaska [ [link removed] ] commissioned a study of block grants, and lawmakers in Georgia, Oklahoma and Utah have also shown an interest in the funding structure.
 
ADEA AGR will continue to monitor and provide updates as more develops.

U.S. Health Officials Take Steps to Contain Coronavirus
 
Last week, the Trump administration declared a public health emergency [ [link removed] ] over the coronavirus and issued mandatory quarantines and travel restrictions that went into effect Feb. 2, escalating its initial response to the outbreak.
 
Earlier that week, U.S. health officials had held a press conference [ [link removed] ] announcing that the administration had no plans to declare a public health emergency. The press conference came after five confirmed cases in the United States and calls from Republican members of Congress to invoke a public health emergency so that additional federal funding can be released. Some congressional members also called for a ban on all commercial flights between the United States and China.
 
At the time, Department of Health and Human Services Secretary Alex Azar stressed Americans’ risk of contracting coronavirus was low. As a result, Secretary Azar refused to declare a public health emergency, but he noted that he “won’t hesitate at all to invoke any authorities I need to . . . but I’ll do it when it’s appropriate.”
 
However, by the end of week, due to the increase in the number of deaths in China and a significant increase in the number of people infected by the coronavirus, the Trump administration changed course, declared the public health emergency and issued the mandatory quarantines and travel restrictions. Under the new rules:
 • U.S. citizens who have traveled in China within the last 14 days will be re-routed to one of eight designated airports, where they will undergo enhanced health screening procedures.
 • U.S. citizens who have been in Hubei province in China where the outbreak originated, within 14 days of their return, will be subject to up to 14 days of mandatory quarantine.
 • U.S. citizens who have been in other areas of China within the last 14 days will undergo “proactive entry health screening” and up to 14 days of “self-quarantine.”

Most non-U.S. citizens who have traveled in China within the last 14 days will be denied entry into the United States, except for immediate family members of U.S. citizens, permanent residents and flight crew.

Regulatory Proposal in Virginia Could Change Education Programs For Some Dental Assistants
 
A regulatory proposal [ [link removed] ] from the Virginia Board of Dentistry would change the educational requirements for individuals who wish to become dental assistants II (DA II). Generally, the proposal would require educational programs that train DA II to shift from programs that require a completion of hours to programs that require the completion of competency assessments based on satisfactory didactic coursework and clinical experience. The proposal also establishes new personnel requirements for training programs and requires each program to enroll practice sites for clinical experience. The Board said in a statement included with the proposal that it is crafting the new rule because current regulations are too burdensome and costly for most dental assistants. A hearing for the proposal is scheduled for Feb. 28. Comments are due by March 20.
In Virginia, a DA II is permitted perform intraoral procedures under the direction and direct supervision of a dentist. Those intraoral procedures are:
 1. Pulp-capping procedures,
 2. Packing and carving of amalgam restorations,
 3. Placing and shaping composite resin restorations with a slow-speed handpiece,
 4. Taking final impressions,
 5. Use of a non-epinephrine retraction cord and
 6. Final cementation of crowns and bridges after adjustment and fitting by the dentist.

Attention, dental and craniofacial researchers, oral health advocates, dental educators, students, residents and fellows:
 
Join the American Association for Dental Research (AADR), the American Dental Education Association (ADEA) and the Friends of National Institute of Dental and Craniofacial Research (FNIDCR) on Tuesday, March 17, 2020, for the 2020 AADR, ADEA and FNIDCR Capitol Hill Day. For Capitol Hill Day registration and information, click here [ [link removed] ] .

ADEA State Calendar [ [link removed] ]

ADEA Washington Calendar [ [link removed] ]

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

Key Federal Issues [ [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.
 
©2020
American Dental Education Association
655 K Street, NW, Suite 800
Washington, DC 20001
202-289-7201, 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
 
Phillip Mauller, M.P.S.
ADEA Director of State Relations and Advocacy
 
Brian Robinson
ADEA Program Manager for Advocacy and Government Relations
 
Ambika R. Srivastava, M.P.H.
ADEA/Sunstar Americas, Inc./Jack Bresch Legislative Intern
 
[email protected] [ mailto:[email protected]?subject=State%20Update%3A%20 ]

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