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American Dental Education Association


Volume 3, No. 37, April 9, 2024

Biden Administration Issues New Rule Regarding Insurance Plans
 
The Biden administration is set to implement a final rule [ [link removed] ] aimed at restricting the sale and availability of "short-term, limited-duration insurance" plans, which have been criticized for offering inexpensive but substandard coverage that circumvents consumer protections outlined in the Affordable Care Act (ACA). These plans were originally designed to assist individuals in maintaining health insurance during periods of coverage gaps, such as while in-between jobs. However, unlike other forms of health insurance, short-term plans are not required to cover essential health benefits mandated by the ACA, can deny coverage to individuals with pre-existing conditions, charge higher rates for those with health issues and are exempt from ACA limits on out-of-pocket expenses.
 
The new rule seeks to address concerns surrounding these short-term, limited duration insurance plans by imposing limitations on their duration. Under the new regulations, initial coverage periods for short-term plans would be capped at three months, with a maximum coverage period of four months, including renewals or extensions. Currently, short-term plans can provide coverage for up to 36 months. Furthermore, the rule mandates that plans provide clear disclaimers to consumers regarding the limitations and costs associated with short-term policies, aiming to increase transparency and consumer awareness in the health insurance marketplace.

Licensure Update
 
In recent weeks, several states have either sent bills to governors or finalized changes to licensure laws that could have an impact on oral health professionals.
 
Kansas Gov. Laura Kelly (D) signed a bill [ [link removed] ] that requires members of the military or their spouses, to be residents of the state or plan to reside in the state due to assigned military station, in order to qualify for reciprocity under special rules that only apply to military families. The bill also waives fees for individuals who qualify under this law.
 
The Colorado General Assembly sent a bill [ [link removed] ] to Gov. Jared Polis (D) that would expand eligibility for its military occupational credential portability program. Eligibility, under the proposed bill, would [ [link removed] ] include gold star military spouses, dependents of military members and dependents and spouses of members of the Armed Forces Reserves and National Guard. The bill also eliminates a provision that limits people licensed under this program to a three-year, nonrenewable license; instead, it allows these individuals to obtain a six-year renewable license. Finally, the bill also waives application fees and allows an applicant to be credentialed under the program if they committed an act that would have been grounds for discipline in Colorado, but not in the state in which they currently reside.
 
The Maryland General Assembly sent a bill [ [link removed] ] to Gov. Wes Moore (D) that makes changes to provisions of current law that require the State Board of Dental Examiners to waive education requirements for foreign-trained dentists who apply for a limited license to work in specified settings that serve traditionally underserved populations. Under current law, these provisions only permit holders of these limited licenses to treat children. If this bill is signed into law, holders of these licenses will also be permitted to treat adults.

Maryland Sends Bill to Gov. Requiring Study of Medicaid Dental Benefits
 
The Maryland General Assembly sent a bill [ [link removed] ] to Gov. Wes Moore (D) that requires the state’s Department of Health to study the feasibility of including coverage under the state’s Medicaid program for removable full and partial dentures and setting adequate reimbursement rates for providers on a per-patient basis. The bill also requires reimbursement rates for these services to be set at no less than 60% of the average commercial rates for all payers in the state who offer the services. The Department of Health will be required to report its findings by Dec. 1, 2024. It will also solicit input from state chapters of national professional dental organizations and advocacy groups that work to improve the oral health outcomes for the state’s low–income residents.
 
CMS Releases Final Rule Allowing States to Choose Adult Routine Dental Coverage as an EHB
 
The Centers for Medicare & Medicaid Services (CMS) released the 2025 Notice of Benefit and Payment Parameters final rule [ [link removed] ] . The rule is designed to enhance accessibility and reliability within the Affordable Care Act (ACA) Marketplaces. These policies aim to simplify the enrollment process for low-income individuals, expand access to routine adult dental services and establish network adequacy standards to ensure reasonable travel distances to in-network providers. The rule builds upon previous efforts by the Biden administration to improve the quality and affordability of health care while standardizing operations across Marketplaces for increased consumer consistency.
 
One significant aspect of the new policies is the expansion of access to health care services, particularly the inclusion of adult routine dental care as a state option. Effective Jan. 1, 2027, states can include adult routine dental services as an essential health benefit (EHB) within their plans offered through the ACA Marketplaces. However, states can begin the EHB benchmark application process on Jan. 1, 2025. This move marks a notable step forward in prioritizing oral health by covering services like cleanings, X-rays, fillings and root canals. Additionally, the final rule sets out network adequacy standards for all providers to ensure that consumers can access in-network providers within reasonable time and distance parameters, enhancing the overall quality of care available through the Marketplaces.
 
Moreover, the rule focuses on making it easier for individuals to enroll in coverage, particularly through special enrollment periods (SEP) and streamlined enrollment processes. The SEP has been extended to allow consumers with household incomes at or below 150% of the Federal Poverty Level (FPL) to enroll in coverage during any month, rather than solely during the Open Enrollment period. Furthermore, efforts have been made to align Open Enrollment periods across Marketplaces and prevent coverage gaps during transitions by enabling coverage to begin promptly after selection. Streamlining measures, such as standardizing operations and providing live call center assistance, aim to enhance the consumer experience and ensure smoother enrollment processes across all Marketplaces.

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.
 
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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 Senior Director of State Relations and Advocacy
 
Contact Us:
[email protected] [ mailto:[email protected] ]

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