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American Dental Education Association
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Volume 1, No. 72, July 29, 2020

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.
 
Lost Clinic Revenue—Provider Relief Fund
May 1 – Joint letter [ [link removed] ] with the Partnership for Medicaid on fund reimbursement for Medicaid providers.
 
Other COVID Issues
July 10 – Joint letter [ [link removed] ] to Sec. Wolf Regarding the Student and Exchange Visitor Program
July 2 – Joint letter [ [link removed] ] to Dept. of State and DHS Regarding Guidance for International Students.
May 28 – Joint letter [ [link removed] ] with the American Council on Education regarding liability protection shields.
 
Dental School COVID Related Capital Needs
July 2 – Joint letter [ [link removed] ] to HELP Committee Regarding Reopening Costs.
June 1 – ADEA letter [ [link removed] ] to Sen. Lamar Alexander regarding reopening guidelines.
 
State Advocacy
July 20 – ADEA webinar [ [link removed] ] on State Advocacy
 
For a full list of ADEA Letters and Policy Memos, click here [ [link removed] ] .

CDC Changes COVID-19 Isolation Guidance
 
The Centers for Disease Control and Prevention (CDC) issued updated guidance [ [link removed] ] for people who test positive for COVID-19. The CDC now says that individuals who are symptomatic with COVID-19 should isolate at home for 10 days after symptoms begin and for 24 hours after their fever breaks without the use of fever-reducing medications, and with improvement of other symptoms. Those persons with severe illness should isolate for 20 days after symptom onset. Asymptomatic patients should isolate for 10 days from the date of their first positive test.
 
The CDC also now recommends [ [link removed] ] people do not need to have two negative tests to end isolation, which was the previous standard.
 
The above guidance is for individuals who have to isolate due to a positive COVID-19 test. However, the CDC has not changed its initial quarantine guidance for those who have been in contact with an infected person. The CDC continues to recommend a 14-day quarantine period for people who have been in contact with an infected person, but do not have a confirmed infection.
 
The updated guidance comes at a time when COVID-19 cases are increasing [ [link removed] ] throughout the Unites States and when testing capacity continues to be a critical component in controlling the spread of the disease. The CDC asserts that the guidance revision has nothing to do with concerns about testing capacity. Rather, the agency points to various studies noting that recovered COVID-19 patients continue to shed the virus for up to three months after recovery, but they do not transmit the virus. “These findings strengthen the justification for relying on a symptom-based, rather than test-based strategy for ending isolation of these patients, so that persons who are by current evidence no longer infectious are not kept unnecessarily isolated and excluded from work or other responsibilities,” the agency notes in the guidance.

Trump Administration Changes CDC COVID-19 Data Reporting Process
 
The Trump administration has ordered [ [link removed] ] hospitals to send all reportable COVID-19 patient data directly to the Department of Health and Human Services (HHS), bypassing reporting to the Centers for Disease and Prevention Control (CDC). Historically, the CDC has collected, analyzed and made publicly available various health care data. It has been collecting coronavirus data through its National Healthcare Safety Network [ [link removed] ] , which was expanded at the outset of the pandemic to track hospital capacity and patient information specific to COVID-19.
 
The administration stated that this reporting change was needed because the COVID-19 Taskforce has to not only quickly access data [ [link removed] ] , but also access correct data. Easily accessing the data is critical to the Taskforce being able to appropriately respond to the spread of COVID-19, namely appropriately allocating personal protective gear and the therapeutic drug, Remdesivir.
 
The administration points to a recent mistake by the CDC to support their decision to change the data reporting process. In May, the agency acknowledged [ [link removed] ] that in tracking the spread of the virus, it had been combining tests that detect active infection with those that detect recovery from COVID-19. That mistake painted a false picture of the pandemic by raising the percentage of Americans tested. The agency immediately took measures to correct the numbers and put systems in place to prevent such a mistake from happening again.
 
There is wide consensus in the medical community that the CDC does not adequately collect and manage data and that their system is inefficient and antiquated. However, many argue that rather than circumvent the CDC, the administration should have upgraded the CDC’s data collection systems. Public health officials, doctors, researchers and media are concerned that the COVID-19 hospital-patient data collected by the HHS will be politicized and possibly tampered with [ [link removed] ] , and that their access to the data will be curtailed.

Trump Administration Asks Supreme Court to Overturn Ruling on Medicaid Work Requirements in Arkansas
 
On July 13, the Trump administration filed a petition with the U.S. Supreme Court, requesting the Court overturn an appeals court ruling [ [link removed] ] that blocked implementation of Medicaid work requirements in Arkansas. The petition [ [link removed] ] argues that the U.S. Court of Appeals for the District of Columbia erred in concluding that the Secretary of Health and Human Services is prohibited from authorizing the work requirements, and that the ruling of the Appeals Court “reflects a fundamental misreading of the statutory text and context.”
 
The fight in federal courts over work requirements has been going on for over two years. They were first blocked in by U.S. District Judge James Boasberg in Kentucky [ [link removed] ] in June 2018, but that same month, Arkansas became the first state to implement work requirements, resulting in more than 18,000 people being disenrolled [ [link removed] ] from care. Arkansas’s policy wasn’t in place for long, however, as Justice Boasberg struck down the requirements in Arkansas, as well as a revised version of Kentucky’s work requirements in March 2019 [ [link removed] ] . The Trump administration went on to appeal the March decision in the U.S. Court of Appeals, but in February 2020, the Appeals Court agreed with Justice Boasberg’s ruling [ [link removed] ] that the Centers for Medicare & Medicaid Services (CMS) allowing the requirements was “arbitrary and capricious because it did not address . . . how the project would implicate the ‘core’ objective of Medicaid: the provision of medical coverage to the needy.”
 
Work requirements were also blocked by Justice Boasberg in New Hampshire [ [link removed] ] and Michigan [ [link removed] ] . If the Supreme Court were to overturn the ruling of the Appeals Court, it would likely have an impact on states throughout the country. CMS has approved requests [ [link removed] ] to implement work requirements in six additional states (two of those states have voluntarily suspended plans for implementation) and is reviewing requests submitted by 10 other states.

Dental Therapy Legislation Moving Through Massachusetts General Court
 
Legislation that would allow the practice of dental therapy in Massachusetts is moving through the Massachusetts General Court. SB 2796 [ [link removed] ] has already passed the state Senate, as well as a committee in the House, and dental therapy is one of several topics addressed in the legislation. Bulleted highlights of the bill can be found below:
 • To qualify for a license, a dental therapist would be required to pass a comprehensive clinical examination and complete a Master’s level dental therapist education program that includes both dental therapy and dental hygiene education or complete an equivalent combination of both dental therapy education and dental hygiene education. All qualifying education programs must be accredited by the Commission on Dental Accreditation and be provided by a post-secondary institution accredited by the New England Association of Schools and Colleges, Inc., or otherwise meet criteria established by the Massachusetts Board of Registration in Dentistry (BORID).
 • A dental therapy education program would be required to employ at least one licensed dentist as an instructor, and include training related to serving patients with targeted dental care needs because of developmental disability, including an autism spectrum disorder, mental illness, cognitive disability, complex medical needs or significant physical disability or because of dental needs specific to aging adults.
 • A dental therapist would be required to practice under the direct supervision of a licensed dentist for at least two years or 2,500 hours—whichever is longer—before being permitted to practice under a general supervision, collaborative management agreement.
 • A dental therapist’s patient panel would have to consist of at least 50% underserved individuals (as defined in the bill) unless the dental therapist operates in a federally qualified health center or look-alike, a community-health center, a nonprofit practice or other public health settings.
 • Dental therapists would be required to apply to participate in the Medicaid program as a condition of licensure.
 • A collaborative management agreement with a licensed dentist would allow a dental therapist to perform an oral evaluation and assessment of dental disease and formulate an individualized treatment plan, and if permitted under the agreement dispense and administer, non-narcotic analgesics, anti-inflammatories and antibiotics.
 • Supervising dentists must be available for consultation and supervision through telemedicine or other means of communication when a dental therapist is operating under general supervision.
 • Dental therapists would be permitted to perform the following “advanced procedures” under direct supervision:

 1.  Preparation and placement of direct restoration in primary and permanent teeth,
 2. Fabrication and placement of single-tooth temporary crowns,
 3. Preparation and placement of preformed crowns on primary teeth,
 4. Indirect and direct pulp capping on permanent teeth,
 5. Indirect pulp capping on primary teeth and
 6. Simple extractions of erupted primary teeth.

BORID is authorized to permit these procedures to be performed under indirect supervision.

New York May Require Parity for Standards of Care for Dental Telehealth
 
The New York State Legislature passed a bill [ [link removed] ] on July 22 that requires dental telehealth services to adhere to the standards of “appropriate patient care required in other dental health care settings.” Under the bill, dental telehealth providers will be required to identify themselves to patients by providing their state license number. Dental telehealth providers are also prohibited from attempting to waive liability for telehealth services in advance of delivering services and from attempting to prevent a patient from filing a complaint with a governmental agency or authority.
 
The bill appears to be aimed at self-applied treatment for orthodontia and has some similarities with legislation passed by California [ [link removed] ] in 2019. According to the bill’s sponsor, the legislation is necessary to protect the public from “unqualified telehealth providers taking advantage of the public and causing harm to patients by failing to adhere to recognized standards of care.”

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 and Advocacy
 
Phillip Mauller, M.P.S.
ADEA Director of State Relations and Advocacy
 
Brian Robinson
ADEA Program Manager for Advocacy and Government Relations
 
[email protected] [ mailto:[email protected]?subject=State%20Update%3A%20 ]

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