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Volume 1, No. 74, August 11, 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 29 – Joint letter [ [link removed] ] regarding Borrower Relief extension
July 22 – Joint letter [ [link removed] ] regarding CARES Act implementation
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.
 
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] ] .

White House Coronavirus Taskforce to Study Virus Aerosolization
 
Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, announced that the White House Coronavirus Taskforce will study both virus aerosolization and transmission of infection. Particle specialists are urging further study of this issue because, based on their findings, the virus produces droplets larger than five micrometers, which means that the droplets linger longer in the air.
 
Though he would like further scientific proof, Fauci believes that there is “a degree of aerosolization” involved with the spread of the virus. He went on to state that it has become “much clearer” that someone is likely at greater risk of catching the virus if they’re in an indoor space where there’s less air circulation and “any degree of aerosolization.”
 
The aerosolization concerns further support the need to wear masks and has implications for indoor air circulation and air filtration.
 
Watch videos of interviews with the Harvard T.H. Chan School of Public Health [ [link removed] ] and the Journal of the American Medical Association (JAMA) [ [link removed] ] where Dr. Fauci discusses aerosolization.

President Trump Issues Executive Order on Improving Rural Health and Telehealth Access, Congress Also Drafting Legislation
 
President Donald Trump issued an executive order [ [link removed] ] directing the Secretary of the Department of Health and Human Services (HHS) to determine which telehealth flexibilities should stay after the COVID-19 Public Health Emergency (PHE) ends. Since 2010, 130 rural hospitals have closed. Though all Americans benefitted from telehealth access during the pandemic, the 55 million Americans in rural areas particularly benefitted from telehealth.
 
At the start of the COVID-19 PHE, the Trump administration expanded access to telehealth visits for all Medicare beneficiaries as a tool to fight the coronavirus. Initially, this benefit had been only for those in remote areas and the type of visits permissible were limited. Since the rules were changed, HHS has recorded a weekly jump in virtual visits for beneficiaries from approximately 14,000 pre-PHE to almost 1.7 million in the last week of April. Almost half (43.5 %) of all of Medicare fee-for-service, primary care visits in April were provided through telehealth. HHS also found that telehealth visits continued to be frequent even after in-person primary care visits resumed in May.
 
Executive orders do not have the force of permanent law. However, Congress is working on legislation that would make permanent some of the changes that President Trump included in his executive order.
 
The Republicans in the U.S. House of Representatives have released a discussion draft bill [ [link removed] ] focused on further promoting telehealth. Language in the draft would permanently extend some of the temporary waivers to increase access to telehealth services that were included in the first two COVID-19 supplemental funding bills as well as make permanent the Centers for Medicare & Medicaid Services’ (CMS) temporary extension of Medicare telehealth benefit coverage.
 
The discussion draft released by Ways and Means Committee Republicans would permanently extend several of the temporary waivers that:
 • Remove geographic and originating site restrictions to allow Medicare beneficiaries to use telehealth services from home,
 • Allow certain practitioners to provide telehealth care,
 • Allow telehealth services through audio-only telephone when the patient and provider have an established relationship,
 • Allow health savings account-eligible plans to cover telehealth services before meeting the plan’s deductible,
 • Allow the remote authorization of dialysis care through telehealth technologies instead of requiring an in-person visit,
 • Require HHS’s Office of the Inspector General to conduct a survey of telehealth claims to study potential improper payments one year after the end of the PHE,
 • Increase funding to HHS to ensure oversight of the increase in telehealth claims since the start of the pandemic and
 • Require CMS to offer education and training sessions to practitioners on Medicare telehealth requirements and related resources.

Senate Finance Committee Ranking Member Ron Wyden (D-Ore.) introduced S. 4230 The Telehealth Expansion Act of 2020 [ [link removed] ] . This bill would, among other things, also remove the geographic restrictions and expand the available originating sites for telehealth services.
 
Both Republicans and Democrats see value in supporting the continued use of telehealth service delivery.

Missouri Votes on Medicaid Expansion
 
On Aug. 4, Missouri voters approved an expansion of their Medicaid program through an amendment to the state Constitution, making it the second state to pass an expansion during the COVID-19 pandemic. The initiative passed with 53.25% support and will go into effect on July 1, 2021.
 
Missouri now joins 37 other states [ [link removed] ] as well as the District of Colombia in having approved Medicaid expansion. This continues the trend of traditionally conservative states passing Medicaid expansion; Oklahoma having been the most recent to do so on June 30. Expanding Medicaid through a ballot initiative effectively bars elected officials from making major modifications to the plan, an issue that has appeared in other states where voter-approved Medicaid expansion has been explored.
 
The potential impact on MO HealthNet, Missouri’s Medicaid program, could be significant. In 2019, researchers at Washington University in St. Louis estimated that as many as 230,000 Missouri residents would enroll in Medicaid if it were expanded. As of 2018, 9.3% of Missouri’s population was uninsured. Opponents of the measure were concerned that an increase in eligibility could result in additional financial burden for the state budget, particularly during the economic uncertainty surrounding the pandemic. In fact, between February and May, Missouri saw an increase of 9% [ [link removed] ] in Medicaid enrollment.

Utah Closing Clinics Due to Pandemic-related Budget Cuts
 
In response to the economic uncertainty surrounding the COVID-19 pandemic, state lawmakers in Utah are moving to close certain health and dental clinics [ [link removed] ] to save money in the state budget. The three health and three dental clinics in question were created more than 30 years ago as a means to provide health care to underserved populations and uninsured Utah residents. The clinics [ [link removed] ] provide a number of medical and dental services, including the clinic located in Salt Lake City, which is one of two locations that provides health screenings to refugees who are seeking resettlement in the state.
 
There has been a growing concern by lawmakers in recent months about how to balance the costs of health care with the increased financial burdens associated with the pandemic. While it has been suggested that physicians, dentists and medical professionals could be willing to offer services pro-bono, many providers in Utah already cap the number of Medicaid patients they see for economic reasons. With the clinics slated to close, there is now additional uncertainty about providing medical services to populations who could be more at risk due to the pandemic.
 
The first two clinics in Ogden and Provo will close on Aug. 15, with Ogden’s dental clinic closing at the end of August. The clinics in Salt Lake City are expected to close by Oct. 31.

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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