G ove r n men t Re lat ions
PDA’s Legislative Goals
The legislative session, which commenced in January 2017,
allows PDA two years in which to advocate on members’ behalf
for these important insurance reforms, and scope of practice
and access to care initiatives:
• Assignment of benefits
• Health practitioner student loan forgiveness and tangential
loan mitigation issues.
• Increased funding in the Medical Assistance program for
dental providers.
While PDA takes a focused approach in limiting its primary
advocacy efforts to these three issues, we will monitor and
address these issues on an as-needed basis:
• Maintaining funding for the Donated Dental Services
program.
• Prescription drug prescribing authority, abuse and patient
monitoring.
• Protecting the current dental team model and patients’
safety by limiting or restricting the unsupervised practice
of non-dentists.
• All other workforce and scope of practice issues.
• Supporting programs and policies aimed at improving
oral health.
• Representing dentistry’s interests on issues pertaining to
the Affordable Care Act.
• All insurance issues, such as balance billing, coordination
of benefits and credentialing.
Assignment of Benefits
At PDA’s request, Sen. John Eichelberger (R-Blair) and Rep. Stan
Saylor (R-York) reintroduced assignment of benefits legislation
in the Senate and House. SB 373 and HB 823 would require
insurers to honor patients’ request to assign benefits directly to
dentists, regardless of whether or not their dentist participates
with the insurer. Payment from the insurer to the dentist may
not exceed the amount that the insurer would otherwise have
paid without the assignment of payment. Without assignment-
of-benefits, patients are forced to pay for the full amount of the
dental service upfront – which can be quite cost-prohibitive
– or dentists risk performing a service without guarantee of
payment. Assignment of benefits remedies this situation for all
parties and thus improves access to care.
PDA is aggressively lobbying for enactment of assignment of
benefits legislation, having spent much of 2016 and the
beginning of 2017 working with Senate and House leaders and
staff on language that satisfied their concerns about adequate
consumer protection safeguards in place when it comes to the
issue of non-participating dentists accepting the assigned
benefit and balance billing patients. The Senate Banking and
Insurance Committee passed SB 373 in October. We are expecting
the Senate to pass SB 373 before the end of the year and are
hopeful that the House of Representatives will also pass the bill
in early 2018.
Telemedicine/Teledentistry
Sen. Elder Vogel introduced SB 780 to address the emerging
issue of telemedicine and other health care services, including
dentistry. Telemedicine and teledentistry are the remote
delivery of health care services and patients’ health information
using telecommunications technology. Telemedicine and
teledentistry is a significant and rapidly growing component of
health care. Many believe that through the use of telemedicine
and teledentistry, health care providers are able to expand their
reach, helping rural patients stay in their communities and
avoid traveling long distances for specialized care.
SB 780 defines telemedicine, offers guidelines outlining who
can provide telemedicine services, and provides clarity around
insurance company reimbursement for these services. Although
the legislation requires payments for telemedicine services,
those payments will be established between the provider and
insurer. SB 780 was assigned to the Senate Banking and Insurance
Committee in June. PDA reviewed the legislation to ensure
that it aligns with the ADA’s policy on teledentistry and
communicated with Sen.Vogel’s staff in the fall to further refine
the legislation.
Balance Billing
Reps. Tina Pickett and Matt Baker introduced HB 1553,
legislation aimed at protecting patients from surprise balance
bills from medical providers.
Surprise balance billing occurs when a patient receives medical
care from providers and at facilities they believe are in their
health insurance plan’s network, but unknowingly receives
services from an out-of-network provider. Surprise balance
billing can also occur following an emergency, when a consumer
has little or no control over where they are taken to receive care,
and are often taken to an out-of-network emergency room.
The Surprise Balance Bill Protection Act would:
• Ensure that consumers are only responsible for their
in-network cost-sharing obligations.
N OVEM BER/DECEM BER 2017 | P EN N SYLVAN IA DEN TAL JOURNAL
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