LEAD

WDA intends to be the primary driver or opponent of these proposals
• Proactive: WDA is actively working on this issue
• Reactive: WDA is responding to an activity not initiated by us
• Hold: WDA is monitoring

Dental Therapy—Proactive

  • After years of steadfast opposition to dental therapy legislation, the WDA, in consultation with the Legislative Advocacy Committee, Board of Trustees and Officers, has adopted a new approach for 2021 as the passage of some sort of dental therapy bill appears to be inevitable in Wisconsin. The more productive approach to ensure that whatever bill is passed is palatable to the dental community, and to preserve WDA’s political capital for more pressing priorities such as Medicaid reimbursement and third party payer legislation, is to work with legislators to pass a bill on which the WDA can comfortably register as neutral.
  • WDA has identified four pillars to ensure whatever legislation is ultimately passed contains common-sense patient safety provisions and actually serves to improve public health.
  • In February 2021, state Sen. Mary Felzkowski (R-Irma) circulated Senate Bill 181 for co-sponsoring. The WDA was at the table as this legislation was developed, and believes this is something we can register neutral on. The Senate Committee on Insurance, Licensing and Forestry held a public hearing on SB 181 on March 17, 2021. WDA Government Services Director Chris Borgerding testified, outlining WDA’s neutrality. The Academy of General Dentistry testified opposed. Over 17 groups testified on this provision – 15 in favor, 1 for information only (WDA) and 1 opposed (AGD).

Assignment of Benefits—Proactive
proactively asks for the payment to be made by their dental benefit plan to a non-network dentist who rendered the service, assuming the plan would reimburse the patient for part of the costs of that out-of-network care. This legislation would
make the “assignment” valid only in those circumstances when the patient has made a written request to assign their benefits to the provider.

Insurance plans fought this legislation very hard (as did labor organizations) in the 2009-10 legislative session. It is unlikely this legislation will have a strong chance of passage under a Republican controlled legislature branch. However, given recent actions taken by Delta Dental of Wisconsin, many WDA members have expressed their wish to see us take on this issue more directly. As such, the Board and Legislative Advocacy Committee have moved AOB and AWP to LEAD.

Any Willing Provider—Proactive
The WDA is supportive of an effort to allow patient freedom of choice and to allow any provider who is willing to agree to the terms and payments offered by a plan to enroll in and receive reimbursement from that plan. This is consistent with the WDA ‘‘Patient Freedom within Dental Benefit Plans’’ policy which reads ‘‘The Wisconsin Dental Association supports dental plans that allow patient freedom to seek care from a dentist of their choice, building an individual relationship of mutual trust in an open supply and demand marketplace.’’ See above.

Dentistry Examining Board (DEB)—Proactive
• Mark Paget, Chris Borgerding, and one current WDA officer attend each bi-monthly meeting of the DEB in order to observe the board’s activity and provide comment when necessary.
• Previously, the DEB had eliminated the live patient requirement for licensing exams. Mark Paget at a DEB meeting was told that the Board had indeed initially done that, but revised its decision at a subsequent meeting. The ADA, WDA, ASDA, and ADHA all have policy positions advocating for the elimination of live patients in the examination process and they should revisit the rule. This could be addressed legislatively.

COLLABORATE

WDA will work with other stakeholders in the development of these proposals
• Proactive: WDA is actively working on this issue
• Reactive: WDA is responding to an activity not initiated by us
• Hold: WDA is monitoring

Marquette University School of Dentistry—Proactive
The WDA continues to be willing to play a supportive role for MUSOD priority issues during the legislative session
• WDA continues to play a supportive role for MUSOD priorities. Last session, the school chose to focus on asking for an increase in their contract with the state, which has not seen an increase since 1997, as well as the development of a rural track scholarship program.

Improving Access for Special Needs Patients—Reactive
• A provision of the 2017-19 budget (Act 59) required DHS to increase reimbursement rates by 200% for dental services rendered by facilities that provide at least 90 percent of their dental services to individuals with cognitive and physical disabilities.
• The Governor included funding his 2019-21 budget to fulfil Act 59. Republicans cut this funding in half.
• DHS is unsure how the funds will be distributed, WDA staff has reached out for more information. Regardless, it is hard to imagine WDA members achieving the 90% threshold.

Silent PPO/Network Rental—Proactive
More dentists in Wisconsin and around the country are discovering their contracts with dental benefit companies are being rented to other networks without their consent. The dentist receives no notification that this transaction has taken place, oftentimes discovering the rental for the first time when they get calls from patients saying the dentist is listed as an in-network provider. There is no requirement that the company that has rented the contract abide by the original terms, nor is the dentist guaranteed the ability to opt out of the rental. While Delta Dental does not engage in this practice, many other dental benefit companies do. The WDA believes that requiring notification of rental is a matter of basic fairness for the dentist.
• Because of recent actions by Delta Dental of Wisconsin, this legislation will take a lower priority this session, as we focus on workforce items. However, a number of other states, including Arizona and Virginia, have successfully passed this legislation, sometimes in unanimous fashion.

OBSERVE

WDA will track these proposals and will become involved when appropriate
• Proactive: WDA is actively working on this issue
• Reactive: WDA is responding to an activity not initiated by us
• Hold: WDA is monitoring

Rural Track Program—Proactive
There is a current state loan forgiveness program that is operating in Wisconsin which offers loan repayment of up to $20,000 the first year and $20,000 the second year and $10,000 the third year (a total of $50,000 over three years) for certain dentists who locate in underserved areas and see a set number of Medicaid patients. The WDA was approached by Marquette University School of Dentistry to work collaboratively to create and obtain funding for a «rural track» dental within their dental school curriculum. This would be a situation similar to the grant program mentioned earlier where the student would make a commitment to serve underserved communities upon graduation and would, in exchange have their tuition forgiven as they moved through the four years of their doctoral dental education.
• Senator Patrick Testin and Rep. Tony Kurtz introduced legislation to create this program, which would have given a $75,000 scholarship to up to five D1 students who, for every year of participation in the program, agreed to practice 18 months in a Dental Health Provider Shortage Area. This concept was inserted into the 2019 state budget by Senator Tom Tiffany, but at a reduced rate of $40,000 per student. Governor Evers vetoed this provision in the budget. Standalone legislation had a public hearing in the Assembly and Senate, but failed to pass.
• While the WDA remains supportive of this issue, it is important that MUSOD takes the lead.

Tobacco 21 (AB 422/SB 364)—Reactive
• In July 2019, the American Lung Association approached WDA requesting our participation as a member of the Tobacco Prevention Coalition, which supports incorporating e-cigarettes and vaping into state and local-level clean indoor air ordinances. The Board of Trustees approved joining this coalition via email on July 19th.
• In July 2019, the American Heart Association approached WDA requesting support for legislation that would raise the minimum purchase age for tobacco and vapor products to 21. After extensive discussion, the Board of Trustees voted to support the legislation on August 2nd.
• The bill failed to pass.

Department of Employee Trust Funds (ETF—state employee dental plan)—Reactive
ETF is the department at the state level that designs all employee benefits for 250,000 state workers and their families. ETF reports to an appointed committee called the Group Insurance Board (GIB) which ratifies ETF recommendations. In 2014, the lobby team along with a direct reimbursement third party administrator, met with ETF as they developed a uniform dental plan for the state. ETF accepted some of the plan design recommendations and although some of the staff was interested in direct reimbursement, the primary decision maker, who has since retired, elected to go with a traditional dental plan. That plan has had several permutations since and is now a Delta Dental Plan where no benefits are paid for treatment with non-Delta PPO providers. ETF’s benefits planning process is about a year and a half ahead of any changes being implemented. The only way to influence this process is by requesting a meeting with ETF as their meetings are not otherwise announced.
• The Department regulated the state employee dental plan, for which Delta Dental of Wisconsin is currently the sole provider of both primary and supplemental plans.
• The Group Insurance Board (GIB) under ETF has authority over these plans. WDA regularly monitors the Board and Department’s activity and initiates contact when necessary.
• ETF provided the Group Insurance Board their recommendation to approve the RFP from Delta Dental for the final contract for the next two years as the primary dental coverage for state employees, supplemental plans to purchase by state employees and now new to carry the vision coverage as well.

Governor’s Budget—Reactive
• State law requires that the Governor introduce a biennial budget, and as such this is a recurring item.
• The last budget included a number of significant oral health-related proposals, including additional special needs funding, a potential change in reimbursement formulas based on for or non-profit provider status, and increased funding for Seal-A-Smile. Membership was kept informed of the budget negotiations as well as the final outcome.
• As we look to the next budget, the state will most likely be facing significant financial struggles as a result of COVID-19. It will be imperative that WDA protects the limited state dollars that go towards oral health in Wisconsin.
• In August, WDA President Raimann sent a letter to Governor Evers urging him to spare oral health dollars from cuts.
• As the next budget process begin, WDA staff will monitor and disseminate necessary information to WDA members.

Managed Care—Hold
• A proposal to move the Medicaid dental program to an all-managed care system makes a regular appearance every two years, but generally fails to gain traction. That said, it occurs often enough for us to give the issue a placeholder in the agenda in order to monitor activity and take meetings. This year, Managed Care of North America and DentaQuest both indicated interest, but did not move forward with a proposal. WDA leadership met with DentaQuest on November 11, 2019; further discussions should be had.