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ISDS Continues to Advocate for Dental Insurance Reform During Legislative Session

We are halfway through the legislative session. Legislators will be returning to Springfield, IL this week to finish out the last five scheduled weeks of the legislative session. We wanted to take this opportunity to update our membership on the current status of our legislative initiatives.

Throughout this session, ISDS has actively pursued several pieces of legislation. A key focus of the ISDS legislative agenda has been and will continue to be dental insurance reform through the remainder of the session. 

In addition to dental insurance reform, this year's agenda also includes a dental practice initiative focused on teledentistry and a change to the Medicaid program that will require the adoption of the American Association of Orthodontics standards for automatic qualifiers for patient eligibility.

We want to thank our members who have responded to our action alerts. Legislators want to hear from you and how these issues affect your practice. Your actions are critical to making our legislative session a success. As we continue into the final weeks of the legislative session, your response to action alerts will be even more critical. 

ISDS Legislative Initiatives

Dental Insurance Reform 

ISDS regularly hears from our members about numerous issues they have with dental insurance companies. For our dental insurance initiatives, ISDS has been promoting the "More for Your Smile" Campaign. This initiative has brought dental insurance reform to the forefront. We have released a social media video, a toolkit for members to engage their patients, and media articles. For more information, go to www.moreforyoursmile.com

The 2023 legislative agenda includes the following dental insurance reform measures:

  • Dental Loss Ratio: Medical insurers must spend a minimum of the premium dollars they collect on patient care, called a medical loss ratio. This type of standard does not currently exist for dental care. This allows dental insurers to spend as much or as little as they want on patient care and administrative expenses.

ISDS is seeking the passage of legislation requiring dental insurers to meet a dental loss ratio. This would require dental insurers to spend a minimum of the premium they collect on patient care. Patients should have more of their premium dollars spent on the dental care they need, not the insurer's administrative expenses.

Current Status: This legislation has been met with strong opposition from the insurance industry. We are continuing to push forward on the issue because of its importance to dental patients. 

  • Network Leasing: Insurance companies will sell or lease their network to another company, requiring the dentist to abide by the new network's fee schedules and contract terms. This often happens without the consent of the dentist. ISDS is seeking legislation requiring the insurance company to notify the dentist that the network is being leased out and allow the dentist to opt out of the new network. 

Current Status: This legislation has passed the House and has now moved to the Senate. We are looking forward to advocating for this issue in the Senate. 

  • Electronic Payment Fee Processing Ban: Dental insurers have been utilizing a new payment method that is putting an added burden on dental offices. The insurers pay the dentist with a virtual credit card. When the dentist receives this payment, the insurer will require the dentist to pay the processing fee on the credit card. Thus, forcing the dentist to accept another decrease in their owed amount. ISDS seeks legislation prohibiting the insurer from requiring the dentist to pay the processing fee on any electronic payments, including virtual credit cards.

Current Status: This legislation has passed the House and moved to the Senate. We are looking forward to advocating for this issue in the Senate. 

Teledentistry 

ISDS has been seeking to implement further patient protections for using direct-to-consumer clear aligners, especially as it relates to teledentistry. This legislation aims to require the following items: 

  • A dentist using teledentistry is subject to the same standard of care as if the services were being offered in a clinic or office setting. 
  • Requires that a patient receiving dental services through teledentistry shall be provided with the name, direct telephone number, and physical practice address of the treating dentist who will be involved in teledentistry services. 
  • Clarifies the definition of informed consent. 

Current Status: This legislation has been met with quite a bit of opposition from the clear aligner industry. ISDS, in cooperation with the American Association of Orthodontists, has been advocating for this legislation. The legislation is currently in a Senate committee awaiting a vote so it can be heard by the full Senate. 

We look forward to advocating for this issue in both chambers. 

Medicaid Program- Orthodontic Standards 

The Illinois Department of Healthcare and Family Services (HFS) has no standard or automatic qualifier for when a patient can receive orthodontic care. The lack of a standard has caused administrative obstacles and denial of claims for orthodontic care. The American Association of Orthodontics (AAO) established a committee that developed a comprehensive list of recommended auto-qualifiers and diagnostic documentation for medically necessary orthodontic care. ISDS is seeking the passage of legislation that would codify these standards in state law. This would help clarify the confusion created by existing administrative obstacles.

Current Status: We are working with HFS to further evaluate the standards and try to agree on the standards that need to be clarified for orthodontic care.  

Additional Legislative Measure

In addition to ISDS legislative initiatives, ISDS has been actively opposing the Medicaid Proposed Provider Tax. 

Medicaid Proposed Provider Tax 

The HFS budget proposal for the State's next fiscal year includes a new proposed tax on all dental providers in Illinois. DHFS proposed a "new [dental] assessment" to help provide additional funding for the Medicaid Program. An assessment is a provider tax. An assessment is a tax on all providers, regardless of participation in Medicaid, to generate money for the Medicaid Program. Illinois dentists already pay taxes into the State's general revenue fund to fund these programs. 

HFS administers the Dental Medicaid program in Illinois. The new tax is estimated to generate $10 million in additional funding for dental service reimbursement in the Medicaid program at the expense of all dental providers. 

ISDS is opposed to the proposed provider tax for the following reasons: 

    • Dentists would be the only individual provider taxed under the Medicaid program.
    • Dentists, like other healthcare professionals, have faced increasing costs due to the COVID-19 pandemic, which will only increase the costs of being a dental provider in Illinois.
    • ISDS has worked diligently to increase access to care for patients under the Medicaid program but taxing providers is not the answer to increasing access to care. 
    • Illinois dentists pay their fair share of taxes and should not be taxed twice. 

Current Status: ISDS has actively opposed and will continue to oppose the provider tax. Our efforts include meeting with legislators and sending action alerts on this issue. 

Future Information 
These remaining weeks of session will be very active. Therefore, to stay up to date on our efforts, please sign up for our text alerts by texting "toothparty" to 52886.

As always, ISDS will keep our members informed as we go through these final weeks of the legislative session, and we strive to move these issues forward.

 

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