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Partnering with you to help create healthy smiles

Your dental policy brief: News updates as of December 6

From the latest on election fallout to recent court rulings, FYI brings you the biggest dental policy stories.

Dentists win re-election in November 9 election

The predicted “red wave” may have fizzled out, but dentists nonetheless had a fantastic night on November 9. The dentists looking to keep their seats in the U.S. House of Representatives were reelected and will serve two-year terms in office:

  • Rep. Dr. Brian Rabin (R-TX)
  • Rep. Dr. Mike Simpson (R-ID)
  • Rep. Dr. Drew Ferguson IV (R-GA)
  • Rep. Jeff Van Drew (R-NJ)
  • Rep. Dr. Paul Gosar (R-AZ)

California voters back flavored tobacco ban

On November 9, California voters backed a ban on flavored tobacco, including vaping products. The ban was supported by voters 63.4% to 36.6%, according to the New York Times. A group of tobacco companies has since asked the Supreme Court to issue an injunction, stating that they will “suffer irreparable harm because they will be unable to sell their products in one of the nation’s largest markets.” The ban is otherwise slated to go into effect on December 22.

Oregon voters make affordable health care a constitutional right

In the November 9 election, Oregon voters narrowly passed Measure 111, which decrees health care a human right. The measure makes Oregon the first state in the U.S. to change its constitution to explicitly declare affordable health care a right, opening the door for individuals who don’t have access to affordable care to sue the state. 

The measure does not define or specify the “cost-effective, clinically appropriate and affordable” coverage it mandates for every resident, nor does it say how the coverage will be funded or provided. It’s also unclear what the impact, if any, on dental care in Oregon will be. Opponents have argued the amendment is vague and that it could trigger legal and political challenges, while supporters say it’s an important step that will test a strategy that health care advocates could try in other states.

Pennsylvania court rules insurance coverage owed to dentist after COVID shutdown

On November 30, a Pennsylvania appellate court ruled that a dental practice was entitled to coverage for income lost because of the state’s COVID-19 shutdown. The court determined in a 5-4 ruling that dentist Timothy A. Ungarean’s property and casualty insurance policy covered the cost of a COVID business interruption. 

Ungarean, who owns the Smile Savers Dentistry clinics in Pittsburgh and Aliquippa, filed his claim with CNA’s Valley Forge Insurance Company after Pennsylvania’s governor ordered the closure of all non-essential businesses in March 2020. State public health directives permitted Ungarean to perform only emergency procedures, causing a loss of income. 

The majority of federal courts that have heard similar COVID business-interruption cases have rejected coverage. However, the decision in Pennsylvania, the first of its kind in the state, mirrors the findings of the Vermont Supreme Court and a Louisiana appellate court, which similarly decided that the virus itself and related government orders did cause a covered loss. With his win, Ungarean becomes part of a very small pool of COVID claimants with winning cases.  

CMS expands Medicare to cover medically necessary conditions requiring dental services, establishes new payment code for hospital dental surgeries

The Centers for Medicare & Medicaid Services (CMS) has announced it will now cover dental services for Medicare Part A & Part B beneficiaries under certain conditions deemed medically necessary. The expanded dental coverage will go into effect January 1. Medicare will now provide dental coverage for the following instances:

  • Reconstruction of a ridge when performed as a result of and at the same time as the surgical removal of a tumor.
  • Stabilization or immobilization of teeth when done in connection with the reduction of a jaw fracture.
  • Extraction of teeth to prepare the jaw for radiation treatment of neoplastic disease.
  • Dental splints only when used in conjunction with medically necessary treatment of a medical condition.
  • Dental services — including both examination and treatment — prior to cardiac valve replacement, valvuloplasty or organ transplant procedures.

The final rule stated that Medicare payment would be provided if these procedures were done on an outpatient or an inpatient basis. Coverage would also be provided for ancillary services such as x-rays, anesthesia or the use of an operating room for medically necessary procedures that fall under the rule.

CMS has also established a new dental billing and payment arrangement for dental surgeries performed in hospital operating rooms. Health Care Common Procedure Coding System code G0330 is applicable to facility services for dental rehabilitation procedures furnished to patients who require monitored anesthesia and use of an operating room. 

CDC urges dental offices to review infection control practices after investigation

In a recent health alert concerning infections tied to contaminated dental waterlines, the Centers for Disease Control and Prevention (CDC) urged dental teams to review and maintain their infection control practices. In the alert, the CDC reported it’s investigating a March 2022 cluster of suspected nontuberculous Mycobacteria infections in children at an undisclosed location. 

The CDC’s advisory said the outbreaks highlight the importance of offices maintaining and monitoring waterlines. While infections are rare, dental waterlines are susceptible to developing biofilms due to the “long, small-diameter tubing and low flow rates used in dentistry and the frequent periods of stagnation,” according to the alert. 

The American Dental Association (ADA) provides guidelines for infection control and prevention, including information on dental unit waterlines.

CDC updates guideline for opioid prescriptions

The CDC has released a new clinical guideline for prescribing opioids for pain. The guideline, which updates and expands the CDC’s clinical guideline from 2016, is intended to improve communication between clinicians and patients about the benefits and risks of pain treatments and to reduce risks associated with opioid pain therapy, including opioid abuse, overdose and death. 

“The science on pain care has advanced over the past six years,” said Debbie Dowell, MD, MPH, chief clinical research officer for CDC’s Division of Overdose Prevention. “During this time, CDC has learned more from people living with pain, their caregivers and their clinicians. We’ve been able to improve and expand our recommendations by incorporating new data with a better understanding of people’s lived experiences and the challenges they face when managing pain and pain care.”

Half of dentists report patients come to appointments high

A recent survey from the ADA showed 52% of dentists say they’ve had a patient attend an appointment while high. The findings were uncovered in two online surveys earlier this year, one of 557 dentists and a second nationally representative survey of 1,006 consumers. Because marijuana can interact with anesthesia, dentists may have to adjust their care during the appointment for patients who use the drug, and studies have also shown regular marijuana users are more likely to have significantly more cavities than non-users.