Laws and regulations in dentistry and oral healthcare are in place to protect both patients and providers. As new technologies and business models gain popularity, the community must ask whether its current ethical guardrails are sufficient. When the answer is no, lobbyists and activists spring into action to promote codifying new measures.
This week, Dentistry 411 will familiarize readers with recent legal proposals dentists need to know about to protect dental practices and their operations.
Improving Dental Administration Act
Federal
The ADA-approved act was introduced on March 12 by two New Jersey representatives, one of whom holds a DMD. The act seeks to close loopholes in the Employee Retirement Income Security Act (ERISA) of 1974, offering less oversight to dental insurance carriers.
ERISA regulates self-funded dental plans with pay-as-you-go structures, designed to save employers money. The issue with ERISA came to leaders’ attention when dental carriers argued that federal guidance was incompatible with certain state laws intended to protect patients. The Improving Dental Administration Act will remedy this and redirect power back to the state level.
“We need to fix this ERISA loophole that keeps state regulators from enforcing pro-consumer insurance laws enacted in their states,” said Rich Rosato, DMD, president of the American Dental Association, in a press release. “Patients and providers should not be left unprotected based simply on how their dental benefits are purchased.”
Independent Dental Practice Act
Federal
This act, proposed by the advocacy organization American Economic Liberties Project, aims to place stronger restrictions on dental practice ownership. Nearly all states ban non-dentists from owning practices. However, a new business model, dental service/support organizations (DSOs), invented a way to circumvent these rules.
DSOs are comprised of a dental practice and financial investors. According to the economic project, a “friendly dentist” serves as the nominal owner, and the financial group leads administrative and managerial functions. American Economic Liberties says this is causing dental care to prioritize profit over quality. The combination of private equity has led to a decrease in dentist-practice owners and an increase in dentist-DSO affiliations. You can find more information on the state of private equity in the dental industry here.
Promoting Dental Health Act
Federal
Senator Dick Durbin (D-Ill.) introduced this act to reauthorize funds to the Centers for Disease Control and Prevention’s Oral Health Program, which has not been reauthorized since 2018. The program currently serves only 15 states, and some, like Illinois, haven’t received a grant in two decades.
Durbin said this act will help states improve access to comprehensive health care in rural communities and address the national shortage of dental professionals.
“Dental care … is a fundamental part of staying healthy,” Durbin said in a press release about the proposal. “It’s critical that oral health care is easily accessible to Americans, regardless of where they live or their income.”
The act will also fill gaps left by the elimination of the CDC’s Division of Oral Health and is endorsed by the ADA and several other notable dental organizations.
SB 6138: Mult-Provider Sedation Act
State, WA
Dentists in Washington state may need to prepare to have more staff available for deep sedation procedures. The proposal, authored by state Sen. Jeff Holy, requires that practices have two providers monitoring a deep-sedation procedure. One provider performs the dental work, the other monitors the anesthesia. The author said he believes the change could reduce sedation-related deaths in the dental industry.
If passed, the law would be singular in its restrictions. In California, pediatric minimal sedation requires an operating dentist and another professional trained in monitoring and pediatric resuscitation. Although the ADA recommends two professionals at all levels of sedation, it does not call for a separate anesthesiologist. Some critics argue that the requirements are unnecessary and difficult for practices to meet, making care less accessible for patients.
