News

Center for Medicare and Medicaid Services Letter

TAPD is committing to ensuring every Texas child has a change at optimal oral health. That is why we recently signed on to the following letter to the Center for Medicare and Medicaid Services (CMS) to highlight concerns for its recent guidance allowing states to apply for a waiver to set caps in their Medicaid programs.

Dear Administrator Verma:

As leading national, state, and local organizations, representing health care consumers and patients, providers, and other stakeholders, we are writing in strong opposition to recent guidance from CMS, Healthy Adult Opportunity, which allows states to fundamentally change the nature of their Medicaid programs. We urge the Administration to rescind this guidance, which could hurt millions of families that rely on Medicaid.

Medicaid is an essential source of coverage for over 70 million people. Medicaid’s current state-federal partnership helps states provide quality health insurance to their residents –it ensures that children are able to get a healthy start in life, provides long-term care to seniors and people with disabilities, and vital health care for many adults including pregnant women. The current state-federal funding structure provides states and taxpayers a level of financial security, ensuring that as Medicaid spending fluctuates from year to year, the state and its taxpayers are not made solely responsible for covering any increased costs. Efforts to restructure or cut Medicaid would shift health care costs to the states, hurt local economies, and threaten care and coverage for millions.

The Administration’s long-anticipated State Medicaid Director Letter, which was published on January 30, encourages states to adopt caps on their federal Medicaid funds voluntarily under a Medicaid section 1115 demonstration waiver. This arrangement involves major fiscal risk for states; the “flexibility” states will have is to cut services or take away coverage if and when they hit their new federal funding cap. Capping and restructuring Medicaid would create an awful choice for states in the event of increasing health care costs. Once that happens, the state will start rolling back coverage for kids, people with disabilities, and seniors and cost-effective optional benefits like dental care, without oversight.

Further, the Administration does not have jurisdiction to waive Medicaid’s financing structure through the 1115 waiver process. Such a fundamental change to Medicaid’s structure requires a change in statute and therefore an act of Congress. In 2017, when Congress considered federal funding caps, millions of people from around the country raised their voices in opposition, and lawmakers rejected the proposal on a bipartisan basis.

We urge the Administration to rescind this guidance that promises flexibility, but will surely lead to catastrophic implications for state budgets, and state Medicaid programs and the communities they serve. We implore you to reconsider this proposal, and protect the children, seniors, people with disabilities, women, parents, people of color, and working families that rely on Medicaid for health care.

Urge Congress to Support the Ensuring Lasting Smiles Act

The Texas Academy of Pediatric Dentistry, along with the American Academy of Pediatric Dentistry and a number of other organizations, supports the Ensuring Lasting Smiles Act (ELSA), which would ensure all group and individual health plans cover medically necessary services, including needed dental procedures such as orthodontic or prosthodontic support, as a result of a congenital anomaly. But we need your help to urge Congress to ensure it passes.

According to the Centers for Disease Control and Prevention, one in 33 newborns in the U.S. suffers from a congenital abnormality, and severe dental anomalies are a common symptom of many craniofacial conditions. Most private health plans cover surgical treatment for these conditions, and their coverage is a requirement in many states. However, claims for oral or dental-related procedures, including orthodontia and dental implants, are often deemed cosmetic and denied. Patients often face significant out of pocket expenses as a result.

ELSA would alleviate this financial burden, ensuring access to necessary diagnosis and treatment for those with congenital craniofacial abnormalities.

With more than 260 bipartian cosponsors, ELSA is a much-needed solution for American patients. Please urge your representatives in Congress and the U.S. Senate to support the bill and sign on as coauthors if they haven’t already.

AAPD will advocate for ELSA during its Congressional visits on March 3-4 as part of our Pediatric Oral Health Advocacy Conference. Help amplify their efforts to get ELSA passed by contacting Congress today.

To find contact information for your representatives, please visit
https://wrm.capitol.texas.gov/home.

For more information about ELSA, please visit https://www.nfed.org/get-
involved/advocate/ensuring-lasting-smiles-act/
.

Coronal Polishing & Pit & Fissure Sealant Requirements

The below information is guidance we received from the Texas State Board of Dental Examiners (TSBDE) regarding coronal polishing and pit and fissure sealant requirements. Please reach out to us at email@tapd.org with any questions.

The TSBDE no longer issues certificates for applying pit and fissure sealants and performing coronal polishing. 22 Tex. Admin. Code §114.3(d) and §114.5(b) do still require that a dental assistant have the required education/qualifications to perform either service.

Because TSBDE no longer requires dental assistants to submit their certification, it is up to the dental assistant and the supervising dentist to ensure that the dental assistant meets the requirements under the rule before dental procedures may be delegated. If not, the dentist and the dental assistant may be subject to disciplinary action.

Pit and Fissure Sealants
Pursuant to 22 Tex. Admin. Code §114.3(d), a Texas-licensed dentist may delegate the application of pit and fissure sealants to a dental assistant if the dental assist has:

1) at least two years of experience as a dental assistant;

2) successfully completed a current course in basic life support; and

3) completed a minimum of 8 hours of education that includes clinical and didactic education in pit and fissure sealants taken through a CODA-accredited dental, dental hygiene, or dental assistant program approved by the Board whose course of instruction includes:
a. infection control;
b. cardiopulmonary resuscitation;
c. treatment of medical emergencies;
d. microbiology;
e. chemistry;
f. dental anatomy;
g. ethics related to pit and fissure sealants;
h. jurisprudence related to pit and fissure sealants; and
i. the correct application of sealants, including the actual clinical application of sealants.

Pursuant to 22 Tex. Admin. Code §114.3(f)(f), the dental assistant must comply with the Dental Practice Act and Board Rules in the application of pit and fissure sealants. Pursuant to §258.003 of the Dental Practice Act, the delegating dentist is responsible for all dental acts delegated to a dental assistant, including application of pit and fissure sealant.

Coronal Polishing
Pursuant 22 Tex. Admin. Code §114.5(b), a Texas-licensed dentist may delegate coronal polishing to a dental assistant if the dental assistant:

1) works under the direct supervision of the licensed dentist; and has

2) at least two years experience as a dental assistant; and either

a. completed a minimum of eight (8) hours of clinical and didactic education in coronal polishing taken through a dental school, dental hygiene school, or dental assisting program accredited by the Commission on Dental Accreditation of the American Dental Association and approved by the Board. The education must include courses on:
i. oral anatomy and tooth morphology relating to retention of plaque and stain;
ii. indications, contraindications, and complications of coronal polishing;
iii. principles of coronal polishing, including armamentarium, operator and patient positioning, technique, and polishing agents;
iv. infection control procedures;
v. polishing coronal surfaces of teeth; and
vi. jurisprudence relating to coronal polishing; or

b. has either:
i. graduated from a dental assisting program accredited by the Commission on Dental Accreditation of the American Dental Association and approved by the board that includes specific didactic course work and clinical training in coronal polishing; or
ii. received certification of completion of requirements specified by the Dental Assisting National Board and approved by the Board.

Pursuant to 22 Tex. Admin. Code §114.5(e)(e), the dental assistant must comply with the Dental Practice Act and Board Rules in the act of coronal polishing. Pursuant to §258.003 of the Dental Practice Act, the delegating dentist is responsible for all dental acts delegated to a dental assistant, including coronal polishing.

Dr. James at AAPD Media Training

Dr. Laji James (Houston) was selected to attend the American Academy of Pediatric Dentistry Media Training Course in Chicago, Illinois.