Improving the oral health of the public and the professional development of ASDA members

CBS Touts Benefits of Fluoridated Water

reprinted from ADA Morning Huddle:

Currently, more than 72% of the U.S. population has access to fluoridated drinking water, according to a video report from CBS. The Centers for Disease Control and Prevention has called this effort “one of the great public health achievements of the 20th century.”

Proponents of fluoride have argued that including it in drinking water may improve oral health, particularly for children with developmental conditions.

Mary Beth Giacona, D.D.S., a pediatric dentist at Rutgers School of Dental Medicine, revealed that individuals residing in areas without fluoridated drinking water often present with higher rates of cavities compared with areas that do supply fluoridated drinking water to its residents. She emphasized that fluoridating water has been shown to prevent up to 40% of tooth decay.

However, RFK Jr. has falsely claimed that fluoride is linked to arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders and thyroid disease, according to the CBS report. As a result, dentists are once again debating the health benefits of fluoridated drinking water.

Read more: CBS

Obituary: Dr. A.C. Brizzolara, ADA Member for 65 Years

Dr. A.C. (Jerry) Brizzolara, III, of Little Rock, Arkansas, passed away peacefully on December 30, 2024, at the age of 96. Jerry was born on April 29, 1928, in Little Rock to Aristo Cornelius Brizzolara and Agnes Mahoney Brizzolara.

He graduated from Little Rock High School and went on to serve in the United States Army Air Corps in 1948, where he proudly served during the Korean War. After his military service, Jerry pursued his passion for dentistry and graduated from the University of Tennessee Dental School with a Doctor of Dental Surgery (DDS) degree in 1959. He returned to Little Rock, where he practiced dentistry for over 43 years, becoming a trusted and respected figure in the community.

Jerry had a deep love for nature, hunting, and spending time outdoors with his four sons. His spirit of adventure was boundless, and he found joy in every moment of life.

He was preceded in death by his beloved wife of 53 years, Barbara Marie Brizzolara; their son, Paul Benjamin Brizzolara; his second wife of 11 years, Judith Robins-Brizzolara; as well as his sisters, Agnes Aday and Marie Maginn; and his brother, Dr. A.J. (Jack) Brizzolara. He is survived by his sons, Aristo Cornelius (Jay) Brizzolara IV and his wife Carol, and their children Aristo, Elena, Elijah, and Emory, Richard Lee Brizzolara and his wife Charlotte, and their son Ian, and Jeffrey Allen Brizzolara and his wife Kristen, and their children Blake, Whit, and Grace. He is also survived by his sister, Ann Shields of Little Rock; and many nieces and nephews who will miss him dearly.

The Lord blessed us with dad for 96 precious years. He had such a good and joyous spirit about him. Life was always an adventure to him, and if not, he certainly sought it out. Sometimes you just don’t know how good you have it, until you look back and see the Lord’s hand in everything! He took us through some amazing storms as only a strong dad could do. Dad had a wonderful way about him that caused you to love him, and, somehow, he is still doing that even now! He just kept looking forward, and I believe that dad is starting the greatest adventure of his life right now with Jesus! Praise the Lord for blessing us with this wonderful soul, whom we called dad these last 96 years!!!

A drop in memorial visitation in remembrance of Dr. Brizzolara will be held at 54 Longlea Ct., Little Rock, Ark., 72212. on Saturday, January 18th, 2025, from 2-4 p.m. No flowers or gifts are necessary, just come with memories to share.

Dental spending increased by $4B in 2023

A new study released by the American Dental Association’s Health Policy Institute shows dental spending in the U.S. increased by 2.5% between 2022 and 2023. The near-entirety of the year’s $4 billion growth is attributed to $3 billion in increased Medicare spending by seniors enrolled in Medicare Advantage plans and $1 billion in increased Medicaid spending.

While government spending on dentistry has increased substantially, private insurance and out-of-pocket spending has dipped slightly by 0.4% and 0.7%, respectively.

For more information and data, click here.

Open Letter to Legislators Re: Medicaid

TO:     Members of the 95th Arkansas General Assembly
FROM: Terry Fiddler, DDS, Senior Consultant, and Billy Tarpley, Executive Director
DATE: December 19, 2024

Re: Fee Increase Request for Medicaid Dental

The dentists of Arkansas and the Arkansas State Dental Association (ASDA) proudly support the Arkansas Medicaid dental program.  With one of the highest participation rates in the nation, more than 700 Medicaid-enrolled dentists currently treat those patients most in need of dental care across our state.  However, the decision to enroll and re-enroll as Medicaid providers grows increasingly difficult for Arkansas dentists.  Record inflation in costs of materials, lab fees, and most importantly staff time associated with Medicaid coverage are but a few of the issues our dentists face.  Moreover, the reimbursement rate for Medicaid-covered services has not changed since 2007 and inadequately addresses the 70+ percent increase in expenses.

Additionally, the Arkansas Department of Human Services (DHS) recently opted not to continue with the dental managed care organization (MCO) system which facilitated the dental Medicaid system for the last 7 years.  Instead, DHS decided to transition Arkansas dental Medicaid back to a fee for service (FFS) system.  This means that Medicaid-enrolled dental practices will now be directly responsible for keeping track of and filing claims for Medicaid-covered services and seek to be reimbursed directly for those services.  While cutting out the middleman serves to cut costs for DHS, this change requires additional staff time and costs on enrolled dental practices.  As a result, many dentists face the difficult choice of whether to continue as a Medicaid provider. 

A 2022 survey of Arkansas dentists (n=212) currently providing services to Arkansas Medicaid beneficiaries indicated some serious concerns:

  • 90.4% of responding dentists indicated that Arkansas Medicaid does not adequately reimburse them for services provided.
  • 73.6% indicated that if Medicaid rates remain at the current level, they may be forced to stop treating Medicaid beneficiaries in the future.
  • Only 7.6% of dentists indicated that they will still be Medicaid providers within 3 years of 2022 if rates do not increase.

The Medicaid dental providers of Arkansas raised these concerns over 3 years ago, and they only grow larger and more dire today.  As 2025 fast approaches, so too approaches an access-to-care crisis for one of Arkansas’ most vulnerable patient demographics.  Nothing short of prompt and decisive support by DHS will avert this looming cessation in dental Medicaid participation.     

The ASDA has met with DHS on multiple occasions to encourage an increase in the current dental Medicaid reimbursement rate, last set 17 years ago.  An increase for all covered treatments and services may maintain the current level of providers. This effort to engage DHS is in keeping with the 1994 Federal Consent Decree which requires that the state work with providers regularly to ensure that beneficiaries have adequate access to health care.

Many years ago, our rates were adequate, but several neighboring states (LA, MO, MS) have already increased Medicaid rates dramatically, and Arkansas has fallen behind.

By way of this proposal, ASDA demonstrates its long-held objective of advocating for the oral health of our public by advocating for the success and support of our dentists and dental workforce.  The issues facing our dental Medicaid system are many and complex, but we are committed to working together with our fellow stakeholders to find creative and lasting solutions.   

Cc: Governor Sarah Sanders

      Janet Mann, Medicaid Director

      Elizabeth Pittman, Director, DMS

Corporate Transparency Act filing deadline approaches

Dental practices must file beneficial ownership reports by Jan. 1, 2025

Reprinted from ADA Morning Huddle, November 14, 2024

Small businesses that meet certain requirements — including many dental practices — must file beneficial ownership information reports by Jan. 1, 2025 before facing penalties.

Enacted in 2021, the Corporate Transparency Act aims to mitigate money-laundering operations posing as businesses. It requires qualifying businesses to report information to the U.S. Department of the Treasury’s Financial Crimes Enforcement Unit about their ownership. The law went into effect Jan. 1. 

Dental practices must file under the Corporate Transparency Act if they employ fewer than 20 people or if they generate less than $5 million (gross receipts) in revenue annually. 

Existing practices will need to report information on both the practice itself, including the legal name, trade names, current address, jurisdiction and tax ID number; and the beneficial owners, including the name, date of birth, residential address, and a valid ID number of either a driver’s license, passport, or state ID, as well as a copy of the form of identification used. 

But what constitutes a beneficial owner?

According to the statute, a beneficial owner owns or controls at least 25% of the business, or exercises substantial control over the business. “Substantial control” includes senior officers of a business, as well as anyone with significant influence over important decisions.

The ADA, which created a FAQ document to help dentists with questions about the Corporate Transparency Act, recommends consulting legal counsel when making determinations on beneficial ownership. ADA has also worked with many other small business groups to advocate for delays to Corporate Transparency Act reporting requirements, but a bill to delay these filings that nearly unanimously passed the House has not yet been taken up by the Senate.

Failure to file a report can result in civil and criminal penalties. Civil penalties include fines of up to $500 per day until the violation is fixed. Criminal penalties include fines of up to $10,000 and/or imprisonment for up to two years.

For more information or to file a report, visit fincen.gov/boi. FinCEN’s Small Entity Compliance Guide walks small businesses through the requirements.

Former presidential candidate makes claims about future of water fluoridation

Reprinted from ADA Morning Huddle, 11/12/24:

National media, including Time.com, reported recent claims from former presidential candidate Robert. F. Kennedy, Jr. that the new Trump administration intends to remove fluoride from the nation’s water supply. The ADA’s well-known position on the public health benefits of water fluoridation is cited in news coverage, such as that adding fluoride to water is a “safe, beneficial, and cost-effective” public health measure and citing studies that it cuts cavities in children and adults by 25%. Immediate-past ADA President Linda Edgar, D.D.S., was quoted by the Washington Post (subscription needed) and USA Today from a previous ADA statement noting, “Decades of research and practical experience indicate that fluoride is safe and beneficial to oral health.” It remains unclear what role Mr. Kennedy will play in the future Trump administration. According to CNN, in a Nov. 9 story by Reuters, the co-chair of Donald Trump’s transition team stated prior to the presidential election that Mr. Kennedy was “not getting a job for [the Department of Health and Human Services].” For more information on community water fluoridation, visit ADA.org.

New information on Medicaid Fee-For-Service program November rollout

The latest issue of the Healthcare Journal of Arkansas features information on Medicaid’s Fee-For-Service program for dental health providers, which rolls out on November 1. The article, by Elizabeth Pittman, is reprinted in its entirety below with the full issue available at this link.

SINCE 2018, the Arkansas Department of Human Services (DHS) has operated the Medicaid dental program by paying Managed Care of North America (MCNA) and Delta Dental of Arkansas (DDAR) a capitated rate for each beneficiary eligible for dental services. MCNA and DDAR were then responsible for paying for the dental claims for their enrolled beneficiaries. Beginning Nov. 1, the dental program will return to fee-for-service, meaning dental providers will bill Medicaid directly for the eligible dental services they provide. Beneficiaries will use their Medicaid ID to receive services, not their MCNA or DDAR cards.

“After careful consideration of dental service utilization, the total program expenditures, and the work underway to ensure a holistic, efficient, and sustainable Medicaid delivery system for all Arkansans, DHS has determined that fee-for-service for Medicaid dental services is both the best and most cost-effective option at this time,” DHS Secretary Kristi Putnam said. “This change shifts management of the program to the DHS Division of Medical Services (DMS), where we will operate it efficiently and effectively. This transition makes better sense for Arkansas patients, dentists, and taxpayers.”

In a letter sent in late May, DHS formally notified the Centers for Medicare and Medicaid Services of the plan to sunset the program and to switch back to Medicaid fee-for-service for dental services instead. The letter also includes a month-by-month transition plan for activities leading up to the targeted Nov. 1 start date. DHS notified both companies that currently operate the managed care dental program of the plan.

Beneficiaries served by the managed care dental program will continue to be eligible for dental services. In the months leading up to Nov. 1, beneficiaries can expect to continue receiving dental services through DDAR and MCNA and should watch for important communications from DHS about this program.

Beneficiaries who are currently enrolled in fee-for-services will continue to use their Medicaid ID card for all dental services. New beneficiaries or those who regained their eligibility on or after Aug. 15, will use their Medicaid ID card for all dental services. Beginning Nov. 1, all beneficiaries who were enrolled in DDAR or MCNA will use their Medicaid ID card for all dental services.

New beneficiaries who became eligible for Medicaid dental benefits on or after Aug. 15 will be enrolled in fee-for-service. Beneficiaries who recently lost Medicaid or Medicaid dental benefits but regained it on or after Aug. 15 will be enrolled in fee-for-service. All other beneficiaries will transition to fee-for-service Nov. 1.

DHS is fully aware that switching to Medicaid fee-for-service will raise questions from providers. Let’s address some commonly asked questions about the change:

Does Medicaid anticipate an increase in reimbursement rates?

Medicaid reimbursement rates are the same as those paid under DDAR and MCNA. At this time, there will be no rate increase in reimbursement rates. Current reimbursement rates can be viewed by visiting ar.gov/dental. Medicaid continuously evaluates rates for all programs.

What services are covered under Medicaid fee-for-service?

Medicaid’s fee-for-service program covers most of the services DDAR and MCNA cover, but some services are not covered. Current covered services can be found in the dental procedure codes table on the arkansas.gov DMS website under the “Helpful Information for Providers: Procedure Code Tables” section. At this time, there will be no changes in the Medicaid covered services, but Medicaid continuously evaluates covered services for all programs.

What services require a prior authorization (PA) under fee-for-service, and how will providers submit PAs?

Medicaid covered services and those that require a PA can be viewed at ar.gov/dental. Dental providers should continue to submit PAs to MCNA or DDAR for services they intend to provide before Nov. 1. Beginning Oct. 18, dental providers should submit all PAs to Medicaid. More information and training on how providers will submit PAs to Medicaid will be provided in the coming months.

How will providers be supported during this transition?

DHS will provide beneficiary-friendly fliers and posters you can print out for your office. AFMC provider representatives will be visiting dental offices in person before Nov. 1, 2024, to discuss the transition, provide job aids, prior authorization information, and contact information for the Provider Relations team and the MMIS billing team. AFMC will also be able to answer any specific questions providers may have.

Additional information about the man-aged care dental program is available on the DHS website at humanservices.arkansas.gov. If you have other questions, please email them to dentalproviderquestions@ dhs.arkansas.gov.

Elizabeth Pitman is the director of the Division of Medical Services. She graduated with a joint law degree and master’s in public health in 2009. After spending a brief time in private practice, she worked as an attorney for Child Welfare Services and Adult Protective Services with the Department of Human Services (DHS). Since 2013, she has spent her career working in policy development with both the Arkansas Department of Health and DHS. Elizabeth’s passion and goal is to make policy that actually works for Arkansans.

ADA Health Policy Institute releases 2024 study on care, coverage, and cost

Using the latest data from Medical Expenditure Panel Survey (MEPS) and the National Health Interview Survey (NHIS), HPI has just released its annual update on trends in dental care utilization, dental insurance coverage and cost barriers to care among the U.S. population through a series of easy-to-read graphs.

Breakdowns by population age, race/ethnicity, income level and insurance type are included.

Among key findings:

  • Forty-five percent of the U.S. population saw a dentist in 2022. While over half of seniors and children had a dental visit that year, only 40 percent of working-age adults did.
  •  Eight percent of children did not have dental coverage, the lowest level in the last two decades.
  • Dental care continues to pose the highest cost barriers when compared to other health services such as medical, prescription drugs and mental health.
  • Disparities in dental care utilization and cost barriers to dental care have remained largely steady over two decades, especially among working-age adults, seniors, people of lower income groups and certain racial/ethnic groups.

Find the full report here at ada.org.

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Obituary: Dr. James Shelton Ellis, ADA Member for 64 Years

Dr. James S. Ellis, 92, of Fort Smith, Arkansas, went home to be with his Lord and Savior on September 29, 2024, in Knoxville, Tennessee. He practiced oral surgery in Fort Smith for 40 years. 

He earned his Eagle Scout Award at age 13 and graduated from Camden High School in 1949. He then attended Henderson University, obtaining a Bachelor of Science degree in chemistry in 1953. In 1956, he graduated from the University of Tennessee School of Dentistry and completed his oral surgery residency at Louisiana State University in 1964.

While attending Henderson University, he met his wife of 67 years, Janette Bryant. They married in 1953 in Camden, Arkansas and had two daughters, Elizabeth and Ruth.

Dr. Ellis served on the Arkansas State Board of Dental Examiners, followed by twelve years of service on the Southern Regional Testing Agency. He was a member of the Fort Smith Dental Association, treasurer of the Northwest Arkansas Dental Association, American Dental Association, Southwest Society of Oral and Maxillofacial Surgeons, American Society of Oral and Maxillofacial Surgeons, and American Board of Oral and Maxillofacial Surgeons.

Additionally, he served on the Dental Staff of Saint Edwards Mercy Medical Center and Sparks Regional Medical Center. After retiring at age 75, he continued to teach Oral Pathology at the University of Arkansas Fort Smith School of Dental Hygiene until he was 84. 

He was a long-time active member of East Side Baptist Church and a men’s Sunday-school teacher. Although he was an avid runner for over 35 years, he also believed in exercising his mind and had memorized most of the Book of Romans. Active in his community, he supported the Fort Smith Symphony and served as president for two seasons.

He was preceded in death by his wife, Janette Ellis. He is survived by two daughters, Elizabeth Hollis of Tulsa, Okla., and Dr. Ruth Lambert and husband Dr. David Lambert of Loudon, Tenn.; two grandchildren, Brandon Son and wife Colleen of Tulsa, Okla., and Ellis Lambert of Loudon, Tenn.; one great-grandchild, Nicole Son of Tulsa, Okla.; and one brother, William Ellis of Fayetteville, Ark.

A graveside service will be held on Saturday, October 5, 2024, at 2:00 p.m., in the Memorial Park Cemetery in Camden, Arkansas.

Memorial contributions may be made to Gideons International, P.O. Box 97251, Washington, DC 20090 or www.gideons.org.  

Proctor Funeral Home is assisting the family in Camden, AR.