Reprinted from ADA What’s Up Wednesday newsletter, June 20, 2024:

The ADA is asking the U.S. Supreme Court to review a decision from a lower appeals court on the Employee Retirement Income Security Act of 1974 that limits states’ traditional authority to regulate health care and insurance, and is at odds with a previous Supreme Court decision on the issue.

Dental plans have often claimed that a federal law called ERISA allows them to avoid complying with state laws impacting dental coverage if the plans are operating as administrators for an employer self-funded plan. In its amicus brief to the Supreme Court, the ADA continues to advocate that most state laws, particularly those that protect patients and dentists from abuse by dental insurers, can be applied to all carriers, including those administering self-funded dental plans for employers.

Read more in ADA News and get more information on ERISA at ADA.org/ERISA.

Reprinted from ADA email, June 5, 2024:

Dear Fellow Leaders:

The American Dental Association has closed on the sale of its headquarters at 211 East Chicago Avenue to Ann and Robert H. Lurie Children’s Hospital of Chicago, our largest tenant in recent years. I’m pleased that the ADA will be passing the torch of 211’s storied history and health care legacy to Lurie Children’s who, like the ADA, is dedicated to the wellbeing of our communities.

The sale represents a convergence of opportunity for the two mission-driven organizations. Lurie Children’s, which was founded in 1882 and moved next door to the ADA in June 2012, aims to move its administrative offices out of the main hospital and expand its clinical capacity. Acquiring 211 East Chicago aligns with the hospital’s mission to provide accessible, high-quality health care to every child who needs it.  

The ADA, as you know, is in a season of transformation. And while we’re financially strong and growing towards better serving our members and professional community, we are also embracing what it means to be a future-forward workplace. With most of our professional team working in a hybrid modality and our science and research operations moving to the ADA Forsyth Institute’s facilities in Massachusetts, we simply do not need as much space as we once did.  

The ADA’s operations will remain at 211 East Chicago Avenue until our early-2025 relocation to 401 North Michigan Avenue. Work begins this summer on a from-scratch renovation to portions of the four floors we’re leasing on this property. We have engaged an architectural firm who will design a hybrid-work-friendly, tech-enhanced environment for our staff and volunteers.

The state-of-the-art offices, tailored to our needs, are an investment in the exceptional work you do to support fellow members and elevate our profession. Less than one mile south of 211, the new property boasts panoramic views of Lake Michigan, the Chicago River, and Michigan Avenue’s skyscape. In addition to convenient access to restaurants and retail, there are ample meeting and conference facilities for volunteers.

More than half a century after the ADA broke ground on what would become 211 East Chicago Avenue, our Association is primed for growth and fresh possibilities once again, and the ADA’s leadership believes our next big move is a step in the right direction for all of our members.  

As we prepare for the next phase in the ADA’s journey, let’s look ahead to the opportunities that await us. The true heart of the ADA lies not in an address, but in all of us — and our belief that the best is yet to come.

We will provide updates as this journey continues. If you have any questions, share them with us at edgarl@ada.org or cohlmiar@ada.org.

Sincerely,

Linda J. Edgar, DDS, M.Ed.
President, ADA

Raymond A. Cohlmia, DDS
Executive Director, ADA

In a move that was not altogether surprising, the Arkansas Department of Human Services (DHS) announced on Monday that it would discontinue the Healthy Smiles Dental Managed Care program and return to the previous Fee for Service system beginning on November 1, 2024.

The managed care system was implemented in 2018 following a report from the Medicaid Task Force that presented a comprehensive view of the state’s $9 Billion Medicaid program, of which dentistry was a small part. After reviewing proposals from four separate companies who bid to become the administrators, DHS settled on two: Delta Dental of Arkansas (Delta Smiles) and Managed Care of North America (MCNA Smiles.) As the first contract came to a close, DHS announced a new request for proposal (RFP) for the second contract. Both Delta Dental and MCNA bid for the contract as did DentaQuest and Liberty Dental, As a result, the DHS Office of Procurement selected all four vendors even though the RFP language stated that the state preferred “two but not more than three” vendors to manage the program. Following a significant level of pushback from a variety of entities, including ASDA, the state made the decision to eliminate the managed care program and return to fee-for-service.

It should be noted that not all details of the FFS system have been decided. It should also be noted that DHS has announced no plans to increase fees for Medicaid dental, which are 16 years old, instead stating that they will take the request under review. The fee increase remains the top priority for ASDA. The association misses no opportunity to state that a 2022 survey of Medicaid dentists revealed that 80 percent indicated they would discontinue participation in 3 years if the fee disparity was not addressed.

DHS released a statement yesterday stating that the agency forwarded a letter to the Centers for Medicare and Medicaid Services (CMS) to notify the federal government of its plan to “sunset the (managed care) program and switch back to Medicaid fee-for-service for dental services instead.”

The leadership of ASDA continues to monitor the situation and will work closely with all parties to make sure that the position of practicing dentists remains a strong consideration.

Download a copy of the DHS Press Release here.

Officials at the Arkansas Department of Human Services have ceased their Arkansas Medicaid Dental Managed Care vendor procurement process and are currently “reviewing options to either rebid the procurement or to move beneficiaries back to Fee for Service,” DHS spokesman Gavin Lesnick tells the Arkansas Democrat-Gazette.

Lesnick cites an impasse in the negotiation process, saying that “during active negotiations with vendors who bid on the Dental Managed Care contract, it became apparent we [would] not reach agreement.”

Current contract holders Delta Dental and MCNA ranked highest in DHS’ proposal scoring, at 774.01 and 766.90, followed by DentaQuest at 759.97 and Liberty Dental at 759.20.

In December 2023, after learning DHS anticipated awarding contracts to all four vendors—not the “two or three” cited in the DHS’ request for proposal—Delta Dental attorney Mark Hodge wrote a letter of protest to DHS Secretary Kristi Putnam, contending Delta is “an aggrieved party due to the impacts of a four-vendor award decision which fails to adhere to the procurement rules set forth in the RFP and the results of the evaluation conducted by the DHS.”

The Office of State Procurement dismissed the protest, citing that the “two or three” language in the RFP was “aspirational” and “more akin to a statement of intent or recitals in a contract rather than a statement prescribing required conduct or action for either the offerors or the DHS”

More from Michael R. Wickline at the Arkansas Democrat-Gazette.

Reprinted from ADA Morning Huddle, April 10, 2024:

A study explored the microbiome of dental plaque in people with varying periodontal statuses. The cross-sectional analysis in periodontal health and disease identified microbial markers associated with different clinical conditions, explored variations in microbial diversity and investigated potential correlations between the oral microbiome and clinical parameters.
Read more

Reprinted from ADA Finance & Operations Huddle, April 8, 2024:

The ADA has an online hub for ready-to-use dental insurance information that can help dentists address and resolve even their most frustrating questions. Some resources cover the basics of dental insurance, including what a PPO plan is and how deductibles and co-insurance work.
Read more

Thanks to our friends from the Dental Lifeline Network, here is a link to the 2023 report for the Donated Dental Services (DDS) activity from Arkansas for July 1 – December 31.

Partial funding for the program is provided by Arkansas Foundation for Medical Care (AFMC), but dentist participation is 100% voluntary. If are already a volunteer, thank you.

For more information about DDS, visit www.dentallifeline.org.