Current Actions

PDA Action Alert: HB 1664 Virtual Credit Cards

Tue, 26 Mar 2024 04:00:00 GMT

Pennsylvania's Legislature Passes PDA's Virtual Credit Card Bill!

HB 1664, PDA's bill requiring transparency, payment options, and choice for dentists passed the General Assembly and is now on its way to Governor Josh Shapiro for his signature!

HB 1664:

Does not prohibit insurers from using virtual credit card payments altogether. It simply states that virtual credit cards cannot be the only option.
Requires that insurers provide notice to participating dentists of all payment options, as well as instructions and contact information for dentists to obtain the exact fees imposed by the insurer or its contracted vendor(s).
Gives participating dentists the ability to opt into the payment option that works best for their dental practice.

It took a lot of hard work, and robust support from our grassroots members, to pass HB 1664!

Check out our infographic to see how HB 1664 wound its way through the legislative process!

PDA Action Alert- Medical Loss Ratio

Fri, 07 Jun 2024 04:00:00 GMT

Dental Insurance Reform: Medical Loss Ratio

PDA Legislative Action Alert

PDA finds sponsor to introduce another Dental Insurance Reform bill! Rep. Kyle Mullins introduced legislation that would require dental insurers to report how much they spend on administrative and patient care costs (commonly referred to as Medical Loss Ratio). A law establishing a reporting requirement on an MLR for dentistry—the percentage of revenue from premiums spent on patient care—would enhance transparency for patients seeking oral health care and make dental insurers more accountable.

We need your help! Call or email your Representative this week and ask that he/she co-sponsor Rep. Mullin’s Transparency of Patient Premiums Invested in Dental Care Act, HB 1457, which simply requires dental insurers to report annually their medical loss ratio (MLR) for dentistry to the Pennsylvania Insurance Department.

How to contact your legislators: Enter your home address at https://www.legis.state.pa.us/cfdocs/legis/home/findyourlegislator/ for your Representative’s contact information. Or contact PDA's government relations team at (800) 223-0016 or djw@padental.org, and we'll provide you with the information you need.

What we’re asking for: Ask your Representative to support legislation that establishes an MLR reporting requirement for dental insurers operating in Pennsylvania. Request that he or she sign on as a co-sponsor to Rep. Mullin’s bill.

Thank you for being an advocate for your profession and patients!

Medical Loss Ratio Transparency Talking points

It is estimated that 40 percent or more of patients’ unspent premiums is used to cover administrative costs rather than the actual cost of care. Patients would benefit from knowing how much of their dental plan premium is invested in dental services rather than administrative costs. It’s time for dental insurers to be more transparent to the people they serve.
Filing an MLR report is already a requirement under the Affordable Care Act for insurers offering medical health plans. A law establishing a reporting requirement on an MLR for dentistry—the percentage of revenue from premiums spent on patient care—would enhance transparency for patients seeking oral health care and make dental insurers more accountable. It is important for the Commonwealth to have a mechanism to obtain this information from dental insurers and make it accessible to the public.
Four other states have laws that require MLR transparency through a reporting requirement: Maine, Arizona, California, and Washington. Several other states have introduced bills this year.

PDA Action Alert - Medicaid Program

Fri, 07 Jun 2024 04:00:00 GMT

Attention PDA Members:

Join the fight to improve Pennsylvania’s Medicaid program!

The need to improve the dental Medicaid program in Pennsylvania has recently been in the news and on the minds of state lawmakers. Many are expressing concern about the inadequate funding to provide comprehensive services to adults, and there is a growing consensus that Medicaid dentists are not reimbursed enough.

NOW is the time to communicate with your Representative and Senator about the need for more funding to restore Medicaid dental benefits and to raise fees to help recruit and retain dentists as Medicaid providers. State lawmakers are in session until the end of June to negotiate and vote on the fiscal year 2023/24 budget.

It’s especially important for legislators to hear from those of you who are Medicaid providers! Please share your personal experience and any difficulties you have faced with caring for your patients.

Call, email, or schedule a visit with your legislators between now and June 16^th and request their support for more funding in the state Medicaid program to a) raise fees for services already covered by Medicaid, and b) restore comprehensive coverage for adults.

How to contact your legislators: Enter your home address at https://www.legis.state.pa.us/cfdocs/legis/home/findyourlegislator/ to find their contact information. Or contact PDA's government relations team at (800) 223-0016 or djw@padental.org, and we'll provide you with the information you need.

What we’re asking for: That the legislature provide enough funding in the dental Medicaid program to increase fees at least 20 percent, and to allocate an additional $76 million (with a $100 federal match) to restore the adult services that were cut in 2011.

Need a few talking points to help guide your discussion?

A 2020 study from the ADA’s Health Policy Institute found that reimbursement for children’s dental services is 58.5 percent of commercial insurance. Reimbursement for adult dental services is 56.1 percent of commercial insurance. Dentists’ fees, which reflect the true cost of doing business, are already reduced by commercial insurers.
Dentists are usually small business owners with significant overhead costs, and they often do not “break even” when treating Medicaid patients. Accepting such low Medicaid rates is not financially feasible, resulting in many choosing not to enroll or dropping out of the system altogether. The state must find a way to fairly reimburse dentists in individual or small group practices so that they can stay financially solvent and so that federally qualified health centers and other clinics do not become overburdened.
In 2011, cuts were made to the adult Medicaid program so that it no longer includes coverage for periodontal and endodontic services, crowns and caps. It also limits dentures to one per lifetime. A restoration of adult services will:
- Reduce out-of-pocket expenses for the poor. A study from CareQuest found that 93 percent of individuals living in poverty have unmet dental needs. Those who do seek care spend 10 times more of their annual family income compared to other families.
- Improve job prospects for adults who suffer from missing or unsightly teeth.
- Reduce costly emergency room visits. Pennsylvania is spending $35 million annually for non-traumatic dental care provided in ERs.
- Save money in the health care system when periodontal services are provided to patients with chronic conditions like diabetes.

Thank you for being an advocate for your profession and patients!

PDA Action Alert- More Co-Sponsors Needed!

Fri, 07 Jun 2024 04:00:00 GMT

Dental Insurance Reform Issue: Credentialing

PDA Legislative Action Alert

Attention PDA Members!

Sen. Ryan Aument is introducing legislation to improve the credentialing process for health care practitioners. This legislation, similar to what was introduced in the House, will:

Require use of the CAQH system for credentialing.
Limit the credentialing period to no more than 60 days complete applications.
Streamline the application process for practitioners with multiple locations.

We need more co-sponsors on this bill. Please contact your Senator TODAY and request that he/she sign on as a co-sponsor to Sen. Aument's Health Care Practitioner Credentialing legislation (Bill # TBA). Our goal is to build bipartisan support, so it passes the House and Senate.

Enter your home address here: https://www.legis.state.pa.us/cfdocs/legis/home/findyourlegislator/ for your Senator's contact information. Or contact PDA's government relations team at (800) 223-0016 or djw@padental.org, and we'll provide you with the information you need to call or email your Senator.

Talk about your own experience with credentialing and use the talking points below:

Standardizing the credentialing process will free up health care practitioners' time and allow them to focus on patient care.
Current credentialing processes can take up to six months or more, which not only costs health care practitioners and facilities money they need to operate, but also hinders access to care by sidelining providers until they have been credentialed by insurers.
Unwarranted delays in credentialing harms both recent graduates who are applying for associate positions in practice, and new practitioners in residency programs, the practitioners we need to most attract to the Commonwealth.

Let us know how it goes…contact PDA’s government relations team after you connect with your Senator or his/her staff. We need to know if your Senator is supportive of credentialing reforms and agreed to sign on as a co-sponsor. Thank you for helping to advance PDA advocacy goals!

PDA Action Alert - Credentialing for Healthcare Providers

Fri, 07 Jun 2024 04:00:00 GMT

Dental Insurance Reform Issue: Credentialing

PDA Legislative Action Alert

Attention PDA Members!

PDA is hard at work lobbying for our Dental Insurance Reform (DIR) agenda. At our request, Rep. Steven Mentzer has introduced HB 1510, legislation that will improve the credentialing process for practitioners in Pennsylvania. The Health Care Practitioner Credentialing Act will:

Require use of the CAQH system for credentialing.
Limit the credentialing period to 45 days for complete applications.
Streamline the process for health practitioners practicing in multiple locations.

Please contact your Representative today and request that he/she sign on as a co-sponsor to Representative Mentzer's Health Care Practitioner Credentialing legislation, HB 1510. Our goal is to build bipartisan support, so it passes the House and Senate.

Enter your home address here: https://www.legis.state.pa.us/cfdocs/legis/home/findyourlegislator/ for your Representative's contact information. Or contact PDA's government relations team at (800) 223- 0016 or djw@padental.org, and we'll provide you with the information you need to call or email your Representative.

Talk about your own experience with credentialing and use the talking points below:

Standardizing the credentialing process will free up health care practitioners' time and allow them to focus on patient care.
Current credentialing processes can take up to six months or more, which not only costs health care practitioners and facilities money they need to operate, but also hinders access to care by sidelining providers until they have been credentialed by insurers.
Unwarranted delays in credentialing harms both recent graduates who are applying for associate positions in practice, and new practitioners in residency programs, the practitioners we need to most attract to the Commonwealth.

Let us know how it goes…contact PDA’s government relations team after you connect with your Representative or his/her staff. We need to know if your Representative is supportive of credentialing reforms or if we should follow-up with more information.

Thank you for helping to advance PDA advocacy goals!