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Advocacy

Dental Exam CIF

The following is a brief description of the Curriculum Integrated Format (CIF) of the dental examination. For more extensive information please download or request the CIF Dental Candidate Manual.

The CIF format of the ADEX Dental Examination consists of five examinations; the Restorative, the Periodontal, the Prosthodontic, the Endodontic and the Diagnostic Skills Exam (DSE) Examinations. The Prosthodontic and Endodontic Examinations are offered at the candidate’s dental school in September or October during the senior year. If either examination is failed it may be retaken in December. The Restorative and Periodontal Examinations are offered at the candidate’s dental school during February or March during the senior year. If either of these examinations is failed or if the candidate failed the retake of the Prosthodontic and/or Endodontic examinations in December, then the failed examination(s) may be retaken one more time in April or May of the senior year. Candidates must take all outstanding parts during the next scheduled examination series. All parts of the examination must be completed successfully within 18 months of the date any part of the examination (clinical or computer-based) was begun or the scores will become invalid and the candidate must apply for and take the full Traditional Exam Format. A score of 75 or more is required to pass each Examination. Application deadline for the CIF Examination is typically at the end of June. Applications received after the application deadline date will not be accepted.

ASDA Policy on Licensure

Unlike most current licensure requirements, ASDA believes that any clinical licensing examination intended to measure technical skill via a sequence of independent clinical tasks should:

  • be a non-patient based examination emphasizing the recognition, diagnosis and treatment planning of disease, in conjunction with the treatment of
  • simulated disease by use of a typodont.
  • be administered in the final year of dental school.
  • provide opportunities for remediation, at the candidates‘ dental school, prior to graduation.
  • guarantee anonymity of candidates and examiners.
  • be administered by examiners who have been calibrated to provide standardized and consistent scoring.
  • not include a written examination that duplicates the content of the National Dental Board Examination Parts I or II.
  • be offered to candidates at the lowest reasonable cost possible.
  • be universally accepted by all state boards of dentistry.
  • be psychometrically sound.

In 2010, the Arizona Legislature, in an attempt to cut costs in the AHCCCS system, eliminated the Adult Emergency Dental Benefit.  This limited benefit provided compensation to AHCCS providers to cover root canal treatment on the 12 anterior teeth, or extractions, both of which were designed to alleviate pain and infection.  We all have heard anecdotal information that hospital emergency rooms have more recently been overrun with patients presenting with dental complaints, where most often they are provided with antibiotics and pain medications without resolving the underlying condition.

AzDA has partnered up with the Arizona Association of community Health Centers, and is collaborating with the Association of Health plans to get to the bottom of the costs associated with this increased utilization.

Preliminarily,  research has concluded that for the top three ICD-9 diagnosis codes for oral conditions, hospital charges have increased by 29% since 2009, an increase of $4,723,442.  These charges only consist of incidents where the patient was seen and released.  In addition, hospital charges for patient admissions due to oral health issues have increased by nearly 40% to a staggering $20.7 million, an increase of over $7 million.  This data does not include physician charges associated with these ER visits and admissions.

This year, AzDA will work hard to reinstate this valuable benefit, and address the wasteful use of health care resources and put the benefit, and the treatment on these individuals, in the hands of dentist.

A Chandler orthodontist was visited by a local revenue official and performed an audit on his use of Invisalign products.  The audit concluded that this dentist would owe over $36,000 in back use tax.  This led to research on how the city would conclude that orthodontic appliances were subject to use tax, and why a use tax was not assessed on typical orthodontic appliances. Without boring you, the research led to a definition of a prosthetic device in Arizona law, and in Department of Revenue regulations that just needs fixing.  As a result, the AzDA are working with the City of Chandler and the Arizona League of City and Towns to change the law to make it clear that orthodontic appliances should be exempt from use tax.

As you know, in 2008, we were successful in getting legislative approval of a regulatory structure at BODEX for Registered Business Entities.  When that law was adopted, one part of the law was adopted that business entities could not interfere with the professional judgment of the licensee performing service for them.  We all know that many of our young dentists are often placed in compromising positions where the business entities’ practice interfere with their professional judgment.

Members have reported some outrageous activities, including business people changing or altering treatment plans.  To protect dentists in this setting, particularly our younger members, we are proposing that the Dental Practice Act should be amended to add a new category of “unethical conduct” to give BODEX the authority to charge a business entity for interfering in the professional judgment of a licensee.

Remove the requirement that a dentist be over 65 in order to get a “Retired” license.

The AzDA will be working with BODEX to support some of their initiatives, especially one that would establish a “statute of Limitations” for complaints that will be tied to the period of time that dentists are required to maintain records, which currently is six years.

We understand that BODEX is also looking to revisit the regulation of mobile dentistry practices, particularly the issue of informed consent.  We are also exploring whether it makes sense to change laws relating to the privacy of school records, to eliminate abuses by some mobile dentistry providers in getting access to the private addresses and phone numbers of parents to solicit their children for treatment.

We invite you thought on any or all of these initiatives, and I thank the members of the Council on Government Affairs for their dedication and input.  This is one of the hardest working of our councils who are always out there looking to protect the profession and watch your back!

Info from aahivm.org:

Summary:
Current Status of Medicaid Expansion in State:
  • State is studying options, likely to expand.
Decision Process:
  • Regular legislative process.
Background:
Currently:
  • As of 2009 data, 1,783,289 people are enrolled and 86% of recipients received Managed Care. AHCCCS contracts with several health plans to provide covered services. An AHCCCS health plan works like a Health Maintenance Organization (HMO). The state’s Medicaid program covers up to 200% FPL depending on the specific program. It is run by Arizona Health Care Cost Containment Services (AHCCCS), Arizona Department of Insurance- Arizona Department of Health Services.
Expansion:
  • The expansion of AHCCCS to 133% FPL would be a 7.7% increase in enrollment from the existing program.
Process:
  • The Arizona Department of Insurance commissioned a study by Mercer to determine the best benchmark plan options and the required EHBs under the ACA. They have sought guidance from the federal government and input from stakeholders and the general public in a variety of forums and are now moving into the regular policymaking process to decide on compliance strategy.
State Activity:
  • Stakeholders and community members provided input before regular policymaking process. The ADOI sought to advise Governor Brewer throughout the legislative process.
  • Governor Brewer also wrote to Director Gary Cohen and Secretary Sebelius to say that Arizona would not accept a plan selected by the federal government that violated the values of the people of Arizona.
  •  Governor Brewer has approved the State Employee Benefit-United Healthcare EPO with pediatric dental and vision coverage supplemented by the Fed-VIP program. ADOI requested a study by Mercer to determine EHB requirements under the ACA, findings are published here-
  • Arizona  has received an 1115 Waiver to expand coverage for individuals not otherwise eligible for Medicaid up to 100% FPL.
  • AHCCCS has held a number of public meetings designed to engage stakeholders in the healthcare and business sectors and the community in general. The public has the opportunity to participate at the presentations, submit comments online, and were able to participate in a survey.

Some info from Medicaid.gov:

Dental Care for Medicaid and CHIP Enrollees

Dental health is an important part of people’s overall health. States are required to provide dental benefits to children covered by Medicaid and the Children’s Health Insurance Program (CHIP), but states choose whether to provide dental benefits for adults. See the 2010 Medicaid/CHIP Oral Health Services fact sheet for information on children’s access to dental services and opportunities and challenges to obtaining care.

Dental Benefits for Children in Medicaid

Medicaid covers dental services for all child enrollees as part of a comprehensive set of benefits, referred to as the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. Though oral screening may be part of a physical exam, it does not substitute for a dental examination performed by a dentist. A referral to a dentist is required for every child in accordance with the periodicity schedule set by a state.

Dental services for children must minimally include:

  • Relief of pain and infections
  • Restoration of teeth
  • Maintenance of dental health

The Early Periodic Screening, Diagnostic and Testing (EPSDT) benefit requires that all services must be provided if determined medically necessary. States determine medical necessity. If a condition requiring treatment is discovered during a screening, the state must provide the necessary services to treat that condition, whether or not such services are included in a state’s Medicaid plan.

Each state is required to develop a dental periodicity schedule in consultation with recognized dental organizations involved in child health care. Dental services may not be limited to emergency services for children entitled to EPSDT.

Dental services must be provided at intervals that meet reasonable standards of dental practice, and at such other intervals, as indicated by medical necessity, to determine the existence of a suspected illness or condition. States must consult with recognized dental organizations involved in child health care to establish those intervals. A referral to a dentist is required for every child in accordance with each State’s periodicity schedule and at other intervals as medically necessary. The periodicity schedule for other EPSDT services may not govern the schedule for dental services.

CHIP Dental Benefits

States that provide CHIP coverage to children through a Medicaid expansion program are required to provide the EPSDT benefit.  Dental coverage in separate CHIP programs is required to include coverage for dental services “necessary to prevent disease and promote oral health, restore oral structures to health and function, and treat emergency conditions.”  For more information see CHIP Dental Care Goals.

States with a separate CHIP program may choose from two options for providing dental coverage: a package of dental benefits that meets the CHIP requirements, or a benchmark dental benefit package. The benchmark dental package must be substantially equal to the (1) the most popular federal employee dental plan for dependents, (2) the most popular plan selected for dependants in the state’s employee dental plan, or (3) dental coverage offered through the most popular commercial insurer in the state.

States are also required to post a listing of all participating Medicaid and CHIP dental providers and benefit packages on www.insurekidsnow.gov.

Dental Health Services for Adults in Medicaid

States have flexibility to determine what dental benefits are provided to adult Medicaid enrollees. While most states provide at least emergency dental services for adults, less than half of the states currently provide comprehensive dental care. There are no minimum requirements for adult dental coverage.

 

For more info please visit:

 

ASDA’s Advocacy Update page

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ASDA’s Advocacy Update page

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ADA’s Advocacy Update page

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 Contact your local representative: