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May 2010
Here is the latest advocacy news from the Texas Academy of General Dentistry.
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TSBDE Hosts Informal Stakeholder Gathering
Dr. William Purifoy, chair of the State Board of Dental Examiners, convened an informal meeting of several stakeholder groups in Dallas on April 10. In part, the meeting was held in response to concerns raised by TAGD and others over the Board's policy regarding cosmetic surgery and treatment.
TAGD President, Dr. Dan McCauley, Advocacy Council Chairman Dr. David Tillman, and legislative consultant, David Mintz represented TAGD at the meeting. Drs. Maxwell Finn and Tamela Gough, who serve on the Board, and several members of the agency's staff also attended, as well as representatives from the Texas Society of Periodontists and the Texas Dental Association.
The main topic of discussion was a TSBDE policy adopted in April 2009 regarding the use of Botox and derma fillers, such as Restalyne.
Many observers, including TAGD, felt the policy went beyond statutory authority by suggesting that only oral and maxillofacial surgeons could perform procedures using Botox and derma fillers.
There was consensus among the stakeholder meeting participants that the policy should be clarified to allow general dentists, periodontists, and others to use Botox and other derma fillers for functional, dentistry-related purposes such as for TMD therapy. A revised version of the policy was adopted at the TSBDE meeting on April 16. Click here to view the policy in full.
Other topics discussed at the meeting included the unlicensed practice of dentistry. This issue has been a growing concern to TAGD's leadership - particularly in regard to care along the border. The TSBDE board members and staffers at the meeting expressed dismay about the matter but explained that the agency can only issue cease and desist orders which do not have a strong deterrent effect. Any enforcement is up to local law enforcement authorities, which often does not view it as a high priority. It was suggested that one approach to combating the problem may involve an effort by organized dentistry to educate both the public and local authorities about the danger of treatment by unlicensed practitioners.
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State Board of Dental Examiners Meets
Adopts Policy Statements
At the April 16 TSBDE meeting, the Board approved several rules intended to update and clarify agency administration. Several proposed rules were also approved for publication that, if adopted, could help to make the agency's procedural rules clearer and more consistent.
The TAGD Advocacy Council and TSBDE Subcommittee will review the proposed rules to assess their impact and determine whether TAGD should provide comments before they are considered for final adoption. A link to the new and proposed rules will also be provided on TAGD's website once they are available.
In addition, the Board adopted three policy statements dealing with facial cosmetic surgery/treatment, use of lasers by dental hygienists, and an agency ethics policy.
Board policies are intended to be interpretations of existing rules to provide guidance to agency staff in responding to inquiries and to stakeholders regarding the Board's interpretation of the Dental Practice Act and the rules and regulations.
Following up from the stakeholder meeting convened by Dr. Purifoy, the Board revisited its policy dealing with the use of Botox and developed a revised policy on cosmetic procedures, which clarifies that a general dentist may use products such as Botox and Restalyne for dental-related therapeutic purposes.
In part, the policy states, "Based on the language in the statute, the Board has determined that the use of facial cosmetic procedures outside the stomatognathic system is not within the scope of practice for a dentist who does not have the specialty of oral and maxillofacial surgery. The products and procedures included within the heading of 'facial cosmesis' can only be used for the diagnosis and treatment of functional issues of the stomatognathic system as part of a comprehensive treatment."
A footnote to the policy defines the stomatognathic system as "the structures of the mouth and jaws as they relate to speech and the reception, mastication, and deglutition of food. The system is comprised of the teeth, jaws, muscles of mastication, epithelium, and temporomandibular joints and nerves that control the functioning of these structures."
The Board also adopted a policy regarding the use of lasers by dental hygienists.
The statement provides " ...that licensed dental hygienists may use lasers that are not capable of cutting or removing hard tissue, soft tissue, or tooth structure to perform clinical tasks that are otherwise within the hygienist's scope of practice. Dental hygienists must perform intraoral procedures involving a laser under the general supervision of a licensed dentist."
In follow up conversations between TSBDE personnel and TAGD staff, it appears that the policy is not intended to dictate to dentists what types of lasers should be used in their practices, but rather to provide some parameters on how those lasers are used. If, for a example, a dentist wants to allow a dental hygienist to use a laser for diagnostic purposes but that laser is capable of cutting or removing tissue, the laser must be at a setting that will not cut or remove tissue and must be used to perform a procedure within the scope of practice for a dental hygienist.
Finally, the Board adopted an ethics policy for the agency board and staff. Among other topics, the policy clearly prohibits an active board member from serving as an expert witness in a liability suit against a dentist involving the injury or death of a patient unless the Board or its Executive Committee has given permission.
Copies of all three policies and other current policy statements are available on the TSBDE website here.
The Board also denied approval for the Dental Organization for Conscious Sedation (DOCS) course to be used to obtain an enteral conscious sedation permit, but they are approved to provide continuing education in Texas. DOCS is a PACE approved program provider for AGD.
TAGD Executive Director Connie Sonnier, Dr. Tillman and David Mintz attended the meeting on TAGD's behalf. The next meeting of the board is tentatively scheduled for August 20.
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Anesthesia Rules Ad Hoc Taskforce Meets
Work continues by the TSBDE anesthesia taskforce comprised of Board members who are charged with the rewrite of the Dental Board's anesthesia rules to align them with ADA guidelines adopted in 2007.
A major concern for TAGD is ensuring protection of anesthesia portability so that a properly trained dentist may work in different offices. The task force met on April 15 and is expected to meet prior to the Board's next meeting to finalize their recommendations to the full Board. At that point, the rules would be discussed by the full board and, if they receive initial approval for proposal, they would then be published in the Texas Register for public comment before going back to the Board for final adoption.
***Click here to view the adopted TAGD position paper regarding anesthesia portability, the wording slightly differs from the paper released in the last Gatekeeper.
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TDA Hosts Legislative Summit
On March 12, TAGD participated in a legislative summit organized by the TDA to discuss issues that may come up in the 2011 Texas Legislature. There were also participants from the Texas Academy of Pediatric Dentistry, the Texas Society of Periodontists, and the Texas Society of Oral and Maxillofacial Surgeons.
Among the issues considered: concerns about practices by some insurance companies to regulate the fees for uncovered dental services, ways of encouraging more dentists to accept Medicaid; and the possibility of providing dental exams before students enter school.
The group also discussed efforts around the country to increase the use of mid-level providers. The Pew Foundation report, The Cost of Delay, which suggests increasing the use of mid level providers, was released in February. A copy of the report can be accessed here.
Another topic included proposed cuts in Medicaid reimbursement rates. In response to state budget problems, the Governor, Lieutenant Governor and Speaker of the House asked all state agencies to identify ways of cutting five percent from their current budgets. In February, the Texas Health and Human Services Commission proposed cutting Medicaid reimbursement rates by one percent. To date, those proposed cuts have not been implemented.
TDA will hold another Legislative Summit before the legislative session begins.
TAGD was represented at the meeting by Dr. Mark Peppard, Dr. David Tillman and legislative consultant, David Mintz.
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Texas attendees Drs. James and Jennifer Bone, Bryan Moore, David Tillman, Andrew Lazaris, and Michael Goulding along with TAGD staff member Sandy Frizzell meet outside the capitol in Washington DC before legislative visits.
AGD Goes to Washington
The AGD held its annual two-day legislative conference in Washington DC last month.
Attendees participated in advocacy training the first day, and then traveled to the capitol for meetings with their respective Congressmen and Senators offices regarding several issues before the legislature.
Issues discussed included: the Red Flags Rule regulation (HR 3763), the Dental Coverage Value and Transparency Act of 2010 (HR 5000), and repeal of the McCarran-Ferguson Act (HR 4626).
HR 3763 would exempt small business owners, including dentists, from the Federal Trade Commission's (FTC) Red Flags Rule requiring all businesses that accept some form of credit to establish a written identity theft prevention plan. The resolution passed Congress in November and currently awaits action in the Senate.
The Dental Coverage Value and Transparency Act of 2010 (HR 5000), introduced in April by Congressman Robert A. Andrews (D-New Jersey) would, among other provisions, prohibit dental insurance carriers regulated by the federal Employee Retirement Income Security Act (ERISA) from capping fees on non-reimbursed or non-covered dental services. TAGD participants asked their Texas representatives in the House to sponsor the bill and to support it through the process.
Attendees also lobbied for the repeal of the McCarran-Ferguson Act's antitrust exemptions for insurance companies. This was supported in the House version of the healthcare reform bill, but dropped from the Senate version of the bill. In February 2010, the House overwhelmingly passed the Health Insurance Industry Fair Competition Act (HR 4626) which would subject health insurance companies to anti-trust oversight by the FTC and the Department of Justice, but the Senate has yet to consider the legislation.
Members of the Texas delegation in attendance included: Drs. David Tillman and Michael Goulding (Ft Worth), Andrew Lazaris and Bryan Moore (Dallas), Jennifer Bone and James Bone (Kerrville) and TAGD staff, Sandra Frizzell.
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Oral Surgeon Runs for Texas Senate
David Sibley of Waco, who served in the Texas Senate from 1991-2002 is running in a special election on May 8 to return to represent Senate District 22, which covers Bosque, Coryell, Ellis, Falls, Hill, Hood, Johnson, McLennan, Navarro and Somervell Counties. The election was called after Senator Kip Averitt resigned due to health reasons.
Sibley was an oral surgeon before pursuing a career as an attorney, politician and later representing clients before the legislature including the Texas Dental Association. More information about the campaign can be found at www.sibleyforsenate.com. Three other candidates are also in the race.
Representative Tara Rios Ybarra (D-South Padre Island), the only dentist currently serving in the Texas Legislature lost her re-election bid in the March Democratic primary. Dr. Rios Ybarra will serve in office until January 2011.
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TAGD Submits Tax Testimony
TAGD submitted written comments to the House Ways and Means Committee at a March 25 meeting that included a discussion regarding the current sales tax exclusion for cosmetic and elective dental procedures.
Chairman Rene Oliveira (D-Harlingen) noted that the committee is examining the public policy justifications for every sales tax exemption and exclusion. He said that just because the committee was studying this issue didn't mean that it was taking a position in favor or against any particular exemption or exclusion.
The state estimates that a sales tax on medical and dental services would generate about $903.5 million. However, there is not an estimate on how much revenue would be generated by just taxing cosmetic and elective procedures. A representative from the state comptroller's office testified that in states where cosmetic and elective procedures are taxed, efforts are made to distinguish between procedures that are purely cosmetic and ones that may be medically necessary.
Among the objections laid out in TAGD's testimony was a concern that many procedures which are done of therapeutic purposes, may also have a cosmetic component. In addition, it would potentially raise health care costs and create administrative burdens
Testimony was also provided by TDA and the Texas Medical Association.
Chairman Oliviera stated that the committee was only interested in what revenue may be generated on purely cosmetic and elective procedures and he made it clear that the committee will not look at taxes on other medical or dental services.
The committee then moved on to hear testimony about nearly two dozen other exemptions/exclusions before hearing other agenda items. There was no action taken. The committee will be holding additional meetings before developing an interim study report outlining recommendations for the 2011 Legislative session.
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May 8th Special & Local Elections
May 8th is the Special Election to fill the vacated seats of Sen. Kip Averitt (R-Waco), Rep. Terri Hodge (D-Dallas) and Rep. Brian McCall (R-Plano) as well as Local Elections.
To find your local election polls and hours click here for local election contacts.
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TAGD
ADVOCACY FUND
TAGD is getting very close to the goal of raising $50,000 for the TAGD Advocacy Fund by Lone Star Dental Conference.
Thanks to all who have already made pledges. These funds will help TAGD to have the resources necessary to represent the GP at the Capitol and before state agencies.
To see who has contributed so far, click here.
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TAGD Advocacy Council
Dr. David Tillman
Chair
Ft. Worth
Dr. Craig Armstrong Vice-chair
Houston
Dr. Dan McCauley
Mt Pleasant
Dr. Jennifer Bone
Kerrville
Dr. Joey Cazares
McAllen
Dr. Mark Peppard
Austin
Dr. Dave Roberts
Dallas
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