2024 Legislative Session

The Affordable Care Act (ACA) established that major medical plans pay certain percentages of the collected premiums for medical care vs. administrative costs. No such requirement exists for dental plans, which are considered “excepted benefits.”

MDA, utilizing the model language approved by the ADA and National Council of Insurance Legislators (NCOIL), will work to require a “Dental” Loss Ratio applies to dental plans the same way it applies to medical.

This bill will require dental insurance companies to spend a minimum percentage of patient premiums on patient care or refund the difference back to the individuals and/or groups.

Additional Resources

• Exploring MLR and What it Means for Dental Patients (ADA Tooth Talk Podcast)

In 2019, the Missouri passed legislation to require health carriers utilizing alternative methods of reimbursement, such as virtual credit cards (VCC), notify the provider of initiating/changing such method of payment, and permit the provider select an alternative payment method (opt-out).

Since then, the Association continues to receive numerous calls about carriers defaulting back to the use of VCC as the form of payment to the provider, despite opting out. In doing so these payments require providers pay a percentage of the reimbursement amount per claim.

MDA will file legislation to enhance the specifics of the provision in law, including that there be an “opt in” provision for VCC requiring that carriers receive an explicit, written consent from the provider before issuing payment via a virtual credit card.

The Dentist and Dental Hygienist Compact allows for greater licensure portability for dental professionals.

The Department of Defense (DoD), the Council of State Governments (CSG), the American Dental Association and the American Dental Hygienist’s Association have been involved in the development of language for these compacts.

The model language of the compacts are legally binding agreements among states that provide pathways through which dentists and dental hygienists can obtain a compact privilege. Dentists and dental hygienists would be licensed in one compact member state and then be allowed to practice in another participating state by obtaining this compact privilege. Seven states must adopt legislation to form a full compact commission, three states have already done so, Iowa, Tennessee, and Washington, and it is poised to be enacted in a few more states in 2023.

In 2024, MDA will monitor and be supportive of the Association of Dental Support Organizations push for Missouri to enter the compact.

During the 2023 legislative session, we successfully maintained $90,000 for Donate Dental Services and $200,000 for Elks Mobile Dental Services in the FY24 budget. Additionally, we maintained last year’s historic rate increase for Missouri Medicaid dental providers (80% of 50th percentile of UCR).

We look forward to continuing conversations with members of the House and Senate budget committees to maintain funding for these dental items again in FY25.

Legislation that would require public water systems that intend to stop or start water fluoridation of their water supply to first seek and receive information from their local health department about the impacts of fluoridation in their communities has been filed five of the last six legislative sessions.

Most recently, freshman Representative Doyle Justus (R – Troy) sponsored the bill in 2023, which passed out of the Health and Mental Health Policy Committee 10-1 but ultimately did not make it across the finish line.

We believe the Missouri Coalition for Oral Health will seek to put forth this legislation again in 2024 and we will continue to monitor this legislation and offer supportive testimony.

Missouri dental schools have filed legislation the last three sessions that would allow for dentists to give certain vaccines, either in a declared state of emergency or related to the oral cavity. The legislation would also require that dentists receive additional training as determined by the Missouri Dental Board before being able to administer any vaccines.

The bill has received a public hearing each year but 2023 was the first year the bill was voted out of committee. The bill continues to be heavily opposed by the Missouri State Medical Association and family physicians, who argue dentists do not have the proper training to administer vaccinations.

We are unsure if the legislation will again be filed, we will continue to monitor this legislation and offer supportive testimony as long as it includes the three following criteria: 1) Vaccines must be related to the oral cavity or in a declared state of energy; 2) A dentist must not be mandated to give a vaccine; and 3) Before giving a vaccine, a dentist must take a proper training course approved by the Missouri Dental Board.

In 2021, the MDA formed an exploratory workforce committee charged with investigating workforce shortages within Missouri’s dental community, and possible solutions. One solution that a few other states have adopted is a type of scaling dental assistant.

The creation of this new health care role titled “Oral Preventative Expanded Function Dental Assistant” (OPA/OPA-EFDA) is being is being pursued through a limited pilot project, to be promulgated through the Missouri Dental Board (MDB), that would allow for expanded function dental assistants, with additional, approved training, to scale supragingivally limited to patients diagnosed as periodontally healthy or with gingivitis. Pursuing a pilot project first will also provide critical data to demonstrate the safety and value of OPAs. The MDB gave approval to the OPA pilot project in July of 2023. Waiving the rules for the pilot to begin will promulgated before the end of the year.

Recent Progress

• In October 2023 the Missouri Dental Board approved the OPA EFDA curriculum the MDA workgroup developed, which will be used to train OPAs for the pilot project.
• We anticipate the pilot project to begin January 2024 (which will likely last 12 months), and through it data will be collected and analyzed to demonstrate the safety and efficacy of OPAs. Once that has been completed, legislation will be necessary to fully allow the creation of, and delegation of skills to, an OPA EFDA.
• In related news, the MDA is in the process of renovating the basement of our office building to be used to host this educational program and other EFDA related training. 
• The Focus MDA Fall 2023 issue gives an updates on various dental workforce projects and outlines the full extent of the work related specifically to the OPA EFDA project and in general to the Expanded Function Dental Assistant program.

In each session, MDA always monitors regulatory changes and pending legislation that may affect dentists (for the good or detriment), and keeps members apprised accordingly.  

The MDA's contract lobby firm, Gamble & Schlemeier, publishes The Weekly Pulse, where its team provides updates on pending legislation, proposed regulations, budget news, and other relevant information. This update gives a "weekly scoop" on various topics, not just dental issues or MDA priority items.

We'll provide a link to read, once the 2024 session begins.