The 436th Session of the Maryland General Assembly starts January 13 and until adjournment "Sine Die” on April 11, 2016. During Maryland’s 90 day legislative session approximately 2500 to 3000 bills are introduced. The Legislative Affairs Committee of the MSDA and MSDA’s lobbyists review these bills and address the approximately 100 or more that will have a potential impact on our dental profession or the patients we serve. A great opportunity for you to get involved in the legislative process is our annual "Dentist Day in Annapolis”, which is on Wednesday February 24, 2016. It has been an MSDA sponsored event for some 25 years! All members of organized dentistry are invited to attend this important event. Last year, we had success in preserving the current law that all clinical decisions should be made between a Maryland Licensed Dentist and the patient without influence from equity interests or management companies. In Medicaid Reform, we were also able to team up with 19 other health organizations to oppose legislation that would have been so onerous that many practioners would be seriously consider withdrawing from Medicaid programs such as Maryland Health Smiles.
Much of the success goes to our membership working one on one with their legislators on "Dentist Day in Annapolis”. This year, there will be at least three very important legislative issues that you will want to discuss with your legislator. First, let me review the logistics of "Dentist Day”.
Several state dental organizations are supporters of Dentist Day in Annapolis. These include the MSDA, the Maryland Dental Society, the Maryland Association of Pediatric Dentistry, The Maryland Children’s Oral Health Institute and the Maryland Academy of General Dentistry. According to MSDA Lobbyist Mr. Dan Doherty, because of the importance of the legislative issues, 2016 is a crucial year for each MSDA member to meet and get to know their legislators. Each Maryland state legislator will be informed that "Dentist Day” is approaching and to expect visits from dentists within their constituency. Visiting dentists will be given a packet to give to each of their legislators. Each packet contains information about organized dentistry in Maryland and dentistry’s position on several bills. It is our hope that between where you live and work, we will have a Maryland dentists visit with delegates and senators from all 47 legislative districts. Although you may not have an opportunity to meet with all your legislators in person, I have found interacting with legislative staff and aides also can be very rewarding.
"Dentist Day” starts at 8am and runs until about 1pm. We meet on the ground floor of the historic Calvert House 58 State Circle in Annapolis. Parking garages are available in Downtown Annapolis but limited and I prefer to ride the MSDA shuttle bus. MSDA staffer Peter Holmes has arranged for continuous convenient shuttle service from the United States Naval Academy Stadium to College Avenue and North Street, as well as the return trip. The parking lot is located near the Navy/Marine Corps Stadium at the Taylor Avenue Entrance (Gate #5 near the Blue Angel Plane). The MSDA bus will take you to the drop off/pick up spot at College Avenue near North Street, it is a two block walk to State Circle and the Calvert House. As you will see, State Circle is beautiful circling the State House but too narrow to negotiate a bus! The shuttle runs about every 10-20 minute and will be marked MSDA verses the trolley buses that also leave the same lot but take a longer route. The shuttle is free but there is a nominal charge for the parking lot. Our MSDA shuttle will run from 7:30am to 7:30pm so if you want to spend time walking the cobblestone streets of Annapolis after "Dentist Day”, feel free! Remember, when returning to your car, pick up the MSDA shuttle bus at the corner of College Avenue and North Street where you were dropped off originally.
Once at the Calvert House, enjoy a continental breakfast as you register and pick up your visitation materials. At 8:15am we will start with Welcoming Remarks and outline our legislative agenda for this year. Usually between 8:30 and 9am we will break to start our Senate/House Visitations. If you have never attended "Dentist Day” before, we will try to pair you with a veteran of "Dentist Day” to help show you around the various offices. My best advice is to go to the web site www.mdelect.net to find your legislators for both your home and office district. From there it’s easy to get their e-mail address and send them a short e-mail that Feb 24 is "Dentist Day”, you are a constituent, and you would like to arrange to stop by the office for a short visit. You will be amazed how quickly your legislator or their aide will get back in touch. From experience, try to schedule your visits on the House of Delegates around the same time, and in the Senate as well, so you’re not running back and forth between the Senate and the House Office Buildings. This is important since you have to go through security before entering each building. Please remember to bring picture ID. The sooner you let them know you are visiting, the better staff can work you into the legislators schedule (just like the dental office!). Some offices will not commit to a time so I will often leave my cell # so they can contact me when they have an opening. If your legislator still has no time, ask to meet with the legislative aide as this will help to begin building a relationship. Bring plenty of business cards, for there will be a place to include that in your packet that you will give to your legislators. I have found the visits to be most congenial and we often talk about issues in our community as well as dental issues. Discuss the position papers and the dental issues of the day and make sure your legislator knows that you and the MSDA are a resource to them should they ever need information during the legislative session. A follow up thank you note to your legislator after "Dentist Day” is always a nice touch. Occasionally, I’m asked a question that I do know the answer or I feel I’m not qualified to answer. I will note the question, stating I will get them the answer to that question within a day or two. During the morning, the House of Delegates and the Senate will go into session around 10am. I always enjoy walking over to the State House to observe the proceedings.
Lunch is provided at the Calvert House at Noon followed by a debriefing during which we can review any questions that may require follow up or comments received during our visits. Also during the day we will have a presentation of the "MSDA 2015 Legislator of the Year Awards”. This year we will recognize three state legislators who have been very supportive of dentistry for all Marylanders. This year’s recipients are Senator Joan Carter Conway (Baltimore City), Delegate Dan Morheim (Baltimore County, also a physician), and Senator Shirley Nathan-Pulliam (Baltimore City). These legislators have been particularly supportive of dentistry and are very deserving of this special recognition.
As of this writing, it is too early to know what legislation we will be in favor of or opposed but I will highlight some of the important dental issues that will likely result in legislation this year.
Dental Practice Ownership: We continue to see in the news from other states incidences of non-dentist owned practices running afoul of the law and paying out large settlement fees for dictating patient care and deceptive advertising (examples New York, Pennsylvania, & Indiana Attorney Generals settlements with Aspen Dental). ADA House of Delegates Resolution 2000:462 states that "the Association supports the conviction…that the health interests of patients are best protected when dental practices…are owned and controlled by a dentist licensed in the jurisdiction where the practice is located”. Further, Resolution 2011:491 states "that licensing authorities be urged to establish regulations which hold entities providing dental services that are owned by non-dentists or dentists not licensed in the state to the same ethical and legal standards as those that are owned by state licensed dentists”. MSDA House of Delegates Resolution 14:104RC supports the concept that ownership and clinical treatment decisions be made by dentists with a current Maryland Dental License. This past summer and fall, the MSDA has participated in a Senate Workgroup that included representatives of Maryland Medicaid, Non-profit dental clinics, Dental Service Organizations (DSO’s), the Maryland State Board of Dental Examiners (MSBDE) and various state dental organization. The MSDA was proactive in drafting initial bill language that accomplished 3 primary goals:
1) A Maryland Licensed Dentist must be the owner of a dental practice in Maryland.
2) Allowed the non-clinical management of dental practices that the DSO representatives stated they needed in material they distributed during a Workgroup session but would not allow equity interests to interfere with clinical decision making of the dental practioner.
3) Strengthen the authority of the MSBDE on matters of practicing without a dental license. In essence, practicing without a license would be elevated from a misdemeanor to felony violation. This would allow the board to go after any non-dentist equity firm that tries to own a dental practice in the State. Safeguard where placed in the draft to preserve a lesser penalty for practioners who accidently forget to renew their license for a short period after expiration.
The initial draft was modified after input from the MSBDE, Maryland Medicaid, and non-profit dental clinics that the MSDA considers friendly amendments. To date, the DSO’s representatives have not provided meaningful comments or amendments but it is likely there could be proposed legislation sponsored by corporate entities to limit the State Dental Boards ability to regulate dental practice ownership. We ask MSDA members to contact their legislators now to discuss this important issue and watch your e-mail for important information and action alerts.
"Medicaid Audits & Bonds”: In the Legislative Affairs Committee report to the MSDA 2015 House of Delegates it was discussed about a "Summer Study "to come up with possible legislation to combat Medicaid fraud (to replace 2015 HB 1101 that was defeated). The MSDA along with 19 other health organizations have been actively participating in this "Summer Study” in hopes that meaningful legislation to combat fraud and abuse while not subjecting well intention providers from unscrupulous audits. The latest proposed bill draft contains provisions for extrapolatory audits. An example might be one clerical Medicaid submission error of a few dollars could piques an auditors Interest. This could subject the office to additional audits in an effort to find an extrapolated error amount when no other errors exist. The current draft does not include provisions for supercedeas bonds but the Maryland Office of Inspector General may introduce a separate bill to require bonds to be collected from Medicaid provides. The coalition of health organizations, including the MSDA, strongly opposes bonds and aggressive audit practices as many providers would probably start to opt out of treating Medicaid patients. This could adversely affect the Maryland Healthy Smiles Program.
Restructuring of All Health Licensure Boards: Partially in response to the US Supreme Court’s decision in "North Carolina State Dental Board vs. Federal Trade Commission”, there could be legislation to restructure all Maryland health licensure boards. These Boards are currently under Maryland Department of Health and Mental Hygiene and there could be legislation to have the licensing boards report to under a new Director or Commission. The MSDA is watching this carefully to maintain the basic principle of licensing boards for protection of the public while at the same time protecting due process of those accused and maintain a jury by our peers.
The Legislative Affairs Committee of the MSDA will keep you informed as the legislative session progresses. We hope the information noted above will motivate you to take a day off to attend. A day off now will eliminate lots of potential headaches for your dental practice in the future. Registration information on "Dentist Day” is included in the issue of MSDA Newsletter. A charge of $50 is included breakfast & Lunch and helps defray some of the cost involved in providing such a worthwhile program. I look forward to seeing you February 24! Don’t forget to bring business cards, wear comfortable dress shoes, call ahead and schedule appointments to meet your legislators, and bring your ID for security checks.