We’re All In This Together
Legislation supported by AAOMP
The following pages contain information on legislation supported
by AAOMP and other specialists in the medical industry.
LETTER #1
April 29, 2020
The Honorable Nancy Pelosi
Speaker, U.S. House of Representatives H-232 Capitol Building
Washington, DC 20515
The Honorable Kevin McCarthy Minority Leader
U.S. House of Representatives H-204 Capitol Building Washington, DC 20515
The Honorable Mitch McConnell Majority Leader, United States Senate S-230 Capitol Building
Washington, DC 20510
The Honorable Chuck Schumer Minority Leader, United States Senate S-221 Capitol Building
Washington, DC 20510
Dear Speaker Pelosi, Leader McConnell, Leader McCarthy, and Leader Schumer:
On behalf of our 163,000 members, the American Dental Association (ADA) applauds Congress’ efforts to combat the challenging effects of the COVID-19 outbreak.
The Coronavirus Aid, Relief, and Economic Security (CARES) Act continues to provide support to small businesses across the country and helps ease the burdens dental practices and other small businesses face during this public health emergency. However, the dental community continues to face additional challenges that require your continued support.
As Congress looks to its next legislative package to help the country deal with this extraordinary crisis, we would like to offer the following recommendations aimed at assisting dental practices, dentists, their staff, and patients:
• Allow small businesses increased flexibility within the Paycheck Protection Program (PPP) for which they seek forgiveness for the PPP loans. This will allow small businesses to make more appropriate decisions about staffing and payroll based on when they plan to fully reopen.
• Ensure adequate oversight over the distribution and loan forgiveness provisions in the CARES Act for PPP loans. This will guarantee that only those small businesses that were economically distressed as a result of the pandemic receive the funds and forgiveness.
• Intensify the production of personal protective equipment (PPE) and focus its distribution to health care providers, including dentists, who are treating emergency cases or near emergency cases now and in the future without an adequate supply of N95 masks and face shields. This will help the dental office staff to continue to practice in a safe environment for themselves and their patients.
• Provide tax credits for the purchase of additional PPE and safety improvements to the office. This will assist financially stressed practices in providing an additional layer of safety and protection for the dentists, their staff, and their patients.
• Extend the Department of Health and Human Services’ discretionary authority during public health emergencies to provide targeted liability protections for providers who administer FDA-authorized COVID-19 diagnostic tests within their scope of practice until the end of 2020. This will expand the nation’s capacity to screen patients for COVID-19 outside of already burdened hospital emergency departments.
• Permit 501(c) (6) organizations to utilize the PPP loan program. This will ensure that non-profit medical and dental associations can continue to serve as a trusted resource for their health care professionals and patients.
While many challenges persist, it is critical to meet these challenges with a long term strategy that includes planning for a post-pandemic future. Because conditions regarding virus transmission vary greatly across the U.S., many state and local governments are considering plans for a multi-phased reopening starting with essential businesses, including dental practices. The ADA’s current recommendation urges dentists to remain closed to all except urgent and emergent dental issues until April 30, though state and local mandates take precedence.
As you work on the next legislative package, please consider these recommendations. With your help, we can lessen the burden of this difficult crisis and restore a more stable and safe environment in the provision of dental care.
Many thanks for your work on these important issues. If you have any questions, please have your staff contact Chris Tampio at 571-213-7756 or tampioc@ada.org. Additional information is also available at ADA.org/virus.
Sincerely,
Chad P. Gehani, D.D.S. President
Kathleen T. O’Loughlin, D.M.D., M.P.H. Executive Director
CPG:KTO:ct
1 Centers for Disease Control and Prevention, Infection Control – Dental Settings, April 2020.
LETTER #2
Dear Speaker Pelosi, Ranking Member McCarthy, Majority Leader McConnell, and Minority Leader Schumer:
On behalf of our collective organizations, we are writing to request flexibility for Paycheck Protection Program (PPP) loans regarding costs related to personal protective equipment (PPE). Our organizations were relieved that Congress provided additional funding to PPP and other critical loan programs, but small business health care providers, especially those in dentistry, are going to require significant increases in PPE in order to protect themselves, their employees and their patients from COVID-19 infections. Given the nature of oral health care treatments and procedures, the exposure to this virus through aerosol generating procedures and droplets in the air is especially concerning for dental offices.
Many of our members have begun to receive their loan funds and are beginning to make decisions on what non-payroll costs they will use these funds for in order to receive full loan forgiveness. It is clear that access to PPE is of primary concern, but the cost of more robust and additional PPE is also causing many of our members to believe that this will have a considerable economic impact on their businesses. At this time, we are asking that the non- payroll costs that are allowable for PPP be expanded to include the cost of PPE. Further, a borrower that uses PPP funds for PPE—so long as it stays within the threshold for non-payroll- related costs—should not be prevented from receiving full forgiveness of these loans.
We understand that the intent of PPP was to encourage small businesses to retain or rehire their staff in a timely manner. However, both dentists and their employees are concerned about their health and safety, especially due to the fact that they are particularly vulnerable. It is important to reopen dental practices and provide dentists and their employees with the wages and benefits they need, but we cannot do so without first ensuring their health and safety as well. Allowing this flexibility for PPP loan proceeds will help to mitigate the increased costs of the PPE that will be required in order to provide care to our patients and protect ourselves and our employees.
We believe that this flexibility could be done through agency action and be included in future guidance from the Department of the Treasury and the Small Business Administration. However if congressional action is required, we are asking that this change be included in the next COVID-19 relief package.
On behalf of our collective organizations, we would like to thank you for recognizing the need for small businesses, including dental practices, to receive financial support during these difficult times. Dental offices are eager to reopen to treat their patients and rehire their employees, but patients, providers and employees need to feel safe to return. PPP loan fund flexibility is a simple way to help address this. If you have further questions, please reach out to Megan Mortimer at the American Dental Association, m ortimerm@ada.org.
Thank you for considering this request.
Sincerely,
American Dental Association Academy of General Dentistry
American Association of Oral and Maxillofacial Surgeons American Academy of Pediatric Dentistry
American Academy of Oral and Maxillofacial Pathology
American Academy of Oral and Maxillofacial Radiology American Academy of Dental Group Practice American Academy of Periodontology
American Association for Dental Research American Association of Endodontists American Association of Orthodontics American Association of Women Dentists American College of Prosthodontists American Dental Education Association American Student Dental Association National Dental Association
LETTER #3
Dear Secretary Mnuchin and Administrator Carranza:
On behalf of our collective organizations, we are writing to request flexibility for Paycheck Protection Program (PPP) loans regarding costs related to personal protective equipment (PPE). Our organizations were relieved that Congress provided additional funding to PPP and other critical loan programs, but small business health care providers, especially those in dentistry, are going to require significant increases in PPE in order to protect themselves, their employees and their patients from COVID-19 infections. Given the nature of oral health care treatments and procedures, the exposure to this virus through aerosol generating procedures and droplets in the air is especially concerning for dental offices.
Many of our members have begun to receive their loan funds and are beginning to make decisions on what non-payroll costs they will use these funds for in order to receive full loan forgiveness. It is clear that access to PPE is of primary concern, but the cost of more robust and additional PPE is also causing many of our members to believe that this will have a considerable economic impact on their businesses. At this time, we are asking that the non- payroll costs that are allowable for PPP be expanded to include the cost of PPE. Further, a borrower that uses PPP funds for PPE—so long as it stays within the threshold for non-payroll- related costs—should not be prevented from receiving full forgiveness of these loans.
We understand that the intent of PPP was to encourage small businesses to retain or rehire their staff in a timely manner. However, both dentists and their employees are concerned about their health and safety, especially due to the fact that they are particularly vulnerable. It is important to reopen dental practices and provide dentists and their employees with the wages and benefits they need, but we cannot do so without first ensuring their health and safety as well. Allowing this flexibility for PPP loan proceeds will help to mitigate the increased costs of the PPE that will be required in order to provide care to our patients and protect ourselves and our employees.
We believe that this flexibility could be done through agency action and be included in future guidance from the Department of the Treasury and the Small Business Administration. However if congressional action is required, we are asking that this change be included in the next COVID-19 relief package.
On behalf of our collective organizations, we would like to thank you for recognizing the need for small businesses, including dental practices, to receive financial support during these difficult times. Dental offices are eager to reopen to treat their patients and rehire their employees, but patients, providers and employees need to feel safe to return. PPP loan fund flexibility is a simple way to help address this. If you have further questions, please reach out to Megan
Mortimer at the American Dental Association, m ortimerm@ada.org.
Thank you for considering this request.
Sincerely,
American Dental Association Academy of General Dentistry
American Association of Oral and Maxillofacial Surgeons American Academy of Pediatric Dentistry
American Academy of Oral and Maxillofacial Pathology
American Academy of Oral and Maxillofacial Radiology American Academy of Dental Group Practice American Academy of Periodontology
American Association for Dental Research American Association of Endodontists American Association of Orthodontics American Association of Women Dentists American College of Prosthodontists American Dental Education Association American Student Dental Association National Dental Association
LETTER #4
June, 2020
The Honorable Mitch McConnell Majority Leader, United States Senate S-230 Capitol Building
Washington, DC 20510
The Honorable Chuck Schumer Minority Leader, United States Senate S-221 Capitol Building
Washington, DC 20510
Dear Leaders McConnell and Schumer:
On behalf of our collective dental organizations, we are writing to support adequate funding to provide oral health care through Medicaid in the next COVID-19 relief package. Specifically, we support temporarily increasing the federal share of Medicaid costs if used to support state Medicaid programs with adult and child dental services, otherwise known as the federal medical assistance percentage (FMAP), while also keeping in place maintenance of effort (MOE) protections.
We believe that Medicaid plays an essential role in a state’s oral health care safety net and our organizations are committed to ensuring that families have access to comprehensive and affordable health coverage, including oral health care coverage.
Medicaid and the Children’s Health Insurance Program (CHIP), our nation’s safety-net health insurance programs, provide vital coverage to over 70 million Americans, including almost 35 million children.1 About 7.4% of all adults and 38.5% of all children in the U.S. have dental coverage under Medicaid.2
Today, Medicaid costs are shared between the federal and state governments. While there are significant differences between states on coverage of optional populations and benefits, states are reimbursed by the federal government for the majority of their Medicaid spending, regardless of changes in enrollment or generosity of benefits.
Currently, 37 states including the District of Columbia (D.C.) have expanded Medicaid eligibility while 47 states, including D.C., offer some dental benefit to their base Medicaid population already.3 There are 33 states, including D.C., that provide dental benefits beyond emergency care4 and the demand for Medicaid dental services among children and adults will increase moving forward, regardless of Medicaid expansion. As the COVID-19 health crisis has also spurred an economic crisis, it has become evident from the dozen states who are just starting to report their recent Medicaid enrollment
1 Medicaid.gov, February 2020 Medicaid & CHIP Enrollment Data Highlights, February 2020.
2 ADA, Dental Benefits Coverage in the U.S., November 2017.
3 ADA, Oral Health and Well-Being Among Medicaid Adults by Type of Medicaid Dental Benefit, May 2018.
4 Ibid.
data that some of the largest enrollment increases have already taken place in Missouri, Wisconsin, Minnesota, Maine, Kentucky, New Hampshire, and North Carolina.5 All of these states have some type of adult dental benefit within their Medicaid programs.6
States are facing severe budget constraints and in some cases are already seeking to end dental benefits as a way to make up for decreased revenues as a result of the economic crisis.7 MOE protections would prevent states receiving the additional FMAP funding from cutting coverage. Both the FMAP increase and the MOE protections are critical to protecting coverage and access to care as the public health emergency continues. In the past when states have faced severe budget constraints, adult dental services in Medicaid have often been among the first to be cut. However, research has shown that “when states reduce or eliminate adult dental benefits, unmet dental care needs increase, preventive dental service use decreases, and emergency department use for dental problems increases.”8 This approach is counterproductive to future cost savings, but without additional FMAP funding and MOE protections, many states will be constitutionally mandated to make large cuts to their budgets that have in the past targeted dental care.
The dental community was one of the first to recommend a postponement of all elective procedures at the onset of the pandemic. As a result, dentists only saw patients for emergencies, and in a time when oral health care needs could now go unmet, dentist Medicaid providers cannot fiscally sustain the loss of these traditionally covered populations. Dentists across the country continue to navigate the unique challenges presented by the COVID-19 pandemic, and a specific and temporary increase in FMAP funding would be most welcome if used to support state Medicaid programs with adult and child dental services along with MOE protections.
Medicaid provider dentists treat the most vulnerable people in our nation, including children, the elderly, disabled, and pregnant women. Without additional FMAP funding and MOE protections, dentists could begin disenrollment from the Medicaid program, which will make it more difficult for Medicaid patients to access needed oral health care. In the near term, the ADA’s Health Policy Institute (HPI) recently surveyed Medicaid provider dentists and found almost 20% of surveyed Medicaid provider dentists were not sure if they would continue to be by the end of June.9 This number could grow in the months ahead.
5 Georgetown University Health Policy Institute, As Expected, Medicaid Enrollment is Starting to Increase, May 2020.
6 ADA, Oral Health and Well-Being Among Medicaid Adults by Type of Medicaid Dental Benefit, May 2018.
7 California Public Radio News, ‘It’s Going To Be Painful’: Steep Cuts Expected In California Gov. Gavin Newsom’s Revised Budget, May 2020.
8 The Henry J. Kaiser Family Foundation; Access to dental care in Medicaid: spotlight on nonelderly adults. March 2016.
9 See ADA HPI survey graphic on page 3.
Thank you for your consideration of these important issues. Medicaid dentists and the patients they serve request your support of these measures. We would welcome the opportunity to speak with you in more detail and answer any questions you have regarding these comments. Please contact Megan Mortimer at mortimerm@ada.org or (202) 701-9593 to facilitate further discussions.
Sincerely, (signatories)
cc: Senate Committee on Health, Education, Labor and Pensions Senate Committee on Finance
LETTER #5
Dear Governor X:
The [STATE Dental Association] wishes to thank you for your administration’s efforts to mitigate the profound impact that the COVID-19 pandemic is having on [STATEIANS].
To assist in this effort, on March 16, the dental profession was among the first national health care provider groups to recommend postponement of elective procedures and treat only urgent and emergency cases. This contributed to slowing community spread of the virus and preserving much needed personal protective equipment (PPE). Equally important, remaining open for emergency procedures helped alleviate emergency departments from having to manage dental emergencies.
As non-emergency dental cases have been delayed these many weeks, some may now be reaching a critical point where they need to be addressed in the dental office. For example, an untreated dental abscess can develop into a body-wide infection that jeopardizes a patient’s life. Dentists are best positioned and should be empowered to treat conditions such as this. Most patients that a dentist needs to see have the potential to be asymptomatic carriers of the virus. Dentists and their staff are at very high risk of infection, since many dental procedures produce aerosols in the normal course of treatment. In order to treat patients in the safest manner, dentists will need access to the appropriate PPE to minimize the risk of COVID-19 transmission among patients and dental team members.
It is of critical importance for our dentists to have an adequate supply of N95 masks to treat these patients. Currently, many dentists do not have enough N95 masks to treat their emergency cases, let alone providing the full range of dental care for the individuals that require treatment in the immediate future.
It is our understanding that the Federal Emergency Management Agency (FEMA) will soon be shipping quantities of N95 masks to the states to use at their discretion. We respectfully request that you consider appropriating equitable proportion of those masks to dentists so that the people in our state can obtain the dental care they need and want while still protecting the members of the dental team, our patients and ultimately the public at large.
I would welcome the opportunity to discuss this matter further as soon as possible. I can be reached at XXX-XXX-XXXX.
Sincerely,
President or Executive Director
State Dental Association
