A ffordable Care Act Overview: What Does It Mean To Your Dental Practice? By Dr. Chris Baker, AOS Advocacy Chair I n the new legislation, “essential health benefits” is defined as services that individual insurance plans and Medicaid will have to cover beginning in 2014. The Afford-able Care Act (ACA) requires that pedi-atric dental benefits be a part of the Essential Health Benefits (EHB). The new rule is still in draft form, so there will be public comment and revisions before it is finalized. -Health and Human Services (HHS) conducted a review of employer-sponsored plan benefits, including small employer products, and found a number of potential benchmark plans that do not include coverage for pedi-atric oral services, which are often covered under stand-alone policies. (Rather than establish-ing a national standard for EHB, HHS decided to allow each state to choose from a set of plans to serve as the “benchmark plan” in their state. Whatever benefits that plan covers in the 10 EHB categories will be deemed the essential benefits for plans in the state). -If a base-benchmark plan option does not cover all of the 10 EHB categories, including pediatric oral services, it must be supplemented by adding the missing services from another base-benchmark plan option. -HHS proposes the following solutions for base-benchmark plans that do not include coverage for pediatric oral services: -Supplement with pediatric coverage included in the Federal Employees Dental and Vision Insurance Program (FEDVIP) with the largest enrollment or; -Supplement with the benefits available under that state’s separate Children’s Health Insurance Program (CHIP), if applicable. -HHS has indicated it will make bene-fit data available to facilitate any supple-mentation by states of their base-bench-mark plans with benefits from FEDVIP dental plans prior to the publication of the final rule. -In the interim, HHS is directing states to look at the FEDVIP dental plans with the highest national enrollment to see a summary of the benefits offered by these plans. In this case, according to HHS, MetLife has the highest national enroll-ment. A summary of its dental benefits offered and excluded is available online. It is unknown how the inclusion of “pediatric dental services” will impact insurers, patients, and you, the dentist. As Medicaid covers more children, the reimbursement rates and the APPROVAL rates for services will drop. Private dental insurers will likely follow suit. It seems likely that your rate of reimburse-ment from insurers and Medicaid will be reduced per patient per treatment. “Pediatric services” is defined as services for individuals under the age of 19 years, although individual states have the flexibility to extend pediatric coverage beyond the proposed 19 year age limit. raising the prices of everything they sell, even software, to cover the tax cost. $63 Per Employee/Insured Person From the Associated Press , here is a bit of what is known about this tax, which will likely be passed on to you to cover your employees’ and your medical insurance. Your medical plan is facing a new, $63-per-head fee to cushion the cost of cover-ing people with pre-existing conditions. Based on figures provided in the regula-tion, employer and individual health p plans covering an estimated 190 m million Americans could owe th the per-person fee. It is intended to be a temporary assessment le levied for three years starting in 2 2014, designed to raise $25 b billion that will go into a fund a administered by the Health and H Human Services Department. It w be used to cushion health will in insurance companies from the in initial hard-to-predict costs of covering uninsured people with medical problems. Under the law, insurers will be forbidden from turning away the sick as of Jan. 1, 2014. The program "is intended to help millions of Americans purchase afford-able health insurance, reduce unreim-bursed usage of hospital and other medical facilities by the uninsured and thereby lower medical expenses and premiums for all.” America's Health Insurance Plans, the major industry trade group for health insurers, says the fund is an important program that will help stabilize the market and miti-gate cost increases for consumers as the changes in this law take effect. The fee will be assessed on all "major medical" insurance plans, including those provided by employers and those purchased individually by consumers. The fee will total $12 billion in 2014, $8 billion in 2015 and $5 billion in 2016. That means the per-head assessment would be smaller each year, around $40 in 2015 instead of $63. It will phase out completely in 2017 unless the U. S. Congress, with lawmakers searching everywhere for revenue to reduce federal deficits, decides to extend it. F or our practicing Texas members, please see your December 2012 AOS eBrief for Texas Medicaid information. Medical Device Tax This is an excise tax that goes into effect January 1, 2013, whereby all medical devices will be taxed. What is a "medical device"? This legislation leaves completely open how a medical device will be defined, AND it leaves open what the responsibility of the dentist will be concerning this tax. Should we hire staff to handle the new reams of paperwork/computer work, identifying what medical devices we have “installed” in our patients each month? Must we report names or just amounts? This issue is complex and can have far-reaching effects on our practices, patients and the economy in general. It has been assumed that this will be a tax on GROSS PRODUCTION in your office, which will simplify reporting. Interestingly, however, the medical device tax will also be charged to your labs, your vendors, etc. They will likely pass these tax raises on to you, so your costs will rise in expense areas. Keep in mind that the medical device tax takes effect January 1, 2013, and will LIKELY -no one is sure yet -be an across the board tax on gross income to each medi-cal and dental practice. In other words, though it may not be "billed" until a year or more later, it will be retroactive to Jan 1, 2013. So, when budgeting, be sure you understand that the companies will be 46 January/February 2013 JAOS
Journal of the American Orthodontic Society January-February 2013: Page 46
