Advocacy
Dentists can't afford to be silent partners in their own business and practice decisions. Legislative advocacy is just good business, and the NDA makes it our business to advocate for you.
Review the Current Legislative Bills we are monitoring.
2024 has been a very busy legislative session. The two bills listed below have hearings scheduled soon and links below that will allow you to submit comments directly to the Committee hearing the bill. Get involved by advocating for your profession. It's simple. See instructions below.
Updated May 1, 2024
LB 358 - Passed!
Although LB 358, last's years bill to increase dental Medicaid fees by $6M (25%), passed this year, the 25% increase was not included in the first draft of the Appropriation Committee's Budget.
During discussons between the Governor and the Appropriations Committee, the Governor agreed to a 12 1/2% increase in dental Medicaid fees for 2024-25.
LB 1138 - Passed!
Based on comments from many NDA members, LB 1138 provides an exemption to the general electronic prescribing requirement for controlled substances for prescriptions issued by a prescriber who issues fewer than fifty prescriptions for controlled substances (Schedule I-V) in one calendar year.
NDA’s legislation - LB 1138 was amended into the Health and Human Services Committee Priority Bill, LB 1215, (p.69, line 21). Passed on Final Reading with Emergency Clause 45-0-4 on March 28, 2024 . . . which means is in effect now!!LB 834 - Passed!
LB 834 Establish requirements for a resident dental license. Repurposes the temporary dental license statute into a resident license statute. Allows an applicant to take the ADEX exam or the CRDTS exam.
UNMC and Creighton Dental School's legislation - NDA testified in support - LB 834 received a Speaker Priorty designation and passed 2024.
LB 1387 - Defeated!
Although recognizing the optimal fluoridation level added to water, it also requires cities or villages who already fluoridate to their water, to place a fluoridation measure on the ballot affirming that they want to continue fluoridating their water . . . if they don’t put it on the ballot, they must cease fluoridating their water.
NDA testified in opposition because there is no need for LB 1387. If communities want to place a measure on the ballot to remove fluoridation, they can do so now. In addition, the ADA addressed the "new science" questioning the benefits of fluoridation in 2023.
LB 1387 was never advanced out of Committee and died this legislative session.
LB824 - Died
LB824 adopting the interstate compact, allowing a dentist or dental hygienist licensed in a different compact state to practice under a compact privilege in Nebraska subject to Nebraska law and regulations. Will NOT be placed on Consent File or amended into a Priority Bill and did not pass this year. The Dental Compact will likely be reintroduced next legislative session.LB 1110 - Postponed
Requires dental plan carriers to meet a minimum dental loss ratio and provide a report to the Department of Insurance as prescribed. Provides that dental plans must meet an 85% minimum loss ratio. In other words the plans must spend 85% of the premiums they receive on dental care services.
Senator Jacobson informed the NDA that he will continue to work with the NDA and insurers regarding LB 1110 over the summer and continue in the 2025 legislative session.
Go to the NDA Dental Loss Ratio webpage for more information.
LB 935 - Died
A companion bill to LB 358 above, appropriates $6,000,000 from the General Fund for FY2024-25 to the Department of Health and Human Services for the purpose of increasing provider reimbursement rates for dental services under the Medical Assistance Act. (approximately a 25% increase in fees). This bill did not come out of Committee and died.
LB 1015 - Died
Change provisions of the Rural Health Systems and Professional Incentive Act. Authorizes the Rural Health Advisory Commission to award loan repayments to dentists who see a disproportionate amount of Medicaid patients (to be defined in Regulations).
NDA’s legislation - testified in support – there was no opposition testimony. LB 1015 did not advanced from Committee and died this legislative session.
To Comment or Review a legislative bill linked here:
Click "Introduced" - to read the bill language
View which Senator introduced the bill and other bill information (hearing date if set, status, etc.)
Click "Submit Comments Online" button to submit your comments (Comments are limited to 500 words.)
2020 Legislative Success - Oct 26, 2020
Legislative Chair Dr. Scott Morrison and Executive Director David O'Doherty attend the ADA Lobbyist Conference every year in December. In 2009, we learned of insurance companies instituting “non-covered services” policies. In 2010, the NDA introduced legislation prohibiting the non-covered services policies. We filed a lawsuit against the Nebraska Department of Insurance over interpretation of our statutory changes and received an Order from the Court in late 2021. As a result of that decision, we created the Dental Insurance page for you going forward.
At the 2019 Lobbyist Conference, we learned of two new insurance tactics disadvantaging dentist providers and introduced two bills to address those issues.
At the 2019 Lobbyist Conference, we learned of two new insurance tactics disadvantaging dentist providers and introduced two bills to address those issues.
Virtual Credit Cards
We would like to thank Senator Lindstrom for introducing LB 954 on behalf of the NDA, addressing Virtual Credit Cards and Network Leasing. Some dental plans are paying the claim with a virtual credit card that must be redeemed by the dental office.The problem??
The dental office takes another 2-4% reduction on the payment due to the electric transaction cost, after already agreeing to a reduction in the fee schedule. Those extra costs don’t disappear. They have to be accounted for somewhere, often in higher fees for private paying patients. LB 954 does not say that insurance companies cannot make a payment with a virtual credit card . . . LB 954 just says that this form of payment cannot be the only form of payment.
Silent Network Leasing
This happens when the dental plan leases its Network Provider List to another dental plan without the knowledge and consent of the dentist. A patient shows up in the dental office with, say, a MetLife card and the office says that they are not a MetLife provider. The patient says, “Yes you are, you are listed as a Provider on their website.”
Essentially, no one becomes a party to a contract to which they never considered and
agreed. The same notion should apply in this situation. About 18 states have already passed laws addressing network leasing.
The image below is from an Ameritas Provider Agreement, prior to passing LB 954.
Summary of Changes
In order for the insurance company to lease their network, they must:
(1) Identify all third parties in existence in a list on its Internet website that is updated at least once every ninety days;
(2) The provider network contract specifically states that the contracting entity may enter into an agreement with a third party that would allow the third party
to obtain the contracting entity’s rights and responsibilities as if the third party were the contracting entity, and when the contracting entity is a dental carrier, the provider chooses to participate in third-party access at the time the provider network contract was entered into; and
(3) The third party accessing the provider network contract agrees to comply with all applicable terms of the provider network contract.
A dentist provider is not bound by and is not required to perform dental treatment or services under a provider network contract granted to a third party in violation of the above requirements.
Essentially, no one becomes a party to a contract to which they never considered and
agreed. The same notion should apply in this situation. About 18 states have already passed laws addressing network leasing.
The image below is from an Ameritas Provider Agreement, prior to passing LB 954.
Summary of Changes
In order for the insurance company to lease their network, they must:
(1) Identify all third parties in existence in a list on its Internet website that is updated at least once every ninety days;
(2) The provider network contract specifically states that the contracting entity may enter into an agreement with a third party that would allow the third party
to obtain the contracting entity’s rights and responsibilities as if the third party were the contracting entity, and when the contracting entity is a dental carrier, the provider chooses to participate in third-party access at the time the provider network contract was entered into; and
(3) The third party accessing the provider network contract agrees to comply with all applicable terms of the provider network contract.
A dentist provider is not bound by and is not required to perform dental treatment or services under a provider network contract granted to a third party in violation of the above requirements.
Medicaid Audits
Some of you may remember in 2014, approximately 300 dentists received a Medicaid RAC Audit letter entitled Improper Payment Notification. The letter was dated April 14, 2014 and gave the dentist 30 days from the date of the letter to respond. Nebraska HHS hired HMS as its Audit contractor and focused on prophylaxis.
There were a number of flaws with the DHHS audit and the NDA was able to pass LB 315 to address those issues. Later that year, CMS changed their audit terminology from RAC (Recover Audit Contractor) to UPIC (Uniform Program Integrity Contractor). In late 2018, when CMS and DHHS launched another series of audits, this time focusing on the Pediatric dentist community and chrome crowns, we argued that LB 315 passed in 2014 prevented DHHS from using parameters in the 2018 audit.
The NDA became aware of multiple Pediatric dentist audits in 2019 and began seeking a senator to introduce legislation to address issues with the current audit. Senator Ben Hansen introduced LB 1105 in January 2020, which sailed through the Health and Human Services Committee, advancing to General File.
Then COVID hit. When the Legislature finally reconvened, LB 1105, merged into LB 956 was included in LB 956, which the Legislature passed and was signed by the Governor on August 8, 2020.
Summary of Changes
1. Changed language to apply to ANY audit where CMS was involved (NDA passed a previous Medicaid Audit bill, but CMS changed their RAC terminology to UPIC the next year . . . DHHS argued our revised Medicaid statute didn’t apply to them.)
2. Allowed payment for services actually performed if DHHS disagreed with the service (Pedo dentists placed chrome crowns as required under AAPD guidelines and were made to pay the entire amount back)
3. Requires the same specialist to review a specialist being audited. (DHHS used a general dentist to review a Pedo’s work and ignored AAPD guidelines.)
4. Prohibits extrapolation of audit improper payment findings. (DHHS found x% of Pedo’s work was not properly documented, so they extrapolated x% of ALL of Pedo’s patients for two years and demanded entire amount repaid, even though services were provided.)
There were a number of flaws with the DHHS audit and the NDA was able to pass LB 315 to address those issues. Later that year, CMS changed their audit terminology from RAC (Recover Audit Contractor) to UPIC (Uniform Program Integrity Contractor). In late 2018, when CMS and DHHS launched another series of audits, this time focusing on the Pediatric dentist community and chrome crowns, we argued that LB 315 passed in 2014 prevented DHHS from using parameters in the 2018 audit.
The NDA became aware of multiple Pediatric dentist audits in 2019 and began seeking a senator to introduce legislation to address issues with the current audit. Senator Ben Hansen introduced LB 1105 in January 2020, which sailed through the Health and Human Services Committee, advancing to General File.
Then COVID hit. When the Legislature finally reconvened, LB 1105, merged into LB 956 was included in LB 956, which the Legislature passed and was signed by the Governor on August 8, 2020.Summary of Changes
1. Changed language to apply to ANY audit where CMS was involved (NDA passed a previous Medicaid Audit bill, but CMS changed their RAC terminology to UPIC the next year . . . DHHS argued our revised Medicaid statute didn’t apply to them.)
2. Allowed payment for services actually performed if DHHS disagreed with the service (Pedo dentists placed chrome crowns as required under AAPD guidelines and were made to pay the entire amount back)
3. Requires the same specialist to review a specialist being audited. (DHHS used a general dentist to review a Pedo’s work and ignored AAPD guidelines.)
4. Prohibits extrapolation of audit improper payment findings. (DHHS found x% of Pedo’s work was not properly documented, so they extrapolated x% of ALL of Pedo’s patients for two years and demanded entire amount repaid, even though services were provided.)
NEDPAC: You can't afford to be a silent partner in decisions that affect your business, your practice, your profession, donate today.
National Representation: The NDA works with the ADA to represent your voice and views on issues effecting the you and your practice. The ADA represents nearly 157,000 dentists and works to improve America’s oral health, advance the science of dentistry and enhance the best oral health care system in the world.
If you have questions about NDA advocacy efforts contact Dr. Scott Morrison or David O'Doherty.
