What’s Going on Up There?: Fall ‘19 Legislation Update

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Ever get so deep in the world of studying and lab work that you have no idea what’s going on above our heads in the world of policy? Me too. Here’s an update from legislative liaison Janae Momchilovich on the dental legislation in the works and why ASDA is working toward these changes:

Licensure Reform

Current dental licensure requires a practical examination utilizing live human subjects. ASDA, ADA and ADEA have taken stances in favor of eliminating human subjects as part of the licensure process. ASDA has established five issues with the current clinical licensure examination:

·       The exam is not valid. There is no correlation to dental school success and exam pass rate.

·       The exam is not reliable. The exam cannot be standardized.

·       The exam does not put the best interests of the patient first.

·       The exam needlessly places candidates in positions of moral distress.

·       The exam is not universally accepted.

In response to these issues, ASDA has worked to formulate a new, alternative licensure process. ASDA’s ideal licensure exam:

·       Does not use human subjects in a live clinical testing scenario.

·       Is psychometrically valid and reliable in its assessment.

·       Is reflective of the scope of current dental practice.

·       Is universally accepted.

An ideal licensure examination according to ASDA is threefold. It includes multiple aspects of dentistry that join together in producing a well-rounded practitioner. They include:

·       Manikin-based kinesthetic assessment

·       A non-patient based Objective Structured Clinical Examination (OSCE)

·       Submission of a portfolio of comprehensive patient care.

ASDA believes moving away from a live patient licensure examination is the best way to keep dentistry current and to move the profession in a positive direction.

Student Debt

With student debt constantly looming over every dental student’s head, ASDA has made this a priority in its advocacy initiatives. This has been a consistent topic for lobbying at ADA/ASDA Lobby Day for a number of years. ASDA encourages Congress to support measures to:

·       Reduce student loan interest rates

·       Provide refinancing opportunities to borrowers

·       Provide opportunities for loan forgiveness, scholarships, grants and tax deductibility

Specific legislation that has been brought up in Washington, D.C., and supported by ASDA includes three main pieces:

Photo from: https://blog.credit.com/2014/06/i-have-520k-in-student-loans-where-do-i-start-84603/

Photo from: https://blog.credit.com/2014/06/i-have-520k-in-student-loans-where-do-i-start-84603/

  1. Reauthorization of the Higher Education Act – This was originally established to allow students access to federal loans. The legislation hasn’t been authorized in over a decade and needs to be updated to ensure dental students have the loan support they need for years to come.

  2. Student Loan Refinancing and Recalculation Act – Currently, any federal loans cannot be refinanced in the federal sector. This legislation would eliminate that rule and allow students to continue to be eligible for loan forgiveness programs even after refinancing.

  3.  Resident Education Deferred Interest (REDI) Act – When graduate students decide to go on to residency, they are also agreeing to accrue interest throughout that time. With reduced (or no) income, the interest accrued during residency can pile on quick. This legislation would halt accrual while students were in residency programs.

Midlevel Providers

Photo from: https://www.khi.org/news/article/national-advocates-mid-level-dental-providers-meet

Photo from: https://www.khi.org/news/article/national-advocates-mid-level-dental-providers-meet

ASDA’s definition for a midlevel provider is “an individual who is not a dentist with four years of post-collegiate education…who may perform irreversible procedures on the public”. Proponents of these providers argue that they will solve barriers to care. While ASDA supports the reduction of barriers to care, it argues that midlevel providers are not the solution. ASDA’s policy states that only a qualified dentist should:

·       Diagnose and treatment plan

·       Prescribe work authorizations

·       Perform surgical/irreversible dental procedures

·       Prescribe drugs and/or other medications.

Given the rigorous educational path dentists traverse, it is not possible for other programs to prepare students to provide comprehensive care and understand all the medical intricacies that dentistry entails. ASDA has provided some alternatives to dental therapy that include:

·       Children’s Health Insurance Program (CHIP)

·       Increasing Medicaid Reimbursement Rates and extend coverage of procedures

·       Increasing health service corps job opportunities for dentists in underserved areas

·       Encouraging increased participation in outreach programs (i.e. Give Kids a Smile, Mission of Mercy).

Be sure to reach out to the Legislative committee if you want to get more involved and educated in dental policy!