2024 Legislative Session

The MDA's contract lobby firm, Gamble & Schlemeier, publishes The Weekly Pulse, where its team provides updates on pending legislation, proposed regulations, budget news, and other relevant information. This update gives a "weekly scoop" on various topics, not just dental issues or MDA priority items.

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The Affordable Care Act (ACA) established that major medical plans pay certain percentages of the collected premiums for medical care vs. administrative costs. No such requirement exists for dental plans, which are considered “excepted benefits.”

MDA, utilizing the model language approved by the ADA and National Council of Insurance Legislators (NCOIL), will work to require a “Dental” Loss Ratio applies to dental plans the same way it applies to medical.

This bill will require dental insurance companies to spend a minimum percentage of patient premiums on patient care or refund the difference back to the individuals and/or groups.

Additional Resources

• MLR: Let's work together to improve access to dental care (Dr. Jeremy Bowen)
• Exploring MLR and What it Means for Dental Patients (ADA Talk Podcast)

HB2087 – Modifies provisions relating to methods of reimbursement to health care providers (MDA Bill)
Sponsor: Rep. Michael O'Donnell (R)
Last action: 04/02/2024 S – Reported to the Senate and read first time.

SB1249 – Prohibits health carriers from using reimbursement methods that charge a fee to health care providers (MDA Bill)
Sponsor: Sen. Rusty Black (R)
Last action: 01/25/2024 S - Referred to Senate Committee on Insurance and Banking

These bills prohibit health carriers from using methods of reimbursement to health care providers which require the provider to pay a fee, discount the amount of a claim, or provide other remuneration.

Additional Information: In 2019, the Missouri passed legislation to require health carriers utilizing alternative methods of reimbursement, such as virtual credit cards (VCC), notify the provider of initiating/changing such method of payment, and permit the provider select an alternative payment method (opt-out).

Since then, the Association continues to receive numerous calls about carriers defaulting back to the use of VCC as the form of payment to the provider, despite opting out. In doing so these payments require providers pay a percentage of the reimbursement amount per claim.

This session, MDA has filed legislation to enhance the specifics of the provision in law, including that there be an “opt in” provision for VCC requiring that carriers receive an explicit, written consent from the provider before issuing payment via a virtual credit card.

HB2400 – Modifies provisions relating to payments made by insurers to providers for health care services
Sponsor: Rep. Bishop Davidson (R)
Last action: 03/06/2024 H – Voted Do Pass as substituted 

Additional Information:

In 2022, MDA passed legislation to include prepaid dental plans under Missouri’s Assignment of Benefits (AOB) statute. Previously, Missouri’s AOB law did not apply to prepaid dental plans. However, even with this passage, prepaid dental plans continue to claim exemption from assigning benefits agreed upon by patients directly to providers.

Insurers should be required to adhere to the law and stop the difficulty this brings to both patients and providers by the refusal to assign benefits to the provider. Since that time, we have been receiving calls that certain dental plans are refusing to assign the benefit to the provider and is still a major issue.

This session, MDA has filed legislation to try and fix certain loopholes these plans claim to have, and are also exploring other avenues to fixing the issue.

HB2075 – Establishes the dentist and dental hygienist compact
Sponsor: Rep. Jeff Coleman (R)
Last Action: 04/03/2024 H – Placed on Informal Calendar

SB778 – Establishes provisions relating to licensure of dentists and dental hygienists, including license reciprocity and the Dental and Dental Hygienist Compact
Sponsor: Sen. Karla Eslinger (R)
Last Action: 02/28/2024 S - Placed on Informal Calendar

These bills create the "Dentist and Dental Hygienist Compact". Dentists and dental hygienists licensed in a state that are participating in the interstate compact can practice in other participating states without additional requirements. The bill also enhances the ability of participating states to protect the public health and safety and cooperate in regulating the practice of dentistry and dental hygiene. 

Additional Details: The Dentist and Dental Hygienist Compact allows for greater licensure portability for dental professionals.

The Department of Defense (DoD), the Council of State Governments (CSG), the American Dental Association and the American Dental Hygienist’s Association have been involved in the development of language for these compacts.

The model language of the compacts are legally binding agreements among states that provide pathways through which dentists and dental hygienists can obtain a compact privilege. Dentists and dental hygienists would be licensed in one compact member state and then be allowed to practice in another participating state by obtaining this compact privilege. Seven states must adopt legislation to form a full compact commission, three states have already done so, Iowa, Tennessee, and Washington, and it is poised to be enacted in a few more states in 2023.

This session, the MDA will monitor and be supportive of the Association of Dental Support Organizations push for Missouri to enter the compact.

During the 2023 legislative session, we successfully maintained $90,000 for Donate Dental Services and $200,000 for Elks Mobile Dental Services in the FY24 budget. Additionally, we maintained last year’s historic rate increase for Missouri Medicaid dental providers (80% of 50th percentile of UCR).

We look forward to continuing conversations with members of the House and Senate budget committees to maintain funding for these dental items again in FY25.

HB1621 – Requires public water systems and public water supply districts that intend to start or stop fluoridation of their water supply on a continuing basis to seek and receive information about the impact of fluoridation from the local health department.
Sponsor: Rep. Doyle Justus (R)
Last action: 1/4/2024 H - Read Second Time

This bill requires any public water system or public water supply district that intends to start or stop fluoridation of its water supply on a continuing basis to seek and receive information about the impact of public water fluoridation from the local health department.

Additional Information: Legislation that would require public water systems that intend to stop or start water fluoridation of their water supply to first seek and receive information from their local health department about the impacts of fluoridation in their communities has been filed five of the last six legislative sessions.

Most recently, freshman Representative Doyle Justus (R – Troy) sponsored the bill in 2023, which passed out of the Health and Mental Health Policy Committee 10-1 but ultimately did not make it across the finish line.

This session, the MDA will monitor this legislation and offer supportive testimony.

SB1215 – Modifies the practice of dentistry to include the prescription and administration of vaccines.
Sponsor: Sen. Steven Roberts (D)
Last action: 01/25/2024 S - Referred to Senate-Governmental Accountability

Under this act, the practice of dentistry shall include the prescription and administration of vaccines for diseases related to dentistry, as well as the prescription and administration of vaccines in a state of emergency.

Additional Information: Missouri dental schools have filed legislation the last three sessions that would allow for dentists to give certain vaccines, either in a declared state of emergency or related to the oral cavity. The legislation would also require that dentists receive additional training as determined by the Missouri Dental Board before being able to administer any vaccines.

The bill has received a public hearing each year but 2023 was the first year the bill was voted out of committee. The bill continues to be heavily opposed by the Missouri State Medical Association and family physicians, who argue dentists do not have the proper training to administer vaccinations.

This session, MDA will continue to monitor this legislation and offer supportive testimony as long as it includes the three following criteria: 1) Vaccines must be related to the oral cavity or in a declared state of energy; 2) A dentist must not be mandated to give a vaccine; and 3) Before giving a vaccine, a dentist must take a proper training course approved by the Missouri Dental Board.

In 2021, the MDA formed an exploratory workforce committee charged with investigating workforce shortages within Missouri’s dental community, and possible solutions. One solution that a few other states have adopted is a type of scaling dental assistant.

The creation of this new health care role titled “Oral Preventative Expanded Function Dental Assistant” (OPA/OPA-EFDA) is being is being pursued through a limited pilot project, to be promulgated through the Missouri Dental Board (MDB), that would allow for expanded function dental assistants, with additional, approved training, to scale supragingivally limited to patients diagnosed as periodontally healthy or with gingivitis. Pursuing a pilot project first will also provide critical data to demonstrate the safety and value of OPAs.

Find complete information here.