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News from the week of May 29, 2023

• AS MEDICAID PURGE BEGINS, 'STAGGERING NUMBERS' OF AMERICANS LOSE COVERAGE (KFF) – An early analysis of Medicaid membership changes across different states finds more than half a million people have already been dropped in the 11 states that have provided data. Four out of every five people dropped either never returned the paperwork or omitted required documents. Some states are pivoting on policy to minimize these paperwork disenrollments. 


• LEGISLATORS NIX GOVERNOR'S MEDICAID SERVICE EXPANSION, BUT IT WILL REMAIN IN PLACE FOR NOW (Winchester Sun) – Medicaid expansion programs remain intact in Kentucky until at least the next legislative session.


• MORE STATES OK POSTPARTUM MEDICAID COVERAGE BEYOND TWO MONTHS (KFF) – At least eight states are seeking approval this year to extend postpartum Medicaid coverage.


• A KICK IN THE TEETH (Leader's Edge Magazine) – A discussion of potential impacts of dental medical loss ratios that have popped up in several states on employers and plan participants.


• MEMBERS' SATISFACTION WITH COMMERCIAL HEALTH PLANS DECLINES (Healthcare Dive) – A JD Power survey found a 13% drop in member satisfaction with commercial health plans. Top issues were customer service, coverage and benefits, provider choice and information and communication.


• A-ROD, ORAPHARMA PROMOTE GUM DISEASE AWARENESS (Dr. Bicuspid) – 2009 World Series champ Alex Rodriguez is the patient ambassador for a new U.S. gum disease awareness campaign.


• 2023 MEDICAID AND CHIP BENEFICIARIES: ORAL HEALTH AT A GLANCE (CMS) – Infographic with utilization, expenditures and oral health statistics among Medicaid and CHIP beneficiaries.

News from the week of May 22, 2023

• RHODE ISLAND LEGISLATURE INTRODUCES MEDICAL LOSS RATIO BILL (Becker's Dental) – Rhode Island has introduced a medical loss ratio bill for dental in the state similar to the plan being implemented in Massachusetts.


• VERMONT COULD RAISE MEDICAID REIMBURSEMENTS FOR DENTISTS IN 2024: 6 NOTES (Becker's Dental) – Vermont is expected to raise Medicaid dental reimbursement rates in 2024.


• MINNESOTA EXPANDS DENTAL MEDICAID BENEFITS FOR ADULTS (Becker's Dental) – An expansion of Minnesota adult dental Medicaid benefits will include comprehensive dental coverage. 


• 21% OF AMERICANS SKIPPED DENTAL CARE IN 2022: REPORT (Becker's Dental) – A May Federal Reserve report found 21% of Americans skipped visiting the dentist in 2022. 


• INSURERS SET TO PAY $1.1B IN PREMIUM REBATES THIS YEAR: KFF (Fierce Healthcare) – Payers will pay about $1.1 billion in rebates, primarily due to lower utilization rates post-COVID. 


• MANY ARE UNAWARE OF MEDICAID REDETERMINATIONS: KFF (Fierce Healthcare) – A KFF study found a great deal of confusion among Medicaid beneficiaries regarding the redetermination process.


• US PREVENTATIVE SERVICES TASK FORCE REPORTS INSUFFICIENT EVIDENCE FOR PRIMARY CARE ORAL HEALTH SAVINGS (Becker's Dental) – A task force working to determine whether primary care clinicians can complement the work of dental professionals said more research is needed.


• CMS ADDS ORAL HEALTH INITIATIVE TO STRATEGIC PLAN (Becker's Dental) – CMS has add an oral health initiative to its’ strategic plan that will “consider opportunities to expand access to oral health coverage using existing authorities and health plan flexibilities.” 


• HOW 5 RETAILERS ARE DISRUPTING HEALTHCARE (AND WHAT THAT MEANS FOR PROVIDERS) (The Advisory Board) – A status update on major retailers efforts to expand their positions in the healthcare space.

News from the week of MaY 14, 2023 

• POOR ORAL HEALTH HOLDS MANY BACK FROM SMILING (Dr. Bicuspid) – A survey of seniors looks at the links between mental health and oral health.


• PRATICE MODALITIES AMONG U.S. DENTISTS (ADA HPI) – The ADA has an updated report on dental practice trends, illustrating the movement towards DSOs and larger group practices.


• DENTAL M&A OUTLOOK FOR 2023: SALES WILL SURGE, THEN COOL FOR 2ND HALF OF YEAR (Dr. Bicuspid) – An M&A advisory firm provides an update on expected growth in the DSO market as well as dental mergers and acquisitions.


• UNINSURED RATE FELL 18% DURING PANDEMIC, CDC FINDS (Healthcare Dive) – A new report from the CDC finds that the number of uninsured dropped by 5.6 million people from 2019 to 2022 thanks to subsidies and rules preventing states from removing people from their Medicaid rolls during the public health emergency.


• ADA RESPONDS TO CMS REQUEST REGARDING RE-INCLUSION OF DENTAL SERVICES AS A SPECIFIC SUPPLEMENTAL BENEFIT (ADA News) – The ADA expressed support for requiring reporting on Medicare dental benefits as well as an assessment of Medicare Advantage spending on dental services and dental loss ratio details.


• CRISPR-BASED TECHNOLOGY SHOWS PROMISE FOR ORAL HEALTH ASSESSMENT (Dr. Bicuspid) – A saliva sample could soon be used to quickly detect a wide range of oral and systemic diseases. 


• EYE CARE SPACE SHOWS NEW DEVELOPMENTS IN 2023 FOR DIABETES CARE (Optometry Times) – Prevention, detection, and treatment of eye disorders brought on by diabetes have seen several recent advances.


• STATE PREPARES FOR MEDICAID DENTAL PROCUREMENT (Florida Politics) – Florida has released a request for information for bidding for their Medicaid Prepaid Dental Program, with an increased emphasis on programs for persons with intellectual and developmental disabilities.


• SKYGEN AND TEAMSMILE ANNOUNCE PARTNERSHIP (Wis Business) – Learn about SKYGEN’s new partnership with TeamSmile.

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News from the week of mAY 7, 2023

• THE 2023 STATE OF AMERICA'S ORAL HEALTH AND WELLNESS REPORT (Delta Dental Plan Association) – This annual survey looks at attitudes around oral health and dental insurance and highlights differences between generations.


• MEDICAID ENROLLMENT AND UNWINDING TRACKER (KFF) – KFF unveiled a tracker that shows state level changes in Medicaid enrollment.


• CAREQUEST URGES STATES TO EXTEND MEDICAID POSTPARTUM COVERAGE (Dr. Bicuspid) – CareQuest’s report on Medicaid postpartum coverage looks at the role of dental benefits.


• MISSOURI LEGISLATURE PASSES POSTPARTUM MEDICAID EXTENSION (Missouri Independent) – Missouri’s bill to extend postpartum Medicaid coverage from 60 days to one year is ready for the governor’s signature. 32 states have already passed similar measures.


• PROPOSED WORK REQUIREMENTS COULD END FEDERAL MEDICAID COVERAGE FOR 1.7 MILLION PEOPLE (KFF) – KFF looks at last week’s Congressional Budget Office report on the impact of proposed work requirements for Medicaid eligibility and finds that an estimated 1.7 million Medicaid members could lose coverage.


• 4 POST-PANDEMIC DENTAL INDUSTRY TRENDS: HERE TO STAY? (Dentistry IQ) – One dentist reflects on changes such as teledentistry and 3D printing in the dental industry post-COVID.


• 3 STATES APPROVING DENTAL, DENTAL HYGIENIST LICENSE PORTABILITY LEGISLATION (Becker's Dental) – Washington, Tennessee and Iowa have passed an ADA-supported policy of license portability for dentists and dental hygienists. At least four more states would need to join for the measure to go into effect. 


• NEW WA LAW WILL BRING DENTAL CARE TO UNDERSERVED COMMUNITIES (Leavenworth Echo) – New legislation in Washington state will authorize dental therapists to work in community health clinics and federally qualified health centers.

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News from the week of April 30, 2023

• ECONOMIC OUTLOOK AND EMERGING ISSUES IN DENTISTRY (ADA HPI) – The ADA’s HPI is out with their latest monthly economic outlook report. Appointment schedules and wait times both increased in April, while recruitment of hygienists and assistants remains challenging.


• U.S. DENTIST DEMOGRAPHIC DASHBOARD (ADA) – The ADA has a new dashboard that digs into dentist demographics including age, race and per-capita numbers. 


• NEVADA MEDICAID GETS $2.5 MILLION TO EXPAND DENTAL SERVICE FOR THE DISABLED (KOLO TV) and SETTLEMENT EXPANDS NY'S MEDICAID COVERAGE FOR MEDICALLY NECESSARY DENTAL PROCEDURES (Newsday) – Nevada is expanding access to dental services for the disabled with a grant that will expand specialty care for a range of services, from cleanings to sedation, while about five million New Yorkers will see expanded dental coverage after a federal class-action lawsuit. 


• MOLINA EXPECTS HALF OF MEDICAID ENROLLESS GAINED DURING COVID TO LOSE ELIGIBILITY DUE TO REDETERMINATIONS (Healthcare Dive) and 70% INELIGIBLE IN START OF NEW HAMPSHIRE MEDICAID UNWINDING (U.S. News) – Two stories touch on some early signs of large drop-offs in Medicaid rolls as the redetermination process gets underway.


• CMS PROPOSES ACCESS, TRANSPARENCY OVERHAULS FOR MEDICAID, CHIP (Fierce Healthcare) – CMS has proposed two new rules focused on increasing access and quality of care, and increasing transparency into provider payment rates for Medicaid and CHIP. 


• CBO: MEDICAID WORK REQUIREMENT WOULD LEAVE 600,000 UNINSURED (Healthcare Dive) – The Congressional Budget Office estimates that over half a million adults would lose Medicaid coverage under new proposed work requirements.


• WITHOUT VEHICLE OR VIABLE PUBLIC TRANSIT 1 IN 5 MISS NEEDED HEALTHCARE: REPORT (Healthcare Dive) – The Urban Institute reports that more than 20% of people without a personal vehicle and lacking good access to public transportation have gone without needed medical care.


• HALF OF ALL ELIGIBLE MEDICARE BENEFICIARIES ARE NOW ENROLLED IN PRIVATE MEDICARE ADVANTAGE PLUS (KFF) and CEO OF CVS WARNS THERE'S A MEDICAID 'TSUNAMI' HEADING FOR THE U.S. (Yahoo Finance) – Medicare Advantage is now providing coverage for 50% of Medicare recipients. This percentage is expected to continue increasing while the total number of seniors is expected to more than double in the next 40 years.


• POLICY CHANGES IN MEDICARE ADVANTAGE AND THE IMPLICATIONS FOR CODING, RISK ADJUSTMENT AND REIMBURSEMENT (Health Management Associates) – Researchers discuss potential impacts of Medicare Advantage rate change policy updates.


• USING ORAL HEALTH EQUITY DATA TO IMPROVE PATIENT CARE (CareQuest Institute for Oral Health) – A webinar on May 18th will look at using oral health equity data to improve patient care.

News from the week of april 23, 2023

• HOW MANY PEOPLE MIGHT LOSE MEDICAID WHEN STATES UNWIND CONTINUOUS ENROLLMENT? and STATE POLICY CHOICES ARE LIKELY TO AFFECT THE EXTENT OF MEDICAID ENROLLMENT DECLINES DURING THE UNWINDING PERIOD (KFF) – As Medicaid redeterminations begin, KFF has two reports that detail expected losses in Medicaid membership nationally (8M to 24M) and by state. They also identify specific state policy choices that are likely to have an impact on membership losses.


• WITH MEDICAID REVIEW UNDERWAY, HUNDREDS OF CALLERS A DAY GIVE UP (Oregon Capital Chronicle) and MEDICAID REDETERMINATIONS, EXPANSION SET TO COLLIDE IN NORTH CAROLINA (Fierce Healthcare) – In Oregon, officials are already seeing cracks in their ability to handle increased call volumes of Medicaid members, while in North Carolina officials hope that simultaneous efforts to process redeterminations and Medicaid expansion launch will help prevent more people from becoming uninsured. 


• UNDERSTANDING THE INTERSECTION OF MEDICAID & WORK: A LOOK AT WHAT THE DATA SAY (KFF) – As Congressional Republicans indicate that their budget will include Medicaid work requirements, KFF looks at the results of previous work mandates.


• SMILED ACT TARGETS MEDICAID ADMINISTRATIVE BARRIERS: 4 NOTES (Becker's Dental) – The SMILED Act aims to reduce administrative burdens for dentists participating in Medicaid. 


• PCC, FAMILIES USA AND 230 ORGANIZATIONS URGE CONGRESS TO REJECT MEDICAID CUTS (Primary Care Collaborative) – A coalition of groups has written Congressional leaders urging them to reject cuts to Medicaid


• BESHEAR ADMINISTRATION ISSUES REGULATIONS TO MAINTAIN EXPANSION OF MEDICAID  (Commonwealth Journal) – Kentucky Governor Beshear tries again to expand dental, vision and hearing benefits for adult Medicaid after the legislature ended previous regulations.


• HEALTHCARE ORGS REMAIN ON THE DEFENSE IN CYBERSECURITY (Fierce Healthcare) – A recent study shows that healthcare organizations are not proactive enough when it comes to cybersecurity. Related content: Why Does SKYGEN Maintain HITRUST Certification?


• AMERICANS SEEK CHEAPER DENTISTRY IN MEXICO'S 'MOLAR CITY' (Yahoo News) – Thousands of Americans make the trek each day to Los Algodones, Mexico or “Molar City,” which caters to Americans seeking more affordable dental care. 

News from the week of March 16, 2023

• 14M PEOPLE COULD LOSE DENTAL COVERAGE AS MEDICAID REDETERMINATIONS RESTART: REPORT (Fierce Healthcare) – CareQuest predicts more than 14 million could lose dental coverage due to the Medicaid redetermination process. Read the CareQuest Medicaid Redetermination Dental Coverage report.


• 6 FEDERAL GOVERNMENT, POLICY UPDATES FOR DENTISTS TO KNOW (Becker's Dental + DSO Review) – Support for the Medicaid Dental Benefit Act and a change in federal student loan interest accrual for dental and medical students are among some recent policy news items.


• MOST PAYERS USED OUTCOMES-BASED CONTRACTING IN 2022 (Healthcare Finance) – Many payers that incorporate value-based programs are incorporating both clinical and claims-based measures. 


• MCKINSEY SEES 45% DROP IN INSURTECH ACA EXCHANGE PARTICIPATION (ThinkAdvisor) – Insurtechs retreated from the ACA market in 2022, while national insurers expanded their footprint.


• GOOGLE, MICROSOFT AND STARTUPS TEST OUT GENERATIVE AI IN HEALTHCARE + QUANTUM COMPUTING POISED TO TRANSFORM HEALTHCARE (Fierce Healthcare) –  Tech giants and startups alike are testing the potential for large language models (ChatGPT), and generative AI, as well as quantum computing and machine learning in healthcare.


• 3 WAYS CMS' 2024 BENEFIT AND PAYMENT FINAL RULE AFFECTS STAND-ALONE DENTAL PLANS (Becker's Dental + DSO Review) – How CMS’ benefit and payment final rule will affect stand-alone dental plans, including rules on network adequacy.


• NO SURPRISES ACT LARGELY SUCCESSFUL IN PROTECTING CONSUMERS THOUGH GAPS REMAIN, STAKEHOLDERS SAY (Fierce Healthcare) – A report from the Urban Institute and others found that the No Surprises Act was largely effective in protecting consumers from surprise balance bills. See the related blog post: SKYGEN’S Proactive Approach to Compliance Means No Surprises for Insurers 


• CMS RAISES CAP ON NONSTANDARD PLANS IN FINAL ACA EXCHANGE RULE (Fierce Healthcare) – CMS is increasing the number of nonstandard plan options to four "will reduce plan choice overload while continuing to provide a robust number of options for consumers to help fit their health needs." The rule also finalizes a special enrollment period that would allow people who lose coverage in Medicaid or CHIP to secure a plan on the ACA exchanges. 


• BIDEN ADMINISTRATION UNVEILS PLAN TO EXPAND HEALTH CARE TO DACA RECIPIENTS (9 News) – The Biden Administration is preparing a rule change that would open Medicaid and ACA coverage to DACA recipients.


• THE COMMERCIAL BENEFITS LANDSCAPE: THREE TRENDS DRIVING INNOVATION AND WHAT THESE MEAN FOR THE CONSUMER EXPERIENCE (Healthcare Business Today) – SKYGEN’s John Schaak highlights three trends transforming the healthcare consumer experience from a panel discussion of industry leaders at last fall’s SKYGEN Summit on “Innovations in the Commercial Market” 

News from the week of April 10, 2023

• IN TWO-STATE TEXARKANA, A WIDENING DIVIDE IN HEALTH CARE ACCESS (Texas Standard) – A study of residents of Texarkana, which is in both Arkansas (Medicaid expansion) and Texas (no expansion and the highest rate of uninsured in the US) shows a stark difference in levels of insured and health outcomes. Joshua Talley, a dentist at Texarkana Care Clinic in Arkansas, said patients with private insurance typically need a “fraction” of the care that self-pay and Medicaid patients do, likely because they have better access to preventive care. “I can just look at X-rays and tell you who’s who,” he said.


• YOUNGER MEDICARE MEMBERS REPORT GREATER ACCESS, COST ISSUES (Fierce Healthcare) – A study found that younger people enrolled in Medicare due to long-term disabilities report more issues with cost and access to care than seniors.


• BILL ADDS MORE DENTAL COVERAGE TO MEDICAID (KFYR) – The North Dakota Senate passed a bill that increases that dental services under Medicaid.


• EMPLOYEES SEE VISION BENEFITS AS CRITICAL BUT OFTEN LEAVE THEM ON THE TABLE, SURVEY FINDS (BenefitsPro) – A recent survey shows a gap in usage of vision benefits by workers due to a lack of clear benefits information from employers and high out-of-pocket costs. 


• ADA REPORT ON ELECTRONIC DENTAL BENEFITS AVAILABLE FOR COMMENT (ADA) – The ADA is seeking comment on a draft set of technical guidelines for electronic dental benefit eligibility and benefit determination for providers and payers.


• COALITION URGES LAWMAKERS TO PASS MEDICAID DENTAL BENEFIT ACT (ADA) – A coalition of oral health and advocacy organizations is urging Congress to pass the Medicaid Dental Benefit Act, which would make comprehensive dental care a mandatory component of Medicaid coverage for adults in every state.


• THE TIME FOR PAYER AND PROVIDER INDUSTRY COLLABORATION IS NOW: INSIGHTS FROM THE SKYGEN TRANSFORM 2022 (Healthcare Business Today) – SKYGEN’s COO Kyle Koltz shares insights from the panel discussion of industry leaders from last fall’s SKYGEN Summit on “The Future of the Provider’s Digital Journey."

News from the week of April 3, 2023

• KFF ROUNDUP: HOW MANY UNINSURED ARE IN THE COVERAGE GAP AND HOW MANY COULD BE ELIGIBLE IF ALL STATES ADOPTED THE MEDICAID EXPANSION? | 5 CHARTS ABOUT PUBLIC OPINION ON MEDICAID | KFF HEALTH TRACKING POLL MARCH 2023: PUBLIC DOESN'T WANT POLITICIANSTO UPEND POPULAR PROGRAMS (KFF) – KFF has several new reports on the Medicaid coverage gap as well as public polling on Medicare, Medicaid and ACA plans.


• CMS TO RAISE MEDICARE ADVANTAGE PAY RATES BY 3.3% IN 2024; PHASE IN RISK ADJUSTMENT CHANGES (Fierce Healthcare) – CMS will raise Medicare Advantage payments by 3.32% in 2024, slightly above the 1% raise that it proposed after an intense lobbying campaign from insurers. 


• BIDEN ADMINISTRATION ANNOUNCES APPEAL TO ACA PREVENTIVE MADATE RULING (Healthcare Dive) – The Biden administration has appealed a ruling by a Texas judge that sought to strike down preventive medical mandates in the Affordable Care Act. 


• 900 ORAL HEALTH CARE PROVIDER VIEWPOINTS INFORM LATEST NCD RECOMMENDATIONS ON MEDICAID, MEDICARE (GlobeNewswire) – The National Council on Disability has released a report focused on addressing unmet oral health care needs of people with intellectual and developmental disabilities (I/DD).


• KENTUCKY LAWMAKERS NIX EXTRA MEDICAID BENEFITS, BUT BESHEAR WILL ACT TO KEEP THEM (WKMS) – Kentucky Governor Beshear is exploring ways to reinstate expanded Medicaid dental coverage in the state.


• MEDICAID ENROLLMENT IN 28 STATES WILL REVERT TO PRE-PANDEMIC LEVELS OR HIGHER: MOODY'S (Fierce Healthcare) – Moody’s estimates that in at least 28 states, Medicaid enrollment will remain at or above pre-pandemic levels. 


• ROUNDUP: UPDATES FROM THE NATIONAL ASSOCIATION OF MEDICAID DIRECTORS (HealthLeaders Media) – New leadership and a host of challenges including staffing challenges are top of mind for the National Association of Medicaid Directors.


• AMERICAN ACADEMY OF OPHTHALMOLOGY RALLIES AGAINST EXPANDING PRIOR AUTHORIZATION TO MEDICARE FEE FOR SERVICES (Ophthalmology Times) – The American Academy of Ophthalmology has expressed opposition to any expansion of prior authorization to Medicare fee-for-service plans.


• AOA, STATE ASSOCIATIONS FIGHT LEGISLATION THAT SPECIFIES 'DOCTOR' DESIGNATION (Healio) – The American Optometric Association opposes legislation that potentially prohibits doctors of optometry from being called doctors and physicians in several states.

News from the week of March 27, 2023

• ADA APPLAUDS MEDICAID DENTAL BENEFITS ACT OF 2023 (Becker's Dental) – The ADA is supporting legislation that would mandate comprehensive dental coverage under Medicaid for adults in every state and would increase the federal medical assistance percentage for these services. 


• 'WE'RE NOT DEAF TO THE COMPLAINTS': BIG PAYERS MOVING TO CUT PRIOR AUTHORIZATION REQUIREMENTS (Becker's Payers Issues) – Large payers are cutting prior authorization requirements for some procedures after criticism from providers.


• OKLAHOMA WINS EXPANDED COVERAGE FOR NEW MOMS (Journal Record) – Oklahoma is the 30^th state to expand Medicaid postpartum care to 12 months.


• BESHEAR VETOES SB, LEGES OVERRIDE BESHEAR VETOES, INCLUDING ANTI-TRANS BILL  (Courier Journal and Forward Kentucky) – Kentucky Governor Beshear vetoed a bill this week that would have cut the recently expanded Medicaid dental and vision. However, his veto has been overridden.


• NORTH CAROLINA BECOMES 40^TH STATE TO EXPAND MEDICAID (Healthcare Dive) – North Carolina’s governor has signed the bill to expand Medicaid in that state. 


• MA BENEFICIARIES SATISFIED WITH COVERAGE BUT FACE FINANCIAL BARRIERS (HealthPayerIntelligence) – An ehealth survey of Medicare Advantage and Medicare Supplement members shows high levels of satisfaction but over half of beneficiaries (65 percent) said out-of-pocket costs higher than $1,000 are unaffordable.


• HOW DOES MEDICAL INFLATION COMPARE TO INFLATION IN THE REST OF THE ECONOMY? (KFF) – Health spending growth continues to lag behind price increases for consumer goods and services, with inflation reaching a four-decade high in mid-2022.


• APRIL JADA FINDS PERIODONTAL TREATMENT MAY REDUCE HEALTH CARE COSTS FOR PATIENTS WITH DIABETES (ADA) – A recent study showed periodontal treatment appears to decrease health care costs for patients with diabetes.