Dental News - Midlevel provider bill is defeated in Maine

Dental Tribune USA

Wed. 7 August 2013

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AUGUSTA, Maine, USA: A recent “issue brief” from The Pew Charitable Trusts provides several examples of dentists in both business and academia supporting state initiatives to expand certain capabilities of non-dentist members of the dental services team. But Maine dentists are not listed among the examples.

An explanation for that might be found in a recent Bangor Daily News article by Matthew Stone in which the defeat of midlevel-provider legislation in the Maine Senate is attributed to heavy lobbying by Maine dentists. Just days before the Pew issue brief was released in June, the Maine Senate voted down legislation that would have created licensed “dental hygiene therapists” to help address the state's access-to-dental-care gap.

Fifty-three countries have similar licensing in place; and in the United States, Alaska and Minnesota have some form of midlevel licensing available to help address access-to-care challenges.

The Pew issue brief reports that approximately 15 states have some type of midlevel dental-care provider legislation under consideration. But in Maine, it’s back to the drawing board for proponents of such licensing.

The Main House had approved the “dental hygiene therapist” legislation by a 95–45 vote, sending it on to the Senate, where it was voted down in a 14–21 vote prior to being killed, Stone reported.

The proposed legislation was sponsored by Mark Eves, D-North Berwick, who is the House speaker. It was cosponsored by more than 40 legislators representing both parties, Stone reported.

Much of the legislation’s focus was on serving dental patients participating in MaineCare, the state’s version of Medicaid. Proponents had presented statistics on how many of the state’s residents were living in dental-service shortage areas identified by the federal government. The Maine Dental Association appears to have successfully challenged the accuracy of some of the statistics used to demonstrate a need for the bill.

One of the main statistics to be challenged was from a legislature-sponsored report on oral health care in Maine that had said 66 percent of the state’s population resided in “rural” areas. The Maine Dental Association argued the correct figure was 25 percent, and that the inaccurate figure was based on mixing together different definitions of ”rural” from two different federal agencies. Not in contention was the statistic that 13.5 percent of Main dentists practiced in “rural” areas. In response to the various statistics being used by the bill’s proponents, the Maine Dental Association posted an article on its website, www.dentalaccessformaine.org, written by one of its members, Jonathan Shenkin, DDS, MPH, a pediatric dentist from Augusta, who also serves on the faculty in Health Policy, Health Services Research and Pediatric Dentistry at Boston University School of Dental Medicine.

In the article, Shenkin acknowledges a need to increase children’s access to “evidenced-based dental prevention,” but chastises The Pew Charitable Trusts and other backers of the dental hygiene therapist legislation for “circulating briefs and information that contain numerous disparities.” Shenkin presents a point-by-point defense of the quality and comprehensiveness of dental health care for children throughout the state, painting a more positive picture than that presented by the bill’s proponents.

Shenkin writes: “Most distressing is the statistic frequently cited that 65 percent of MaineCare children do not have a dental home. Proponents of the bill suggest that their data comes from the federal CMS 416 form, a reporting tool used by Medicaid to compile statistics on services provided to eligible children in states. What interest groups, including Pew, fail to disclose is that MaineCare children who visit dentists at any of Maine’s 18 Federally Qualified Health Centers (FQHC) dental clinics are not reported on the CMS 416 form. This is a grave and unconscionable oversight.”

The bill’s proponents also had presented statistics showing that nearly 25 percent of Maine dentists planned to retire during the coming five years and 16 percent planned to cut back on their work hours. The Maine Dental Association countered that a dental school opening this fall at the University of New England, Biddeford, would help make up for the loss of providers.

In a press release issued after the defeat, House Speaker Eves says, “For no good reason, the Maine Senate has dealt a considerable blow to children who desperately need oral health care in our state. It’s terribly disappointing to see the interests of one special group win out over the best interest of the people of our state.”

Aug. 9, 2013, Editor’s Note: Following publication of this article, Tribune International received an email from Nate Myszka, senior associate, communications, with The Pew Charitable Trusts Children’s Dental Campaign, challenging Shenkin’s statement about CMS 416 form reporting. Myska forwarded a letter from Stefanie Nadeau, director of the Office of MainCare Services, in which Nadeau confirms that because of reporting rules implemented in February 2011, “It is our understanding that the CMS 416 does contain oral health data from the FQHCs that submitted encounter claims under the new rules.”

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