The Role of Law and Policy in Increasing the Use of the Oral Health Care System and Services Law and Health Policy Law and Health Policy Authors Burton L. Edelstein, DDS, MPH, Professor of Dental Medicine and Health Policy & Management at Columbia University Irving Medical Center; former Senior Fellow in Public Policy, Children’s Dental Health Project Jane Perkins, JD, MPH, Legal Director, National Health Law Program; Senior Attorney, Network for Public Health Law Clemencia M. Vargas, DDS, PhD, retired Associate Professor, Division of Pediatric Dentistry, University of Maryland, School of Dentistry, Baltimore, MD Report Working Group Carol Bassim, DMD, former Project Officer, Division of Oral Health (DOH), Indian Health Service (IHS) Diane Brunson, RDH, MPH, Director of Public Health and Interprofessional Education, University of Colorado Denver School of Dental Medicine Shelly Gehshan, MPP, Health Policy Consultant and Coach Julie Frantsve-Hawley, RDH, PhD, former Executive Director, National Office, American Association of Public Health Dentistry (AAPHD) Timothy J. Iafolla, DMD, MPH, Public Health Analyst, Office of Science Policy and Analysis, National Institute of Dental and Craniofacial Research, National Institute of Health (NIH) Elizabeth Jackson, National Center for Health Statistics, Centers for Disease Control and Prevention (CDC), Department of Health and Human Services (HHS) Nicole Johnson, MPH, Associate Director for Policy Partnerships and Strategic Communication, DOH, CDC Renée W. Joskow DDS, MPH, FAGD, Chief Dental Officer, Health Resources and Services Administration (HRSA) Frances Kim, DDS, MPH, DrPH, Executive Director, AAPHD David Krol, MD, MPH, Medical Director, New Jersey Institute for Food, Nutrition, and Health, New Jersey Healthy Kids Initiative -— 2 Law and Health Policy Laurie Norris, JD, former Senior Policy Advisor, Centers for Medicare and Medicaid Services (CMS ) Kathleen O’Loughlin, DDS, MPH, Executive Director, American Dental Association (ADA) Timothy L. Ricks, DMD, MPH, FICD, IHS Oral HPDP Consultant and Healthy People 2020 Oral Health Workgroup Member Gina Thornton-Evans, DDS, MPH, Dental Officer, Surveillance, Investigations, and Research Team, DOH, CDC Marko Vujicic, PhD, Chief Economist and Vice President, Health Policy Institute, ADA Katherine Weno, DDS, JD, former Director, DOH, CDC; current Public Health Consultant Cassandra Yarbrough, MPP, former Lead Public Policy Analyst, Health Policy Institute, ADA Sirin Yaemsiri, PhD, former Data Analyst, CDC/National Center for Health Statistics (NCHS) Project Staff Angela K. McGowan, JD, MPH, Project Director, Office of Disease Prevention and Health Promotion (ODPHP), HHS Tiffani M. Kigenyi, MPH, Public Health Analyst, ODPHP, HHS Katheryne (K.T.) Kramer, JD, MHA, former Public Health Analyst, ODPHP, HHS (CDC Foundation Assignee) Boatemaa A. Ntiri-Reid, JD, MPH, former Associate Service Fellow, ODPHP, HHS (CDC Assignee) Other Acknowledgments • Carter Blakey, Deputy Director, ODPHP, HHS • Julia Charles, JD, former Legal Analyst/ORISE Fellow, Public Health Law Program, CDC • Kathleen Ethier, PhD, former Director, Program Planning and Evaluation Office, CDC • Rachel Ferencik, MPA, Senior Program Officer, CDC Foundation • Abigail Ferrell, JD, MPA, Public Health Analyst, Public Health Law Program, CDC -— 3 Law and Health Policy • Sheri Gaskins, Technical Director, Divison of Benefits and Coverage, Center for Medicaid and CHIP Services, CMS • Healthy People 2020 Federal Interagency Workgroup’s (FIW) Law and Health Policy Workgroup • Healthy People 2020 Oral Health Workgroup • Alexandra Hess, JD, former Intern, ODPHP, HHS • Deborah Magsaysay, former Program Officer, CDC Foundation • Giridhar Mallya, MD, MSHP, Senior Policy Officer, Robert Wood Johnson Foundation (RWJF) • Linda McGehee, PhD, RN, Team Lead for Infectious Disease Programs, CDC Foundation • Emmeline Ochiai, JD, MPH, Senior Public Health Advisor, ODPHP, HHS • Matthew Penn, JD, MLIS, Director, Public Health Law Program, CDC • Matthew Pierce, JD, MPH, Senior Program Officer, RWJF • Montrece Ransom, JD, MPH, Team Lead, Training and Workforce Development, Public Health Law Program, CDC • Donald Schwarz, MD, MBA, MPH, Vice President, Program, RWJF • Sekou Sidibe, MPH, former Senior Program Officer, CDC Foundation • Andrew Snyder, MPA, Health Insurance Specialist, CMS • Claire Stinson, Communications Officer, CDC Foundation • Eric Strunz, MPH, Program Officer, CDC Foundation • Amy Tolchinsky, Communications Director, CDC Foundation • Don Wright, MD, MPH, former Deputy Assistant Secretary for Health; Director, ODPHP, HHS • Catherine H. Zilber, MSc, Associate Vice President for Infectious Disease Programs, CDC Foundation -— 4 Law and Health Policy Table of Contents Preface ............................................................................................................................... 7 Introduction ....................................................................................................................... 9 Legal Background ......................................................................................................... 14 Financing ....................................................................................................................... 14 Workforce ...................................................................................................................... 15 Utilization ....................................................................................................................... 16 Financing of Oral Health Care ....................................................................................... 17 Publicly Financed Oral Health Coverage ...................................................................... 26 Medicaid .................................................................................................................... 26 Coverage of Oral Health Services for Adults ............................................................. 27 Medicaid Coverage of Children ................................................................................ 31 Medicaid and Provider Participation ......................................................................... 34 Medicaid Delivery Systems ....................................................................................... 35 Children’s Health Insurance Program ....................................................................... 37 Indian Health Service (IHS) ....................................................................................... 37 The Patient Protection and Affordable Care Act ....................................................... 38 Population-Based Oral Health ....................................................................................... 41 Ryan White HIV/AIDS Program (RWHAP) .................................................................. 41 Head Start .................................................................................................................. 42 Government’s Role in the Oral Health Workforce ....................................................... 43 Approaches to Expanding Oral Health Access Through State Authorities ................... 48 Traditional Oral Health Providers and Access to Care .............................................. 49 New Dental Providers Who May Contribute to Expanded Access and Improved Oral Health ................................................................................................................. 54 The Role of States in Improving Access to Oral Health through Practice Acts and New Models of Care .................................................................................................. 58 The Role of States in Improving Access to Oral Health Through Dental Public Health Authorities and State Oral Health Coalitions ................................................................. 61 -— 5 Law and Health Policy Challenges in Accessing Available Oral Health Care .................................................. 62 Transportation ................................................................................................................ 63 Immigration Status ......................................................................................................... 64 Cultural Competency ..................................................................................................... 66 Cultural Sensitivity ..................................................................................................... 67 Plain Language .......................................................................................................... 68 Language Interpretation ............................................................................................ 68 Hours of Service ............................................................................................................ 70 Discrimination Based on Race, Color or National Origin, Disability, Age and Sex ....... 72 Summary ........................................................................................................................ 73 Recommendations for Additional Research ................................................................ 74 Integrating Oral Health Research into Payment and Delivery Systems ........................ 74 Evaluating Models of Care ........................................................................................ 74 Caries Management .................................................................................................