Dental Insurance Reform Takes Center Stage in ISDS’s 2024 Legislative Agenda

The dental insurance industry has not been accountable or transparent for decades, and it is a well-known issue that has persisted for far too long. Dentists continue to see firsthand the negative impact of inadequate coverage on patients who expect better value for their premium dollars.

Access to dental care is critical, not only for oral health, but also for overall physical, academic, and economic well-being. A 2021 study revealed that almost half of insured Americans forego dental visits or necessary procedures due to cost constraints. Neglected dental issues can rapidly escalate into severe pain, tooth loss, and gum disease, which is associated with serious conditions like diabetes, heart disease, strokes, kidney disease, Alzheimer's disease, adverse pregnancy outcomes, and even mental illness.

That is why at the forefront of ISDS's legislative agenda and strategic plan is the reform of dental insurance. Three key pieces of legislation are being proposed to revamp the existing system.

• Prioritizing Patient Care Over Profits with a Dental Loss Ratio: ISDS continues our fight to rectify decades of unaccountable behavior and practices within the dental insurance industry. Our proposal aims to shed light on dental insurance, making it more transparent and patient-focused. Under our dental loss ratio legislation, any health insurer or dental plan carrier offering dental insurance policies must annually submit a dental loss ratio filing to the Illinois Department of Insurance (DOI). The goal of this legislation is to establish a minimum dental loss ratio for dental carriers, ensuring that an adequate portion of premium payments are directed towards patient care. This not only enhances transparency but also empowers patients and employers to make well-informed decisions when evaluating dental insurance plans that provide the most value.
• Shielding Patients from Surprise Insurance Denials: Aiming to address cases where insurance companies initially agree to cover a dental procedure through prior authorization but later deny claims, ISDS is pushing to limit insurers’ ability to backtrack their commitments, except in specific situations.
• Simplifying Electronic Claims Submission: Dentists will soon be mandated to submit insurance claims electronically starting January 1, 2025. In light of this impending requirement, ISDS is working on legislation to extend the compliance deadline, provide exemptions, demand enhanced patient information from insurers, and require the insurer to provide an electronic claim system for dentists to use. This will ensure that dentists have the necessary insurance information they need to provide correct and accurate information to their patients.

Dental Practice Act

ISDS is introducing two pieces of legislation that will amend the Illinois Dental Practice Act.

• Protecting Consumers from the Dangers of DIY Teeth Straightening: ISDS seeks to bolster consumer protection for those using Do-It-Yourself (DIY) teeth straightening products in the state. The legislation aims to ensure that these individuals receive quality care, undergo proper examinations, and are provided informed consent.
• Licensing Legislation: Following significant delays in licensing various professions, including dentistry, the Illinois State Dental Society (ISDS) is taking proactive steps to mitigate future setbacks. Over the past year, the Illinois Department of Financial and Professional Regulation (IDFPR) faced substantial licensing delays, leading to adverse consequences such as delayed patient care, disruptions in the education of residents, and obstacles for newcomers entering the field.

Recognizing the urgency of the situation, ISDS engaged in a collaborative effort with IDFPR to promptly address these pressing issues. However, this collaborative effort also shed light on more systemic problems within the licensing process, prompting ISDS to champion proactive legislation aimed at preventing similar situations from recurring in the future.

This legislation seeks to address these items:

• Prevents residents from missing crucial training time by proposing a pre-practice allowance, allowing up to three months while awaiting licenses.
• For the year 2024, it waives faculty restricted license renewal fees for those who renewed in both 2022 and 2023, providing financial relief for faculty members.
• Waives renewal fees for licensure applicants, who are typically recent graduates not yet earning an income, who applied within six months before the renewal period starts, ensuring they can start practicing and providing patient care without extra renewal costs during the renewal year.

Illinois Medicaid Program

In this year’s legislative agenda ISDS continues to address the issues within the Illinois Medicaid program. Over the last year, we have heard from dentists in the Medicaid program about several issues. This year we have focused on two primary issues.  

• Anesthesia Rate Increase: The Medicaid rates for deep sedation dentistry have been a continued barrier to access. There have been situations where children have had to go from Southern Illinois to Chicago to receive dental care that requires deep sedation. To improve access to deep sedation, ISDS is seeking legislation that will increase the Medicaid reimbursement rates.
• Orthodontic Coverage: Currently in Illinois, the rules for determining who qualifies for orthodontic coverage are subjective and lack clear guidelines. The Illinois Department of Healthcare and Family Services (DHFS) uses a scoring tool to assess whether a Medicaid patient qualifies for orthodontic coverage. There have been cases where the provider believed the patient qualified for orthodontic care, but Medicaid later denied it.

Therefore, during the 2023 legislative session, ISDS introduced legislation to establish automatic qualifiers for determining eligibility for orthodontic services. ISDS collaborated with DHFS throughout the 2023 session to address this issue. By the end of the session, DHFS agreed to implement these standards through official rules. ISDS worked closely with DHFS over the summer to update both the scoring tool and the rules. These changes were initially planned to take effect by January 1, 2024. However, DHFS has now indicated that these changes will not be implemented.

Therefore, ISDS is seeking legislation to ensure these agreed upon changes are implemented by DHFS.

How to Stay Involved with Our Legislative Efforts

Your input matters. Legislators genuinely want to understand how these issues impact your practice. Your active involvement is crucial as we push forward. When the time is right during the session, we will send out action alerts to our members. We'll ask you to promptly respond to these alerts by reaching out to your legislators.

To ensure you stay in the loop about our efforts, please sign up for our text alerts. Simply text "toothparty" to 52886.

As always, we are committed to keeping our members informed throughout the session’s progress as we work to advance these issues. Together, ISDS can make a difference.