MDA Legislative History

Virtual Credit Cards (VCC) ( SB1359) Our virtual credit card legislation made it across the finish line! With so few bills being truly agreed to and finally passed, VCC legislation found success by being amended onto SB1359. Our bill this year required carriers to receive explicit, written consent from the provider before issuing payment via a virtual credit card. This legislation took effect August 28, 2024.

Assignment of Benefits (AOB) (SB1359) Assignment of benefits legislation also passed this year in SB1359. This legislation focuses on two things: 1) If a person with health insurance assigns their benefits to a healthcare provider, the insurance company must make the payment for healthcare services directly to that provider within 30 days. 2) If a person’s insurance doesn’t cover payment to out-of-network providers, and the insurance company approves the services from an out-of-network provider, payments will be made directly to that provider. This legislation will take effect January 1, 2026. 

Dental Related Appropriations were maintained in the budget as follows:

• Medicaid Reimbursement Rates: FY22 increased reimbursement rates for Missouri dental Medicaid providers have been maintained, and an increase in extraction and anesthesia codes to match 80% of the 50^th percentile UCR that was approved in the FY25 budget.
• Donated Dental Services: This funding was increased from $90,000 to $180,000 in the FY25 budget.
• Elks Mobile Dental: Funding was increased for the Elks Mobile van to $600,000 in the FY25 budget. The Elks Mobile van provides dental services to those with developmental disabilities or intellectual disability populations. 

Dental Network Leasing (SB45) – After two years of pushing this legislation, our dental network leasing bill made it across the finish line! It will require providers check a separate box on a contract allowing the insurance carrier to lease out their “in-network” status to other plans. If the box is not checked, then the insurance carrier may not lease out the provider’s “in-network” status to other plans.

Follow the links below for access to the recap video and the session recap article.
Video: Success for Dental Priorities
Focus Article 2023 Issue 2

Dental Related Appropriations

• Medicaid Reimbursement Rates: Last year’s increased reimbursement rates for Missouri dental Medicaid providers have been maintained in the FY24 budget.
• Donated Dental Services: This funding was maintained at $90,000 in the FY24 budget.
• Elks Mobile Dental: This funding was increased to $700,000 in the FY24 budget. The House budget committee added an additional $300,000, and the Senate added an additional $200,000, bringing the total allocation up from $200,000 to $700,000!
• Smiles of Hope Dental Clinic: Funded at $1 million, this is a new decision item in the FY24 budget for this charitable care clinic located in Dexter, Mo.

Historic Medicaid Rate Increase – One of the largest Medicaid rate increases in the state’s history, reimbursement rates for MO HealthNet dental providers will be 80 percent of the 50th percentile of 2022 UCR beginning July 1, 2023. In other words, this means 80 percent of the average 2022 fees for codes in a particular area. This increase means Missouri’s dental Medicaid reimbursement rates will be comparable to those of traditional insurance. Additional Resources: FY23 Rates | The Ins, Outs and In-Between: How Dental Medicaid Works and How It Can Work for You (ADA CE)

Assignment of Benefits (SB710) – Passed legislation to include pre-paid dental plans under Missouri’s Assignment of Benefits (AOB) statute. Previously, Missouri’s AOB law did not apply to pre-paid dental plans. 

Credentialing (SB710) – Passed legislation to include pre-paid dental plans under Missouri’s credentialing statute. Previously, Missouri’s credentialing laws did not apply to pre-paid dental plans. 

Medical Retainer Agreements (In-Office Dental Plans) (HB2168) – Previously, Missouri law only allowed for in-office plans, also known as “medical retainer agreements”, in medical settings. This legislation changes that statute to also include dental providers, therefore allowing Missouri dentists to create and offer in-office plans to their patients. In-office dental plans are a revolutionary development in health care, empowering patients to deal directly with their provider of choice. These plans may provide many of the benefits of a traditional fee-for-service dental plans or traditional dental insurance plan, without the red tape. 

Missouri Dental Board Pilot Project (HB2149) – Successfully advocated for legislation to give the Missouri Dental Board to the statutory authority to develop pilot projects to extend dental care to under-served populations throughout the state. This legislation will allow the Missouri Dental Board and Office of Dental Health to consider innovative ways to extend the oral healthcare workforce to populations that may otherwise have difficulties utilizing existing oral healthcare facilities. 

DHSS Student Loan Program (SB710 and HB2331) – Adds dental surgery, dental medicine, and dental hygiene students to the list of types of students eligible for a loan through the Missouri Department of Health and Senior Services. The bill also raises the maximum loan from $7,500 to $25,000 per academic year.

COVID-19 Liability (SB51) – Shields businesses from most COVID-19 related lawsuits. MDA was involved with extensive outreach to members through VoterVoice to encourage passage. Special Note: Offices must post, “WARNING: Under Missouri law, any individual entering the premises or engaging the services of the business waives all civil liability against the individual or entity for any damages based on inherent risks associated with an exposure or potential exposure to COVID-19, except for recklessness or willful misconduct.” Additional Resources: Download PDF Sign

Prescription Drug Monitoring Program (PDMP) (SB63) – Passed which put an end to Missouri being the only state in the nation without a prescription drug monitoring program. The bill authorizes the creation of a Joint Oversight Task Force for Prescription Drug Monitoring which will include a dentist from the Missouri Dental Board (MDB). Dr. William Kane was elected by the MDB to serve in this role. This group will oversee the creation of a centralized prescription drug database. Special Note: St. Louis County already has a PDMP in place with participating neighboring counties. Learn more. Additional Resources: Issue 5, 2021 Focus article

Non-Patient Based Exams (DCI Rules, page 4) – Permanently placed into the Dental Practice Act as a means for licensure in the state of Missouri through testing agencies accepted by the MDB. All licensure exams are accepted in Missouri. Effective January 1, 2021, competency examinations shall be administered by any of the following: the Central Regional Dental Testing Service (CRDTS), the Commission on Dental Competency Assessments (CDCA), the Western Regional Examining Board (WREB), the Southern Regional Testing Agency (SRTA), the Council of Interstate Testing Agencies (CITA), or by an individual state dental board. The tested procedures are to be patient based, manikin based or a combination of both.

Carrier Overpayment Reimbursement Responsibility (HB1682) – Requires an insurance company must collect an overpayment from the provider or the third-party the carrier made the overpayment to. Also requires the health carrier must inform the provider of the date, service and claim that they are collecting the overpayment for.

Temporary and Emergency Credentialing (Locum Tenens) (HB1682) – Allows for providers to practice under another provider’s credentials for a period of 60 days for FMLA purposes without having to be credentialed. Dentists also can be reimbursed for covered services provided during a credentialing period.

Retroactive Payment (HB1682) – Requires a health carrier to reimburse a provider for covered services performed during the credentialing period.

Virtual Credit Cards (SB 514) – Allows healthcare provider to choose reimbursement methods and requires insurance carriers offer a form of reimbursement that does not include a fee.

Retroactive Denial of Prior Authorizations (SB514) – Insurance carriers are now held accountable for the payment of prior authorization they have issued in the state of Missouri.

Increased Medicaid Reimbursement Rate (Details) – Secured a 1.5% increase to Medicaid reimbursement rates for dental care for FY20. This restored Medicaid reimbursement rates to original levels before 2016 when Governor Jay Nixon cut the reimbursement rate by 3%.

Teaching Faculty Permit (HB1268) – MDA worked with dental school representatives on compromise language which had previously been adopted by MDA House. Allows the MDB to issue dental faculty permits to individuals who are employed by accredited dental schools, colleges or programs in Missouri.

Insurance Provider Reform (SB982) – Requires insurance carriers to update their provider materials upon being notified of any changes by the provider. Additionally, it provides that all payments are made to the health care providers when a health carrier has authorized out-of-network provider services in which the services are covered in-network.

Advertisement of Sedation Services (HB1719) – The MDB removed advertisement rules from the Dental Practice Act in April 2018. In working with the MDB, the MDA was able to add advertisement related to sedation services into the statute in an effort to maintain protection of the public.

Telehealth Fix (HB1617) – Modifies provisions related to telehealth. The Missouri Department of Social Services (DSS) created two sets of rules: one for Medicaid patients, one for private insurance carriers. This fix created one set of rules for the standard of care and reimbursement for both Medicaid and private insurance.

Radiology Licensing (SB926) – Defeated legislation that would require all medical staff in dental offices be certified x-ray assistants.

CBCT/Panoramic X-Ray Systems (SB50) – Changes current annual inspections from one year to every three years. Also required machines be inspected within 30 days of installation or whenever moved within an office. With average CBCT unit inspection costs around $2,000, it’s easy to figure the thousands of dollars in cost savings for doctors utilizing this technology. Additional Resources: Visit the MDA webpage for Radiation Machine Inspections (Members Only) to find clarification on the process and links to inspection services. 

Medicaid Funding (HB11) – Achieving adult dental services Medicaid coverage (Tier 1-6) and a 1.5% increase to provider reimbursement rates.

Dentists as Hospital Employees (SB50) – Allows hospitals to contractually employ a dentist for specific services.

UMKC-MSSU Satellite Dental School Funding (HB3 and HB17) – Appropriated $3 million from the state Higher Education budget and $482,000 from the state Capital Improvements budget for establishing a satellite dental program at Missouri Southern State University in collaboration with the University of Missouri-Kansas City School of Dentistry. Although funds were appropriated, concerns were raised about having funds to sustain the program; thus, satellite dental school was not established.

Limited Adult Dental Medicaid Coverage (HB2011) – $14.7 million appropriated to fund limited adult dental services for Medicaid patients (Tier 1-6) recently implemented for the current fiscal year, but now extending into the 2017 fiscal year ending June 30, 2017.

Community Water Fluoridation (HB 1713) – Requires public water works systems to notify customers at least 90 days prior to a vote to either implement or cease water fluoridation.

Telehealth (SB579) – Allows for MO HealthNet providers to be reimbursed for teledentistry services which they already are reimbursed for in-person and for reimbursement for the use of asynchronous store-and-forward technology.

Medicaid No-Shows (SB608) – Enables providers to charge a nominal fee to MO HealthNet participants who are habitual no-shows.

Adult Dental Medicaid (HB11) – Includes some restorative and preventative measures which almost exactly mirror what was in 2014 budget, as well as a 3% provider increase.

Tax Amnesty (HB384) – Allows for the allocation of monies collected by tax amnesty to be used for limited adult benefits and provider increases in addition to what is already included in the budget.

Medicaid Dental Services (HB2011) – Funding for MO HealthNet to offer a limited dental benefit to all currently eligible qualified adult populations, for the first time since 2005; also includes billing and reimbursement for certain CDT codes.

Silent PPOs (SB884) – Mandates PPOs must provide information to participating providers identifying the third-party insurance company in writing, upon request, and/or when entering a contract. Also mandates PPOs must provide a regularly updated list available through a public website or toll-free number that identify third party insurance companies leasing a provider’s services on a patient’s insurance card.

Non-Covered Services/Capped Fees (HB315) – Prohibits capped fees on non-covered services. The bill outlines that no contract between a health carrier or health benefit plan and a dentist, for the provision of dental services under a dental plan, shall require that the dentist provide dental services to insureds in the dental plan at a fee established by the health carrier or health benefit plan, if such dental services are not covered services under the dental plan. For purposes of this section, the following terms shall mean: (1) “Covered services”, services reimbursable by a health carrier or health benefit plan under an applicable dental plan, subject to such contractual limitations on benefits as may apply, including but not limited to deductibles, waiting periods, or frequency limitations; (2) “Dental plan”, any policy or contract of insurance which provides for coverage of dental services; (3) “Health benefit plan”, the same meaning as such term is defined in section 376.1350.

Adult Medicaid Extractions, Exams and Imaging (HB11) – Funds extractions, exams and imaging needed to complete extractions for single adults who otherwise would qualify for Medicaid.

Carve Out (HB11/SB127) – In prior years, the passage of the Carve Out language was achieved only through appropriations bills, which required annual renewal. With the passage of SB127, DSS authorization to implement these changes was made permanent. This authorizes MO HealthNet to carve out dental benefits from the managed care system if they so choose.

Sealants (SB330) – Allows dentists to delegate to assistants the tasks of placement of pit or fissure sealants and application of topical fluoride to dental assistants under direct supervision.

Carve Out (HB11) – Authorization for the development of a Dental Medicaid Carve Out.

UMKC Teaching License (HB591/SB325) – Assisted the MDB and UMKC to establish a Limited Dental Teaching License.

Prompt Pay Reform (HB1498) – Requires health carriers to send an electronic acknowledgement of the date of receipt of a claim within 48 hours of being electronically filed; has 30 days to pay completed claims, or notify the provider that additional information is needed; has up to 15 days to respond once additional information is received; and, any claim not paid within 45 days is subject to a penalty of 1% of the total claim amount per day.

EFDA Registration (HB2226) – Included within its several provisions is the requirement that Expanded Function Dental Assistants register with the MDB every five years.

Medicaid Reimbursement Rates (HB11) – $2.5 million appropriated from General Revenue to improve Dental Medicaid reimbursement rates. This money was matched with approximately $5.8 million from the Federal government, adding approximately $8.3 million to the Dental Medicaid budget. Dentists were the only provider group to receive an increase.

Teeth Whitening (SB296) – Prohibits teeth whitening procedures from being performed by those outside of the dental team passed as part of the omnibus professional registration bill.

Volunteer License (SB296) – Retired dentists and dental hygienists are able to maintain their licenses with reduced fees and reduced CE requirements so long as they are providing volunteer services. Missouri joined 26 other states who offer a volunteer license.

Medicaid Reimbursement Rates (HB2011) – More than $7 million appropriated for Medicaid reimbursement rates

MOHealthNet Instituted (SB577) – Reinstated adult dental Medicaid services.