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OHP May 2009 Update

MDA Successful in Holding to Principles for Mid-Level Practitioner Legislation

Late last week, the proponents of the Oral Health Practitioner (OHP) agreed with many of the concerns of the MDA and relinquished their push for broad-based OHP legislation. What came out of intense negotiations will be a new mid-level dental practitioner, called a Dental Therapist, that reflects MDA membership’s demands for appropriate training, scope of practice, and supervision in an effort to alleviate some of Minnesota’s dental access issues.
While numerous circumstances led to this final outcome, several occurrences last week led to an agreement on compromise language.
As we had reported both the OHP and Dental Therapist had been incorporated into the House Omnibus Licensing bill.  We had been working diligently behind the scenes to take the OHP language out of the House bill when and if it reached a full floor for a vote.  We were confident that we had the votes to do this.  Last week, when the bill was finally scheduled for a vote, the author, Representative Cy Thao, and the many OHP lobbyists realized that we were going to succeed.
The best move for OHP supporters at that time was to force the Higher Education Conference Committee to get the House conferees to accept the Senate language - even though the House had not voted on the subject.  We worked the committee very hard and had assurances from all of the House conferees, as well as House leadership, that they would not accept the language.  MDA members actively communicated with conference committee members and we know that each House conferee received between 80-100 phone calls from concerned citizens.
Last week, however, legislative activity and pressure intensified as the Constitutional deadline for adjournment approached.  The confluence of numerous legislative dynamics (see below) then led to the development of an agreement regarding dental therapist legislation.  While the end result is not everything we would want it to be, we truly believe that we got the best outcome possible.
Week of May 4-8
Monday
The week started off with 310 letters opposing the OHP language being delivered to legislators from dentists, dental hygienists, and dental assistants that had attended the Star of the North meeting.
House leadership was getting very nervous about the tone of the campaign and wanted both sides to work out their differences.  We were called to a meeting that evening where legislators representing both sides attempted to negotiate a compromise:
Dental Therapist supporters                  Oral Health Practitioner supporters
Rep. Kim Norton                                   Rep. Cy Thao
Sen. Yvonne Prettner Solon                   Sen. Ann Lynch (invited but did not attend)
Rep. Tina Liebling                                 Rep. Erin Murphy
Rep. Loren Solberg                               Sen. Sandy Pappas
Dean Patrick Lloyd (U of M)                  Michael Scandrett (Safety Net Coalition)
At the end of the meeting, no agreements were reached and in fact, relations may have grown further apart. 
Tuesday
Speaker of the House Margaret Anderson Kelliher demanded that a second meeting be held and that both sides work harder for an agreement.  Rather than send lobbyists into the meeting, it was agreed that both sides would be represented by dentists and legislators. 
Dental Therapist supporters                  Oral Health Practitioner supporters
Rep. Kim Norton                                   Rep. Cy Thao
Rep. Loren Solberg                               Dr. Craig Amundson
Dr. Jamie Sledd                                    Dr. Pat Tarren
Dr. Judith Buchanan (U of M)
After this meeting there was still no progress made.
Wednesday
On Wednesday, the Senate Conferees made an offer in the Higher Ed Conference Committee that asked that the House accept the Senate OHP language.  At that time, the House members were so infuriated by the Senate offer (because of other things included in the offer) that they immediately adjourned the meeting.
At that time, a representative of the Safety Net Coalition independently proposed compromise language that substantially changed the OHP proposal.  The MDA and the School of Dentistry then developed a counter-proposal for Representative Kim Norton to bring to House leadership to show that good faith efforts were being made.
Thursday
In a surprise move on Thursday, Representative Tom Rukavina, co-chair of the Higher Ed Conference Committee, came back with a House counter-offer to the Senate.  In his surprise move, Representative Rukavina and the House conferees acceded to the Senate position and agreed to accept the OHP/DT language as part of the bill!  Our lobbyists talked with him and asked why he had “sold us out.”  He admitted that it was more to get negotiations moving faster and stated that we better work something out within the next 24 hours or it would stay in the bill.
We quickly went back to House leadership and were assured that there was no way this was going to happen unless there was an agreement from all sides.  What they really wanted was to avoid a House floor fight that would show the division of the House Democrats on the subject.  In fact, our lobbyists had also been working with the House Republicans to offer a bevy of amendments to substantially alter the OHP language.
Discussions between the MDA and the Safety Net Coalition occurred throughout the afternoon and resulted in a proposal that addressed key MDA concerns. The offer was vetted with the MDA leadership and the interested parties from the other side.  The proposal was then sent to Senate Counsel to be drafted as an amendment to the Higher Education Bill.
Friday
In the Conference Committee, Rep. Rukavina admitted that he would likely have to take the language out.  Senator Lynch gave a very emotional speech about how concerned she was about all of the ads that were being run.  Rukavina’s response was that he was not concerned about those that were trying to twist his arm, but was concerned about passing bad legislation.  Rukavina then recessed the meeting and stated that the conference committee would meet again when the amendment was ready.  He specifically pointed out our lobbyists in the room and stated, “The train has left the station.  You better get the negotiating done quickly or you will be stuck with the OHP language.”
We received the language at approximately 2:35 on Friday afternoon and the Conference Committee convened ten minutes later.  The amendment was offered, somewhat grudgingly, by Senator Lynch and explained by MDA lobbyist Dominic Sposeto and the representative from the Safety Net Coalition.  After a few brief questions, the compromise amendment was adopted and incorporated into the Higher Ed bill.  Since Conference Committee bills are not allowed on the floor, the Higher Education bill language  is what the bill will look like when it passes.
Afterwards, Senator Lynch strongly expressed her disappointment with many of the changes that were made. She was very upset that the language had taken on a completely different look that was not her original legislation or intent. 
 This week, the Higher Education Conference Committee wrapped up its work and sent the bill to the Senate and House floors for approval.  We understand that the Governor does not have major problems with this bill and is expected to sign it.
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The new mid-level provider would be called a dental therapist.  There would be another level of training/experience to qualify as an advanced dental therapist.
  • A Dental Therapist (DT) will have to work under the indirect (onsite) supervision of a dentist.
  • An Advanced Dental Therapist (ADT) will need additional education (beyond that of a dental therapist) in order to treat a patient under general supervision.
  • The supervising dentist will need to approve surgical procedures for each individual patient prior to treatment by an Advanced Dental Therapist.
  • Training for these programs can be done by educational institutions that are either accredited or approved by the Minnesota Board of Dentistry.
  • Neither the DT nor ADT will be authorized to prescribe medications.
Special thanks go out to:
  • Our authors, Representative Kim Norton and Senator Yvonne Prettner Solon, who championed our cause and believed that the MDA and U of M had the best program.
  • Representative Loren Solberg who helped to broker the best deal possible.
  • The MDA Membership. Legislators were constantly commenting on hearing from their dentists. Without your calls, e-mails and visits during Dental Day at the Capitol, we would not have been successful.
  • Our lobbying team of Dominic Sposeto, Tom Day and Mary Daugherty Gilbert, led by Executive Director Dick Diercks, spent days, nights and weekends at the Capitol working on the MDA’s behalf. In addition, thank you to Tom Poul and Nancy Haas, from the lobbying firm of Messerli & Kramer.
  • The University of Minnesota School of Dentistry. In particular, to the Dean of the School, Dr. Patrick Lloyd, and the U’s lobbyist Marty McDonough.

 

Dental Programs Avoid Budget Cuts Thus Far

If this past week wasn’t crazy enough, during the whole time, the Health and Human Services Committee was also meeting to resolve differences between the House and Senate language.  If you remember, Governor Tim Pawlenty had proposed eliminating the Critical Access Dental Provider Program, eliminating adult dental care for all program participants, and eliminating the Health Care Access fund (but not the provider tax).  In addition different legislators had offered increasing the provider tax to as high as five percent and allowing the health plans to terminate dentists from the Critical Access Program.
The HHS Conference Committee wrapped up its business at 6:00 am on Sunday morning - Mothers Day!  We are very pleased to report that we were extremely successful in:
  • Saving the Critical Access Dental Provider Program
  • Saving adult dental care - although the benefits will be limited
  • Saving the Health Care Access fund
  • Preventing the Provider Tax from being increased
  • Preventing health plans from having the ability to terminate dentists from the Critical Access Dental Provider Program
The bill passed out of the full House and Senate was immediately vetoed by Governor Pawlenty.  The Conference Committee is already meeting to come up with “Round 2” of an Omnibus HHS Bill.  We will keep you apprised of this action.