2023 ISDS End of Legislative Session Report

The key focus of our legislative agenda this year was dental insurance reform. ISDS was victorious in passing two pieces of legislation to begin addressing dental insurance reform in Illinois.

-The legislation addressed network leasing, a bait-and-switch tactic insurance companies use to gain more revenue.

- A second piece of dental insurance reform legislation, virtual credit cards, was passed to address the issue of insurance companies requiring dentists to pay a fee to obtain payment for the services they have rendered to patients.

ISDS passed legislation related to the upcoming e-prescription requirements and legislation clarifying Illinois Dental Practice Act provisions. Additionally, we have agreed with the Department of Healthcare and Family Services (HFS) to implement rules to clarify when orthodontics is covered under the Medicaid program.

ISDS advocated very strongly to defeat the proposed Medicaid provider tax, which would have taxed all dentists in Illinois. We are pleased to announce that this tax did not pass this legislative session. 

Our legislative success would not be possible without the efforts of our members. This past session, the membership responded when we called upon our members to reach out to their legislators. The voices of our members were heard by state legislators at the 2023 Capital Conference. At the Conference, ISDS members met with state legislators to inform them about dentistry's issues.  Thank you for reaching out to your legislators and making your voices heard on these important issues.

More detail on our legislative measures is provided below.

Dental Insurance Reform Measures

This legislative session, ISDS made it a top priority to address dental insurance reform. Our dental insurance reform package consisted of three pieces of legislation: a dental loss ratio requirement, network leasing, and virtual credit cards.

ISDS created and implemented the “More for Your Smile” campaign to further promote our dental insurance issues. This campaign included in-office toolkits for dental offices, social media advertising, videos, and marketing materials. This campaign and our member's advocacy efforts were critical to our success this year.

More information about this campaign can be found at www.moreforyoursmile.com.

Dental Loss Ratio: HB 2070 (Gong-Gershowitz/ SB 1287 (Fine)

ISDS introduced legislation to implement a dental loss ratio in Illinois. This legislation would require dental insurance companies to spend at least 80% of collected patient premiums on patient care. 

Current Status: The Dental Loss Ratio legislation was met with extensive opposition from the insurance industry. There were two legislative subject matter hearings on this issue throughout the session. Additionally, we had several media articles and letters to the editors that outlined the need for a dental loss ratio in Illinois. Due to the insurance industry's opposition, the legislation did not advance this past session. ISDS will continue to advocate for dental patients on this issue.

SB 1287 (Fine) has been re-referred to the Senate Committee on Assignments.

HB 2070 (Gong-Gershowitz) has been re-referred to the House Rules Committee.

Network Leasing: HB 2072 (Gong-Gershowitz/Fine)

Network leasing is a bait-and-switch tactic insurance companies use to gain more revenue. They lure dentists in with one network, and once dentists are on the hook, they’re forced to make an impossible choice to take on a network they can’t afford to sustain or risk losing the patients they’ve served for years when insurance fails to honor their agreement.

ISDS introduced and passed legislation requiring insurance companies to notify the dentist that the network is being leased out and allow the dentist to opt out of the new network.

Current Status: Initially, the network leasing bill received opposition from the insurance industry. ISDS was able to negotiate with the insurance industry on this issue. These negotiations resulted in the passage of this legislation in both chambers and await the Governor’s signature.

HB 2072 (Gong-Gershowitz/Fine) has passed the House and Senate and awaits the Governor’s signature.

Virtual Credit Cards: HB 2072 (Gong-Gershowitz/Fine)

ISDS introduced and passed legislation prohibiting insurance companies from requiring dentists to pay the processing fee on any electronic payment, including virtual credit cards. 

Current Status: Initially, the virtual credit card bill received opposition from the insurance industry. ISDS was able to negotiate with the insurance industry on this issue. ISDS agreed to accept the National Conference of Insurance State Legislators model legislation about virtual credit cards. These negotiations resulted in the passage of the virtual credit card bill in both chambers and await the Governor’s signature.

HB 2072 (Gong-Gershowitz/Fine) has passed the House and Senate and awaits the Governor’s signature.

Unregulated Direct to Consumer Orthodontic Care: SB 1509 (Cunningham)/HB 2215 (Moeller)

In the last two legislative sessions, ISDS has introduced legislation to implement patient protections for using direct-to-consumer clear aligners, especially regarding teledentistry. The legislation sought to require the following items:

• A dentist using teledentistry to be subject to the same standard of care as if the services were being offered in a clinic or office setting.
• Requires that a patient receiving dental services through teledentistry shall be provided with the name, direct telephone number, and physical practice address of the treating dentist who will be involved in teledentistry services.
• Clarifies the definition of informed consent.

Current Status: This legislation was opposed by the clear aligner industry. ISDS, in cooperation with the American Association of Orthodontists (AAO), advocated for this legislation.  Due to the opposition to this bill, it could not pass this year. We will continue to advocate on this very important issue.

SB 1509 (Cunningham) has been re-referred to the Senate Committee on Assignments.

HB 2215 (Moeller) has been re-referred to the House Rules Committee.

Medicaid and Orthodontic Changes: SB 200 (Morrison)/HB 2050 (Avelar)

The Illinois Department of Healthcare and Family Services (HFS) has no standard or automatic qualifier for when a patient can receive orthodontic care under the Illinois Medicaid program. The lack of a standard has caused administrative obstacles and denial of claims for orthodontic care. The American Association of Orthodontics (AAO) established a committee that developed a comprehensive list of recommended auto-qualifiers and diagnostic documentation for medically necessary orthodontic care. ISDS sought the passage of legislation that would codify these standards in state law and help clarify the confusion created by existing administrative obstacles.

Current Status: During the session, ISDS worked with HFS to agree on clarifying the standards for when orthodontic care would be covered under the Medicaid program. These changes are expected to be implemented through the Administrative Rule process and include standards regarding cleft palate, overjet greater than 9 mm, and impacted teeth.

SB 200 (Morrison) has been re-referred to the Senate Assignments Committee.

HB 2050 (Avelar) has been referred to the House Rules Committee.

Dental Practice Act Changes: HB 2077 (Vella/McClure)

This past session, ISDS introduced legislation that provides several clean-up changes to the Illinois Dental Practice Act. Some of the items addressed included the following:

• Clarifying language to existing provisions to correct an oversight from the workforce legislation passed last spring.
• Allowing a holder of a faculty limited license to advertise their specialty degree as part of their ability to practice at the dental facility.
• Allows a licensed dentist or dental hygienist who is a military service member or the spouse of a military service member to apply for licensure by credentialing.
• Continuing education providers must disclose that a course is approved for continuing education in Illinois.
• Clarifies the provisions regarding patient records when an office closes, which is consistent with the other provisions in Illinois law. 

Current Status: ISDS worked with the Illinois Department of Financial and Professional Regulation to reach an agreed to bill. This legislation passed the House and Senate. The bill now awaits the Governor’s signature.

HB 2077 (Vella/McClure): Passed Both Houses

E-Prescription Requirement: HB 2077 (Vella/McClure) 

Beginning January 1, 2024, all healthcare providers prescribing controlled substances schedule II-V must submit prescriptions electronically. During this session, ISDS worked with other stakeholders to pursue legislation to outline further and clarify the requirement. The legislation provides for the following exemptions to submitting the prescriptions electronically:

• A provider does not issue more than 150 prescriptions during a 12-month period until December 31, 2028. Starting January 1, 2029, a prescriber would be exempt if they do not issue more than 50 prescriptions during a 12-month period.
• Before January 1, 2026 the prescriber demonstrates financial difficulty in buying or managing an electronic prescription option.
• On and after January 1, 2026, the prescriber provides proof of a waiver from the Centers for Medicare and Medicaid Services for economic hardship.
• Temporary technological or electrical failure that prevents an electronic prescription from being issued.
• The practitioner determines it would be impractical for the patient to obtain in a timely manner if prescribed electronically and would adversely impact the patient’s medical condition.
• Patients in certain locations and situations, such as nursing homes, correctional facilities, or undergoing hospice care.

Current Status: ISDS worked with the other interest groups and the Illinois Department of Financial and Professional Regulation to further define and clarify the exemptions to the e-prescription requirement. The legislation passed both chambers and awaits the Governor’s signature.

HB 2077 (Vella/McClure): Passed Both Houses

Other Legislative Initiatives

In addition to ISDS initiatives, several other pieces of legislation impacted dentistry.

Delta Dental of Illinois Structural Changes: HB 592 (Hoffman)

During this legislative session, Delta Dental of Illinois (DDIL) introduced legislation (HB 592) that would have allowed them to create a holding company, eliminate dentists from their Board of Trustees, and remove their requirement to file certain reports with the State of Illinois. ISDS was strongly opposed to this legislation.

Current Status: This legislation is still being discussed between DDIL and ISDS. The legislation has not passed this session.

HB 592 (Hoffman) has been re-referred back to the House Rules Committee.

Medicaid Provider Tax

The Department of Healthcare and Family Services (HFS) budget proposal for the State’s next fiscal year included a new proposed tax on all dental providers in Illinois. DHFS proposed a “new [dental] assessment” to help provide additional funding for the Medicaid Program. An assessment is a provider tax. An assessment is a tax on all providers, regardless of participation in Medicaid, to generate money for the Medicaid Program.

HFS administers the Dental Medicaid program in Illinois. The new tax is estimated to generate $10 million in additional funding for dental service reimbursement in the Medicaid program at the expense of all dental providers.

ISDS was strongly opposed to this provider tax for the following reasons:

• Dentists would be the only individual provider taxed under the Medicaid program.
• Dentists, like other healthcare professionals, have faced increasing costs due to the COVID-19 pandemic, which will only increase the costs of being a dental provider in Illinois.
• ISDS has worked diligently to increase access to care for patients under the Medicaid program but taxing providers is not the answer to increasing access to care.
• Illinois dentists pay their fair share of taxes and should not be taxed twice.

Current Status: ISDS expressed our strong opposition to this legislation to legislators and HFS. ISDS activated our members to contact their state representatives, state senators, and the Governor’s Office. Due to our strong opposition and member efforts, this proposal was not included in the final budget and was defeated.

Cultural Competency Continuing Education: HB 2450 (Avelar/Villivalam)

The legislation was filed early in the session that would have required all healthcare professionals, including dentists, to complete mandatory cultural competency continuing education (CE) training. The bill required that the cultural competency training include information on sensitivity training relating to providing affirming care to people in the person’s preferred language, people with disabilities, people who are intersex, people living with HIV, and people of diverse sexual orientations and gender identities. The legislation would have required that at initial licensure and renewal, a healthcare professional who has continuing education requirements must complete at least 5 hours in cultural competency training.

Several healthcare associations, including ISDS, joined a coalition to oppose the continuum of proposals for mandated education. The opposition to the legislation was not about the subject matter. The coalition expressed concern and opposition to lawmakers about the State’s continuum to mandate continuing education subjects. 

In response to the continuum of mandating education, the coalition worked with the stakeholders of the groups pursuing the mandated education to agree on the legislation. A proposal that would allow individual professionals more time to complete mandated education was developed but did not eliminate or repeal any current mandated topics. This proposal allows healthcare professionals to have the flexibility they would need to complete required training.

The proposal accomplished the following:

• Adds one hour of cultural competency training for all healthcare professionals, including dentists.  Cultural competency is a set of integrated attitudes, knowledge, and skills that enables healthcare professionals or organizations to care effectively for patients from diverse cultures, groups, and communities.
• Allows healthcare professionals two licensure cycles to complete mandated training on opioids and cultural competency.
• For healthcare professionals who have to receive opioid training at the federal level, including dentists, the state-mandated hours are reduced from three to one hour.
• Adds that if any additional mandates are added, physicians and dentists will have three licensure cycles to complete the new mandated education.
• Maintains that implicit bias training and sexual harassment prevention training be taken every licensure cycle.
• Effective January 1, 2025.

ISDS, along with other coalition members, was supportive of this proposal. This proposal provides dentists and other healthcare professionals the flexibility they need to meet the continuum of mandated education.  For example, healthcare providers that are required to complete the federal opioid training, which includes dentists, would only be required to complete one hour of state mandated opioid training instead of three hours required by the State.

Current Status: The proposal presented by the healthcare coalition did pass both the House and Senate. The legislation now awaits the Governor’s signature.

HB 2450 (Avelar/Villivalam): Passed Both Houses.

IDHA Legislation: HB 2267 (Stuart/Cunningham)

The Illinois Dental Hygienists’ Association (IDHA) introduced legislation (HB 2267) that contained clean-up changes from last spring’s workforce bill. The bill also clarifies that dental hygienists may perform health education functions at health fairs.  Finally, the bill increases the number of public health dental hygienists (PHDHs) that one dentist can enter into a collaborative agreement with from 2 to 4.

Current Status: ISDS worked with IDHA to have an agreed to bill.

HB 2267 (Stuart/Cunningham) has passed both the House and the Senate and awaits the Governor’s signature.

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