Dental Insurance Reforms

ISDS has been advocating for dental insurance reform for our members and patients.  On January 1, 2024 three new dental insurance laws will go into effect that will impact dental insurance in Illinois. 

Cranial Facial Anomaly Insurance Coverage

Health insurance companies will be required to cover services for children with cranial facial anomalies. Specifically, health insurance companies will be required to provide coverage for the medically necessary care and treatment of cleft lip and palate for children under 19. This includes the following:

• 1.) Oral and facial surgery, including reconstructive services and procedures necessary to improve and restore and maintain vital functions;
• 2.) Prosthetic treatment such as obdurators, speech appliances, and feeding                 appliances;
• 3.) Orthodontic treatment and management; and
• 4.) Prosthodontic treatment and management; and
• 5.) Otolaryngology treatment and management

Network Leasing

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

Under the new law advocated for by ISDS, insurance companies will be now required to notify the dentist that the network is being leased out and allow the dentist to opt out of the new network.  Under the new law, this notification must be provided in writing via certified mail 60 days before any scheduled assignment or lease of the network. The notification is also required to include all contract terms, a policy manual, a fee schedule, and statement that the provider has the right to choose not to participate.

Virtual Credit Cards

Insurance companies often make payments through a virtual credit card (VCC) instead of a physical check or direct deposit. VCC fees can be as high as 5% for dentists while insurance companies often receive cash-back incentives from credit card companies.

Under the new law, insurance companies are prohibited from requiring dentists to pay a processing fee on any electronic payment, including virtual credit cards. 

E-Prescription Requirement

All healthcare providers, including dentists, prescribing controlled substances schedule II-V must submit prescriptions electronically. During this past legislative 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 that does not issue more than 150 prescriptions during a 12-month period is exempted from this requirement 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.

The Illinois Department of Financial and Professional Regulation (IDFPR) is expected to issue guidance on how the exemptions will need to be certified. ISDS will inform its members when this information becomes available.

New Paid Time Off Law

In March 2023, Illinois enacted the Paid Leave for All Workers Act, which requires most Illinois employers, including dental offices, to provide their employees with up to 40 hours per year of paid leave for any reason. This law goes into effect on January 1, 2024.

To further assist members with compliance with this new law, ISDS hosted a 1-hour continuing education webinar that outlined the requirements of the law. For more information about the law and to view the webinar please visit: https://isds.ce21.com/item/understanding-implementing-2024-illinois-paid-leave-workers-act-123916

Additionally, the Illinois Department of Labor has issued a Frequently Asked Questions document which can be accessed here: https://labor.illinois.gov/faqs/paidleavefaq.html

Dental Practice Act Changes

There have been several clean-up changes to the Illinois Dental Practice Act that will be in effect on January 1, 2024.  These changes are highlighted below:  

• 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. 
• Increases the number of Public Health Dental Hygienists (PHDH) that can have a collaborative agreement with a dentist from 2 to 4.

As always, ISDS will continue to keep its members informed and advocate on behalf of its members.