Midlevel Provider Overview:
On April 6th, the MDS Board approved a comprehensive alternative bill targeted at improving access and utilization problems in the Commonwealth. The MDS proposal included a new category of practitioner but with more appropriate training and scope of practice. This proposal was sent to PEW Charitable Trusts and the bill sponsors. Unfortunately, they were only willing to consider the midlevel provider, not the other important items included in the MDS proposal.
On April 27, the Joint Committee on Health Care Financing sent the midlevel provider bill to study. This effectively killed the legislation for this session. While encouraging, it was still possible for the midlevel provider legislation to be attached to this year's state budget.
In early May, Senator Chandler of Worcester and Representative Pignatelli of Lenox, the bill sponsors, asked MDS leadership, staff, and lobbyists to meet with them and PEW at the State House. During this meeting, Senator Chandler made it clear she was only focused on their midlevel provider legislation, and she intended to attach it as an amendment to the budget with or without us.
As Senator Chandler promised, she filed the midlevel provider legislation as an amendment, #479, to the Senate budget. During deliberations, the Senate approved this amendment and attached it to their final budget. Partly due to animosity between the Senate and House, the Senate added several hundred non-budgetary items to their budget. Conversely, the House only attached approximately 100 non-budgetary items to their budget. Most importantly, midlevel provider legislation was not one of those items.
The budget conference committee, made up of three Representative and three Senators, had the important task of reconciling the two budgets and the wide array of attached amendments. After several meetings with the conferees and hundreds of emails/letters from individual members, the conference committee did not include the midlevel provider in the final budget. This ended the two year battle to stop this legislation from passing.
This year’s midlevel provider legislation put Massachusetts oral health in the spotlight like never before. The public and legislators are now more aware of the oral health problems faced by many residents. Here is a look at some of the information our opponents frequently referenced through the media and in meetings with public officials:
- 47 percent of young people ages 1 to 21 (more than 290,000 individuals) who were enrolled in MassHealth did not see a dentist in 2014.
- In 2014, only 35 percent of dentists treated a MassHealth patient and only 26 percent billed at least $10,000 to the program.
- As of January 2016, more than 500,000 Massachusetts residents lived in areas with a shortage of dentists. A previous study found that residents from shortage areas were less likely than those in other areas to see a dentist.
It is evident that the status quo cannot continue in order to solve the above problems. As leaders of the dental team it is important for the MDS to be part of the conversation rather than being the party of “no”. As we move forward in considering our own solutions, we must consider the following questions.
- How can we get more young people to the dentist?
- How can we increase the number of MassHealth providers?
- How can we get more providers into provider shortage areas?