On the state level, Northeast Delta Dental has been actively involved in Maine, New Hampshire and Vermont efforts regarding the development of state exchanges and the manner in which dental benefits will be handled on those exchanges. Under PPACA, HBEs are to become fully implemented by January 1, 2014. Northeast Delta Dental representatives are working with legislators, regulators and others in all three states to clarify and secure the role of dental benefits, both within and outside, the HBEs.

One of the primary objectives of Northeast Delta Dental’s activities has been to make certain that state legislators and regulators understand the provisions of PPACA as those provisions relate to dental benefits. Pediatric dental benefits is one of ten categories of benefits included as “essential health benefits” under PPACA. However, as of yet, the precise definition of the pediatric dental benefit has not been set. Additionally, the role of adult dental benefits within the exchange also has not been defined. Many other related questions also remain unanswered at this point in time.

A second primary objective is to try to make certain that any HBE adopted by a state is designed to make it easy for persons using the exchange to find information about available dental coverages and to select an appropriate dental plan. Small employers (employers having fewer than either 50 or 100 employees, as a state may elect) will also be able to go through the Small Business Health Options Program (“SHOP”) under PPACA. The SHOP exchange may either be separate from the HBE or combined into a single HBE, at the option of the state.

PPACA requires individual states to set up their own exchanges, to be operational by January 1, 2014, or have the federal government become involved in setting up the exchange(s). By the end of 2012, states must be progressing sufficiently toward implementation, in the judgment of federal officials, to avoid having the federal government become involved.

Maine, New Hampshire and Vermont are all at different stages with respect to implementation of PPACA and development of the required exchanges. Vermont is the furthest along, having passed the Governor’s health care reform bill (Act 48) in 2011. The state is actively working toward HBE implementation with the ultimate goal of establishing a “universal health care” system. Northeast Delta Dental representatives are actively engaged in the implementation process with Vermont state officials.  

Efforts to develop the exchanges are also under way in Maine, although Maine is not as far along as in Vermont. Northeast Delta Dental representatives are also actively engaged in the process in Maine to try to assure that dental benefits are appropriately included within the exchanges and are protected outside the exchanges.

In contrast, the exchange implementation situation in New Hampshire is much less clear. Although a bill (SB 163) has been introduced to begin implementation of PPACA, and is progressing through the legislative process in the Senate, it will face stiff opposition in the House and its ultimate fate is uncertain at best.

Northeast Delta Dental believes that implementation of the exchanges by the states is preferable to having them set up by the federal regulators. Federal intervention would reduce (or possibly eliminate) the ability or a state to design an exchange that would best serve the state’s needs. The state and its citizens and employers will be best served by a state-designed and run exchange, and Northeast Delta Dental is continuing to work toward that end. Look for further updates to follow.