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The American Academy of Pediatric DentistryAdvocacy Activities

2004 Update

John S. Rutkauskas, DDS, MBA, CAEExecutive Director, AAPD

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Organizational Relationships

Federal� Health Resources and Services Administration

(HRSA)� Bureau of Health Professions (Title VII)� Maternal and Child Health Bureau (MCHB) - grants

� Centers for Medicare and Medicaid Services (CMS) - Medicaid

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MCHB Funds� AAPD �Filling Gaps� CHIP grant� Partners in Program Planning for Adolescent Health

(PIPPAH)� National Center for Oral Health Policy (Jim Crall at

UCLA)� National Center for Education in Maternal and Child

Health: National Maternal and Child Oral Health Resource Center � Georgetown University

� Centers for Leadership in Pediatric Dentistry Education � University of Iowa, University of North Carolina, University of Washington

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Other �players� in child health

� American Academy of Pediatrics� Children�s Defense Fund� American Public Human Services

Association� National Governors� Association� National Conference of State Legislatures

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Potential new player

� Medicaid Dental Program Managers Association� AAPD BOT approved $1000 for organizational

support� Ross Wezmar to serve as advisory board

member

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Child Advocate: Dr. James Crall

• Monitors, provides information to, and influences federal agencies and coalition initiatives affecting children�s oral health such as: − U.S. Surgeon General�s Report on Oral Health and

�Call to Action�− HRSA-CMS Oral Health Activities− NGA Oral Health Policy Academies � served as

faculty− Medicaid EPSDT Manual (Guide to Children�s Dental

Care in Medicaid) � AAPD contract with CMS

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− Milbank/Reforming States Group �model plan� for dental care under SCHIP and Medicaid

− General Accounting Office Reports on Oral Health− Oral Health: Dental Disease is a Chronic Problem

Among Low Income Populations (June 2000)− Oral Health: Factors Contributing to Low Use of

Dental Services by Low-Income Populations (September 2000)

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Key Current Activities• Analysis of Medicaid fees, �percentile basis,� and state

impact � in conjunction with UCLA/MCHB Oral Health Policy Center:• ADA Report �State Innovations to Improve Access to Oral Health

Care for Low Income Children, and related policy briefs (www.ada.org)

• Upcoming ADA �White Paper� on Access and model reform plans

• Latest power point analysis is at www.aapd.org, Advocacy section (members-only)

• HRSA Advisory Committee on Training in Primary Care Medicine and Dentistry (still advises dental members)

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Key Current Activities (cont.)

• Head Start Oral Health Forums

• AAPD Head Start grant proposal?

• Effort to release CMS Medicaid Children�s Dental Manual

• Towers-Perrin/AAP analysis of per child per month cost for oral health care benefits

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Congressional Liaison: Dr. Heber Simmons, Jr.• Represents AAPD on Capitol Hill with monthly visits on

priority issues to AAPD such as pediatric dentistry workforce and �Bingaman bill�

• Testified for AAPD on FY 2001 federal appropriations in April 2000

• Was responsible for securing an additional $2 million in FY 2001 for Title VII Pediatric Dentistry Residency training grants; resulted in 8 new awards in addition to six continuation grants

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Children�s Dental Health Project Founding Director: Dr. Burton Edelstein

A separately incorporated Washington-D.C. based �child health policy and technical assistance center.�

AAPD has a contract to support CDHP policy analysis such as on pediatric oral health access and utilization and coalition building.

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AAPD Membership Involvement

� Council on Government Affairs(All priority issues except as noted for the Council on Dental Benefit Programs)

Chair: Dr. David JohnsenBoard Liaison: Dr. Ross M. WezmarStaff Liaison: C. Scott Litch

� Pediatric Dental Medicaid and SCHIP Advisory CommitteeConsists of regional pediatric dental consultants to the (former) HRSA-CMS Oral Health Initiative

Chair: Dr. Ross M. Wezmar

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� Beginning in 2004 CGA develops and presents to BOT recommended Legislative and Regulatory priorities

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� Council on Dental Benefit Programs(General anesthesia legislation and related issues that affect status of Pediatric Dentist as a primary care provider, including expanded activities in dental coding area)

Chair: Dr. Warren BrillBoard Liaison: Dr. Rhea HaugsethStaff Liaison: C. Scott Litch

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• AAPD Deputy Executive Director and General Counsel, C. Scott Litch, Esq., CAE, coordinates all of the Academy�s legislative, regulatory, and public policy issues

AAPD Headquarters Staff Coordinates These Efforts

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• Hogan and Hartson, Washington law/lobbying firm engaged beginning in 2003

−Regularly �brain trust� strategy calls initiated in June 2003

−Bi-monthly calls with Congressional Liaison, Hogan and Hartson, and HQ staff

Recent Addition to the Team

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Key Issues: Pediatric Dentistry Workforce

� Title VII federal start-up grants first funded in FY 2000 with slightly under $4.5 million available for general and pediatric dentistry� FY 2000: 19 applications, 13 approved, 5 awarded (plus one

partial) with slightly over $600,000 allocated to pediatric dentistry� FY 2001: 23 applications, 8 pediatric dental programs funded, 3

approved but unfunded � $2 million allocated to pediatric dentistry

� FY 2002: 10 pediatric dentistry awards � $3.54 million allocated to pediatric dentistry

� FY 2003: 5 pediatric dentistry awards- $2.64 million allocated to pediatric dentistry

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History of Title VII pediatric residency training grants to date

� FY 2000� Indiana University; University of Nebraska; University of Medicine

and Dentistry of New Jersey; Ohio State University; University of Puerto Rico; University of Texas Health Science Center San Antonio

� FY 2001� University of Alabama; Howard University; Bronx Lebanon

Hospital* (New York); Columbia University; Maimonides Hospital (New York); University of Rochester; St. Barnabas Hospital (New York); University of Washington

* New Program

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History of Title VII pediatric residency training grants to date

� FY 2002� Children's Hospital and Health Center San Diego; Denver

Medical Center; Yale-New Haven Hospital; University of Mississippi; University of Nevada; Long Island Jewish Medical Center; New York University; University of Pennsylvania School of Dental Medicine (Children�s Hospital of Philadelphia); University of Tennessee, Memphis; Children's Hospital of Wisconsin

� FY 2003� University of Florida; Bronx Lebanon Hospital (New York);

Lutheran Medical Center (New York); University of North CarolinaChapel Hill; University of Puerto Rico

* New Program

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Concern: Overall total of $6.3 million spent on dental Title VII in FY 2002 dropped to $4.8 million in FY 2003

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FY 2004 Cycle

� $5.5 million earmark obtained for pediatric dentistry in appropriations report language� tremendous victory for pediatric dentistry in several ways:� Unprecedented earmark in this area� Agency fully aware how much Congress supports pediatric

dentistry� 14 pediatric dentistry applications for cycle� Lousy HRSA peer review process and approved but

unfunded grants� Ongoing efforts to hold agency�s �feet to the fire�

regarding the Congressional directive

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• MCHB Centers for Leadership in Pediatric Dentistry Education

• Medicare Graduate Medical Education (GME) (especially since dental residents are exempt from a residency cap established in 1997)

− Dental GME crisis caused by CMS regulatory decision and failure of legislative relief in 2003 Medicare prescription drug bill

− Hogan and Hartson is preparing a legal analysis/guide for pediatric dentistry program directors

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Big Institutions for Pediatric Dentistry Residency Training

� Children�s Hospital GME received $305 million for FY 2004; dental residents not capped

� This is their own separate funding stream, separate from Medicare GME

� Is subject to vagaries of annual Congressional appropriations process

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Medicaid Issues

� Raise reimbursement rates to market levels

� Get EPSDT kids into care � Eliminate administrative barriers and

burdens� Support providers through outreach� Engage dental community by creating

dental advisory committees, etc.

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Medicaid Issues (continued)

� Pass the �Bingaman Bill� � Children�s Dental Improvement Act of 2002 (S. 1142)� Includes Medicaid dental performance grants

to states (authorization of $50 million)� Goal: States should set market-based payment

rates; pursue reforms such as Michigan Healthy Kids Dental Program

� Pediatric Dental Medicaid and SCHIP Advisory Committee � work with dental Medicaid Managers

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Medicaid Issues (cont)

� ADA Analysis and forthcoming �White Paper� are very consistent with AAPD�s efforts over the past 5 years to promote effective �models� of Medicaid dental reforms at the state level

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Assistance to AAPD District and State Unit Organizations

� Analysis of setting Medicaid dental fees at market-based rates

� Various technical assistance materials, most web-based

� Web updates� Consulting program � Medicaid and general

anesthesia� �Mini� Legislative Workshops

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Our Collaborators

• Dental organizations (ADA, ADEA, CDHP, AGD)− Monthly strategy meetings/conference calls

• Child health organizations (American Academy of Pediatrics, National Association of Children�s Hospitals and Related Institutions, Association of Maternal and Child Health Programs, Children�s Defense Fund)

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Advocacy Training

• 2000, 2001,2002, and 2003 Legislative Workshops for Pediatric Dentistry Leaders trained advocates from 29 states

• Next workshop: September 10-11, 2004 Supported by Sunstar Butler in cooperation with ADA Department of State Government Affairs

• Spring �Lobby Day� in Washington, D.C.

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Political Influence

� Initiation of AAPD Political Action Committee� Operated by Steering Committee: Chair � John

Bogert; Vice Chair � John Hendry; Secretary �Scott Litch; Treasurer � John Rutkauskas; Assistant Treasurer � Charles Hall; Board Liaison � Rhea Haugseth; District Representatives: Lois Jackson (I); Elliot Maser (II); Ed Moody (III); Curt Ralstrom (IV); Paul Kennedy (V); Mark Lisagor (VI))

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� AAPD PAC Goal: �Support candidates for federal offices who advance the oral health of children, adolescents, and those with special health care needs�

� Candidate evaluation grid is updated each cycle

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� 2002 Elections� 33 candidates supported; 30 won� $66,000 expended

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� AAPD PAC Collections (Hard $)� 2001: $68,400� 2002: $89,745� 2003: $106,185

Total collected to date: $263,680Amount available for 2004 elections: at least

$195,680

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Improving the System• 4 year federal �Filling Gaps� SCHIP grant, $400,000 to

AAPD from Dept. of Health and Human Services (HRSA Bureau of Maternal and Child Health)

• This developed �best practices� to disseminate to federal and state policymakers for better design of SCHIP, Medicaid, and private dental insurance plans for children

• Final report available on-line, including 2001 site visits to the ABCD program (Washington state), North Carolina �Into the Mouths of Babes� program, and Michigan Healthy Kids dental program AND . . . . . .

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� �Interfaces� White paper and related background papers prepared for July 28, 2003 conference

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Next Steps?

� Link Advocacy and Media Efforts� AAPD began work 17 years ago with a public relations

firm to raise the visibility of pediatric dentistryThere is a method to �pitching� or interesting the media in covering certain areas. It is a longer process to get interest and coverage in a serious complex issue vs. �general preventive health tips.�

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� The media firm tries to link local media spokespersons to issues, so there is a Pediatric Dentist who can be interviewed for local print, television, or radio media

� AAPD Media Spokesperson training has covered the top 50 media markets

Note: Public relations firms offer contacts and networks of reporters that know each other. This is equivalent to the benefit of engaging a lobbyist and/or lobbying firms that are effective in working with legislators and legislative staff. Recognition and �getting in the door� are among the benefits that an association is paying for.

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AAPDF �Good Health Starts Here� Campaign

� The AAPD Foundation is working with Jordan Associates on a �public education� campaign to reach pediatricians and parents with preventive oral health messages (e.g., brush your baby�s teeth, don�t put your baby to bed with a bottle). This is supported in part by Procter and Gamble, with a matching grant of $100,000 per year for three years.

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AAPDF �Building a Healthy Future for Children� Capital Campaign

� $6 million goal� Research� Public Awareness� Pediatric Dentistry Education� Leadership Institute

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Upcoming Initiatives

�Public Service Announcement on Age 1 Visit�New mothers� kit at hospitals�Leadership Institute (applications due July 31, 2004)�Adolescent health campaign (via PIPPAH)�Enhancement of overall PR efforts