The Louisiana House of Representatives today passed a bill calling for tighter regulation of mobile dentistry.
— Rep. Kevin Pearson (R-Slidell)
The amended bill falls short of the ban on dentistry in schools originally proposed by the Louisiana Dental Association (LDA) -- so short that its chief opponent came close to declaring victory. "The tide has turned," said Gregory Folse, D.D.S., whose Big Smiles company employs 15 dentists to treat mostly indigent children in school gymnasiums, cafeterias, and libraries.
If passed by the Senate without further amendment and signed by the governor, the bill will require the Louisiana Board of Dentistry to promulgate new regulations for "dental services at mobile dental clinics and locations other than the dental office."
Several of the legislators said the board should already have passed regulations on mobile dentistry. The board met May 30 to discuss the issue, and some of its draft regulations were reflected in the amendment. But the board opted to defer further discussion until its August 14 meeting so it could respond to whatever legislation passes.
The bill would require the board to pass regulations on mobile dentistry by January 1, 2010, or face dismissal.
In other provisions of the amended bill, only dentists licensed in Louisiana would be allowed to operate mobile clinics in the state. They would have to indemnify the schools where they practice and would have to have $1 million in malpractice insurance.
Rep. John Bel Edwards (D-Amite) challenged this provision. "Regular dentists are only required to have $100,000 [of malpractice insurance]," he said.
"It's to protect the school districts," responded Rep. Fred Mills Jr. (D-St. Martinville), chief architect of the amendment.
Also under the amendment, if a mobile dentist hires anyone to help, then the officers of that "entity" must be licensed to practice dentistry in Louisiana as well. This provision appears aimed at one of the primary concerns of the LDA: that mobile dentists will swoop into Louisiana from other states.
The LDA lobbied the legislature for several years to increase Medicaid reimbursement rates, finally winning legislation that increased them to about 70% of usual and customary fees. At an LDA meeting where he proposed the ban on school dentistry, pediatric dentist Don Donaldson, D.D.S., commented that two political action committees for the state's dentists had contributed $232,000 "into funds for politicians" and $93,000 "in individual contributions."
"I think it's safe to say that we got a pretty good reputation over there as far as the LDA goes, as far as we go with Medicaid," Dr. Donaldson said, according to a transcript of the meeting.
"I wanted to provide something to every dentist in this state that if they so desired to improve their incomes, improve their practices to add patients, improve their standard of living, then I could do that through this Medicaid program," Dr. Donaldson said.
But Dr. Donaldson went on to express concerns that Dr. Folse was collaborating with the Maryland company Reach Out America. He warned that the company would only do the most lucrative procedures, such as placing sealants, but not follow up with children who needed more substantial care. "It's cherry picking, is what it is," he said.
In an interview with DrBicuspid.com, Dr. Folse, who is licensed in Louisiana, confirmed that he contracts with Reach Out, but only for paperwork. "Why the heck should I not hire a marketing firm from out of the state?" Dr. Folse asked. "These people at Reach Out have great expertise treating children in schools."
Dr. Folse said his company follows up on any further treatment need by most patients and has not collected fees for initial exams on those patients it refers to specialists.
Asked to comment, LDA spokesman Marc Ehrhardt said, "Dr. Folse did not get his calling to treat children in schools until the reimbursement was up to 70%." Dr. Folse acknowledges that the increased reimbursement made his school-based venture "viable." Previously, he worked primarily in nursing homes.
Dr. Folse opposed the bill, even in its amended form, arguing that "there is no reason for legislation," and several legislators spoke against it before it passed by a vote of 64-30.
"The amendment in a sense is a clever way to make it impossible to practice mobile dentistry," said Rep. Christopher Roy Jr. (D-Alexandria).
The bill's author, Rep. Kevin Pearson (R-Slidell), argued that the bill was just pushing the dental board to do its job. "This bill was seeking originally, and always has been, to give children quality care in schools."
In fact, Rep. Mills commented that "both sides don't really like the amendment, but that makes it a really good piece of legislation."
Copyright © 2009 DrBicuspid.com
