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Health minister says feds still working out the bumps of new dental health care plan

Uninsured seniors first to receive dental care coverage when program starts in May
Health Minister Mark Holland says much like when universal health care was introduced to Canadians in the 1960's, there will be a similar adjustment period for patients and oral health providers while the federal government rolls out its new Canadian Dental Care Plan.

Health Minister Mark Holland knows Canadians have more questions than answers about a new dental care plan the federal government is unveiling this spring.

Holland says there was similar confusion and worry among patients and care providers in 1968 when universal health care was created and he says the Canadian Dental Care Plan (CDCP) will eventually live up to its promise to provide an oral health safety net for the one in four Canadians who have no dental coverage.

“I think it’s a lot like when we rolled out medical care in this country, if you look back at the 1960s there were a lot of bumps, it’s a big deal to pull the whole population and make sure everybody has oral health care and that takes time,” said Holland, from his Ottawa office.

“Just like doctors had concerns when we launched a national medical system, dentists have concerns as we’re covering nine million Canadians who didn’t have medical coverage before.”

The federal plan will provide coverage to uninsured families whose income does not exceed $90,000. Initially, the CDCP is being offered to seniors so that by May, anybody aged 65 and older will be eligible. By 2025, people aged 18-64 will also qualify.

After a large majority of providers declined to sign up in the initial registration process in March, the minister promised the government is going to make it easier for dentists and hygienists to register.

“This plan works like any other insurance plan,” said Holland.

“We did have it as a requirement and now we’re losing it as a requirement to indicate participation. Somebody is going to be able to walk into a clinic, hand over their card, and that information will be plugged into (the dentists) existing system and in over 90 per cent of cases they’re going to be paid for the procedures within two days.”

A Canadian Dental Association survey of the country’s 25,500 licenced dentists determined that 61 per cent are not registering in the CDCP. Holland says that reluctance to join the program is only a temporary glitch.

“We have thousands of dentists who have signed up but we also have this alternate pathway (details of which are expected to be announced in a few days) that doesn’t require you to sign up,” Holland said. “We’re going to get there. We’re actively having great conversations with the provincial and territorial associations, and they’re doing their job, negotiating, so they’re holding back, trying to get the best deal for dentists possible and I’ve got a responsibility to get the best deal possible for patients and taxpayers.”

The CDCP fee structure generally provides lower payouts compared to the fee guides care providers in provinces and territories use to determine recommended charges for each procedure. If a procedure is not fully covered by insurance, Holland says dentists and hygienists would still have the ability to equal-bill patients to make up the difference.

“The dentists have their own process to set their fees, the government isn’t involved in that at all, so we can’t agree to fund a process we’re not involved in,” said Holland. “We have to independently look to make sure that what we’re paying is something we can defend to taxpayers.”

More complex dental work will require pre-authorization to ensure that work is required. Decisions on complex care won’t be made in the initial startup of the program in May and patients will have to wait until the fall when the online pre-authorization portal becomes available.

“We’re really trying to make it so the vast majority of day-to-day procedures require no pre-authorization and dentists can get paid instantly,” said Holland.

For cleaning teeth, which typically requires two units of scaling, each patient covered under the CDCP will be allowed four units per year. Holland said if a medical need can be demonstrated for more than the annual allotment of scaling, the plan would make an exception through the pre-authorization process to pay that cost.

“If we didn’t put a limit on how much cleaning could be done or how much scaling could be done and we just allow dentists to automatically bill, then that would create an opportunity for fraud,” said Holland.

Critics have said the government needs to simplify the billing process and reduce the paperwork required to process insurance claims to ease the burden on dental health offices already struggling to hire enough administrative staff. But Holland says the public system in place with Sun Life Assurance Company of Canada won’t be any different or any more complicated than submitting a claim to a private insurance provider and the government plans to release a video which will explain the billing process.

The national dental program was one of the key initiatives of the NDP to maintain their agreement to support the Liberal minority government on confidence votes to keep them in power.

Holland says giving Canadians the opportunity to have healthy teeth and gums is well worth the $13 billion five-year investment because of the plan’s potential to prevent serious medical conditions and ultimately reduce health care costs.

“There’s extremely good evidence that bad oral health leads to bad overall health, whether or not that’s cardiovascular disease or diabetes or a myriad of other possible chronic disease or illness,” he said. “We also know that one of the leading causes of preventable surgeries that are gumming up our hospitals (is related to) bad oral health, people who had a dental problem and didn’t get it addressed until it became a critical issue that requires surgery, which is extremely expensive and blocks up our hospitals.

“It’s really a fundamental issue of prevention and it’s also an issue of social justice. I talk to so many seniors who haven’t been able to replace their dentures in 10, 20, 30 years and have no money to replace them and don’t know what they’re going to do.

“The end result will be for all time, Canada will be a country where everyone has access to oral health care, and that’s absolutely essential.”