Dental groups urge Senate to pass Ensuring Lasting Smiles Act

Legislation requires medically necessary dental procedures be covered for those with congenital anomalies

The Organized Dentistry Coalition is asking the Senate to support the Ensuring Lasting Smiles Act. If enacted, the bill would ensure all group and individual health plans cover medically necessary services, including needed dental procedures such as orthodontic or prosthodontic support, as a result of a congenital anomaly.

The Ensuring Lasting Smiles Act, or ELSA, previously passed the House of Representatives in April. The coalition sent a letter Oct. 7 to the Senate Committee on Health, Education, Labor and Pensions urging lawmakers to include the bill in any legislative package it takes up before the end of the year.

According to the Centers for Disease Control and Prevention's National Center on Birth Defects and Developmental Disabilities, approximately 1 in every 33 babies born in the United States each year has a congenital anomaly, commonly referred to as a birth defect, the groups wrote. This includes craniofacial anomalies such as cleft lip and palate, skeletal and maxillofacial deformities, facial paralysis, microtia, hypodontia and craniosynostosis.

"These conditions often impede daily functioning, particularly that of the nose and mouth area, potentially restricting a patient's ability to breathe, eat and speak," the coalition wrote. "Corrective procedures allow these patients to grow and function normally. While many private health insurance companies cover preliminary procedures for congenital anomalies, they routinely deny or delay follow-up or corrective procedures - notably, dental-related procedures involving orthodontia and dental implants - deeming them cosmetic or covered by dental plans."

"Severe dental anomalies are a common symptom of many craniofacial anomaly conditions, but coverage limits in dental plans are more restrictive than those in health plans," the letter continued. "As a result, patients are often forced to incur significant out-of-pocket costs on medically necessary reconstructive dental care related to their disorder during their lifetime."

The coalition also pointed out that if health insurance coverage is required by a state, it may be limited to minor patients or patients with specific conditions, such as cleft lip and palate.

"Even in states with laws requiring health insurance coverage, [Employee Retirement Income Security Act  plans] are exempt from those requirements - making federal legislation essential to ensure coverage for all patients," the groups wrote.

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