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09/18/2013

What CDA's legal action means to providers


CDA’s legal action challenges both Delta’s right to make certain amendments to dentists’ individual contracts and reduce Premier fees unilaterally. CDA will request that the arbitrator, once appointed, maintain the status quo until a final ruling is made in the binding arbitration. If the arbitrator agrees to maintain the status quo, then no change can occur until the arbitration is concluded. If the arbitrator declines to maintain the status quo, Delta would be able to make fee reductions at some time after Oct. 4, although it would still be required to provide 45 business days’ notice of any fee reduction.

It is CDA’s belief that the proposed contract amendments are Delta’s first step toward implementing Premier Plan fee reductions. The current contract prohibits those reductions, and Delta’s regulatory filings appear to make it clear that this is the reason it wants to amend dentists’ contracts now.

“Delta’s filing with the Department of Managed Health Care indicates it will be taking action to reduce provider reimbursement rates,” said Walt Weber, DDS, chair of the Dental Benefits Research Task Force. “The filing shows Delta laying a foundation to issue unilateral fee reduction notices to providers. We want our members to be informed about the process and the impact it may have on their practices.”

The arbitration process can be lengthy and a final ruling is expected to take approximately a year. If the arbitrator does not prevent Delta from implementing the contract amendments during the arbitration, and Delta subsequently reduces fees, individual providers will need to determine whether to accept or reject Delta’s proposed changes based on what is in the best interests of his or her patients and practice.

Regardless of whether CDA is able to delay the Oct. 4 effective date of Delta’s attempted contract amendments and any subsequent fee reductions, the association will continue to challenge the lawfulness of those attempted contract amendments and fee reductions. 

CDA’s legal action, if successful, may result in maintaining Delta’s current contract terms and could result in Delta’s rescission of the proposed revisions to the Participating Dentist Rules and MAPP.

Members who are Delta Dental providers interested in joining the arbitration as a potential claimant or witness, or believe they may have pertinent evidence related to this issue can contact CDA’s Jan Katerkamp at 916.554.4913 or jan.katerkamp@cda.org.