Press Release
Lawsuit Argues Changes to Board Rule 1.7 Exceed Legislative Authority and Threaten Patient Access, Particularly for Medicaid Patients
The Association of Dental Support Organizations (ADSO) recently announced that it has filed a legal challenge against the Colorado Dental Board regarding its recently adopted amendments to Rule 1.7. The updated rule fundamentally changes how dental support organizations (DSOs) — which provide business support such as billing, compliance and facility support to dental practices — can operate and reduces the time dentists can dedicate to treating patients, threatening their ability to serve Coloradans in a state where 1.2 million residents already live in dental health professional shortage areas.
“The Dental Board clearly overstepped its authority in this rulemaking, risking patient access to dental care in Colorado, particularly for the communities across the state that need more access and greater affordability,” said ADSO CEO Andrew Smith. “DSO support of dental offices helps increase access to quality, affordable care; gives dentists greater access to the latest dental technology and the ability to offer better patient experience and outcomes. DSO-supported dentists also serve the Medicaid population to a much greater degree than traditional dentists, expanding dental care for Colorado residents. All of this is under threat as a result of the Dental Board’s rulemaking.”
Rule 1.7 changes were adopted earlier this year through the Board’s rulemaking authority under the 2025 Dental Practice Act Sunset Bill (SB25-194) despite SB25-194 not mentioning DSOs anywhere in its text. While the changes don’t prohibit DSOs outright, the updated rule imposes new restrictions on dentist-DSO relationships and creates compliance challenges and uncertainties for dentists, provider networks and DSOs. This includes making it impermissible for DSOs to lease office space and equipment to supported practices; exposing dentists and hygienists to potential Board discipline simply for practicing in certain DSO-supported settings; and requiring disclosure of financial and business records with no limit on scope, no advance notice, and no cap on frequency. None of this changes the fact that dentists have always had, and should continue to have, the right to contract for the level of non-clinical support that fits their practice, while retaining sole and independent authority over clinical care.
Importantly, the Board did not appear to establish a record of patient harm that would justify these restrictions. Instead, they risk reducing the very access to care they claim to protect — particularly for Medicaid patients, since DSO-supported practices accept Medicaid at higher rates than solo practices (53% vs. 40%).
The ADSO’s legal challenge will ask the Colorado Court of Appeals to set aside the new rule changes.
The Dental Board’s rulemaking comes as dental Medicaid continues to be a severely underfunded benefit in Colorado and across the country, with a worrying lack of providers. Pediatric Medicaid dentistry is even more underserved. DSO supported offices help fill those gaps by intentionally expanding their support of dental offices into areas with limited dental providers — helping address geographic access barriers and helping dentists bring quality care to communities that need it most. DSO-supported practices also tend to be located in counties with lower income households and are more likely to have access to the latest dental technology, improving quality of care and treatment outcomes.
“DSOs support efforts to improve access to quality care for larger populations. But this new rule is a solution in search of a problem that doesn’t exist,” Smith said. “The rule exceeds the Dental Board’s authority and injects the Board into commercial transactions while threatening access to care and unnecessarily increasing healthcare costs.”
