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American Dental Education Association
Volume 2, No. 62, July 12, 2022
CMS Proposes Expanding Medicare to Include Additional Dental Coverage
The Centers for Medicare & Medicaid Services (CMS) released its unofficial proposed Calendar Year 2023 Physician Fee Schedule (PFS) rule [ [link removed] ] . This proposed rule is updated and released every year. However, unlike the previous year’s rule, this new proposed rule seeks to expand access to dental care, as well as to behavioral health services, Accountable Care Organizations (ACOs) and cancer screening. The expansion is in line with CMS’s focus on health equity and overall health—specifically on the evidence-based connection of oral health to whole body health.
Though President Biden and the Democrats were unable to legislatively expand Medicare coverage to include dental, the Biden administration is attempting to do so regulatorily. CMS would do this by expanding the definition of “medically necessary” dental services. Currently, Medicare Part B pays for dental services when that service is integral to medically necessary services required to treat a beneficiary's primary medical condition, for example, covering reconstruction of the jaw following accidental injury. But under the proposed rule, CMS would pay for dental services, such as dental examinations and treatments preceding an organ transplant because the dental services have been inextricability linked to, and substantially related and integral to, the clinical success of clinically related services, or furnished in connection with other covered medical services.
In the proposed rule, CMS seeks public comment on:
1. Its proposal to clarify and interpret “medically necessary” and codify certain current Medicare Fee-For-Service (FFS) payment policies for medically necessary dental services;
2. Its proposal on payment for other dental services, such as dental exams and necessary treatments prior to organ transplants, cardiac valve replacements and valvuloplasty procedures that may be inextricably linked to, and substantially related and integral to, the clinical success of an otherwise covered medical service;
3. Other types of clinical scenarios where dental services may be inextricability linked to, and substantially related and integral to, the clinical success of clinically related services, or furnished in connection with other covered medical services;
4. The potential establishment of a process to review public submissions of recommendations for identifying the circumstances when the policies may apply;
5. Other potentially impacted policies; and
6. The potential future payment models for dental and oral health care services and other impacted policies.
There will be a 60-day comment period on the proposed rule. The comment period begins on the day of the publication of the official proposed rule in the Federal Register. Though CMS released the unofficial proposed rule last week, the official proposed rule will not be published in the Federal Register until Friday, July 29 [ [link removed] ] .
FDA Temporarily Stays Order Banning Sale of Juul E-Cigarettes
The Food and Drug Administration (FDA) issued a stay on its order blocking the commercial sale of Juul e-cigarettes from the U.S. market. The FDA notes that the order is not rescinded, just temporarily stayed while the agency considers additional issues unique to Juul’s application.
The stay comes only two weeks after the FDA’s initial order was issued on June 23. A federal court issued a temporary stay blocking the FDA order one day after the order’s release.
The FDA’s announcement [ [link removed] ] was issued via the agency’s Twitter account.
New Hampshire Expands Dental Coverage for Adults Enrolled in Medicaid
On July 1, New Hampshire Gov. Chris Sununu (R) signed two bills, SB 422 [ [link removed] ] and HB 103 [ [link removed] ] , that will expand the state’s Medicaid dental benefits for adults. The state currently offers coverage emergencies, but under the new law, the state’s Department of Health and Human Services can solicit information and contract with managed care organizations to manage the benefits program. A managed care organization awarded a contract would be required to cover:
• Diagnostic and preventative services;
• Comprehensive restorative treatment to prevent or treat oral health conditions;
• Oral surgery and treatment necessary to relieve pain, eliminate infection or prevent imminent tooth loss; and
• Removable prosthodontics for specified populations.
Additionally, the benefit would be capped at $1,500 annually, excluding preventative services. The program would also be required to implement maximum cost sharing allowed under federal guidelines for all services other than diagnostic and preventative services for families with incomes 100% above the federal poverty level.
Expanding or adding dental benefits has been trending among states. In recent years, Delaware [ [link removed] ] , Maine [ [link removed] ] , Maryland [ [link removed] ] , Minnesota [ [link removed] ] , Tennessee [ [link removed] ] and Virginia [ [link removed] ] have all added or expanded dental benefits for adults enrolled in Medicaid.
Missouri Gov. Signs Bill Making Dentists, Dental Surgeons and Dental Hygienists Eligible for Student Loan Repayment Program
On June 30, Missouri Gov. Mike Parson (R) signed a bill [ [link removed] ] that makes dentists, dental surgeons and dental hygienists eligible for the state’s medical student loan program. The authorizing statute [ [link removed] ] allows the program to issue to a limited number of students, loans that can be forgiven when loanees practice in a defined rural area or an area of defined need. Loanees who practice in qualifying areas can have a quarter of the interest and principal of their total loan forgiven for each year they practice in a qualifying area. The bill also increases the maximum annual award to $25,000.
Additionally, the bill makes changes to prepaid dental plans. These plans will now be required to pay providers directly if a patient has assigned his or her insurance benefits to the provider, and they will also be added to the definition of “health carrier” under laws that regulate the assessment of a practitioners’ qualifications to provide patient care services and act as a member of the health carrier’s provider network.
Virginia Budget Increases Reimbursement for Medicaid Dental Services
Medicaid dental providers in Virginia will soon receive more money for providing services as the state’s recently signed budget [ [link removed] ] includes a 30% increase in reimbursement rates [ [link removed] ] . The Virginia Dental Association estimates that the cost of providing services has increased 60% since 2005 [ [link removed] ] , but reimbursement rates have remained the same.
ADEA Advocacy in Action
This appears weekly in the ADEA Advocate to summarize and provide direct links to recent advocacy actions taken by ADEA. Please let us know what you think and how we might improve its usefulness.
Issues and Resources
• ADEA memo [ [link removed] ] regarding vaccines at the state level
• ADEA report [ [link removed] ] on teledentistry
• ADEA report [ [link removed] ] on the Impact of the COVID-19 Pandemic on U.S. Dental Schools
• ADEA policy brief [ [link removed] ] regarding overprescription of antibiotics
• For a full list of ADEA memos, briefs and letters click here [ [link removed] ] .
ADEA U.S. Interactive Legislative and Regulatory Tracking Map [ [link removed] ]
Key Federal Issues [ [link removed] ]
Key State Issues [ [link removed] ]
The ADEA Advocate [ [link removed] ] is published weekly. Its purpose is to keep ADEA members abreast of federal and state issues and events of interest to the academic dentistry and the dental and research communities.
©2022
American Dental Education Association
655 K Street, NW, Suite 800
Washington, DC 20001
Tel: 202-289-7201
Website: www.adea.org [ [link removed] ]
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B. Timothy Leeth, CPA
ADEA Chief Advocacy Officer
Bridgette DeHart, J.D.
ADEA Director of Federal Relations and Advocacy
Phillip Mauller, M.P.S.
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Brian Robinson
ADEA Program Manager for Advocacy and Government Relations
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