CDA commends the Biden administration and CMS for their decisive action; many of their recommendations are reflected in the new regulation.
Quick Summary:
This week, the Biden administration increased Medicare’s coverage for dental operations that are medically required. Some services will be covered starting in 2023, including some cardiac procedures and the removal of infections before organ transplants. Dental services related to head and neck cancers will be covered starting in 2024.
The Biden administration this week expanded coverage for medically necessary dental procedures in Medicare, a crucial move that CDA and hundreds of leading organizations have supported through years of advocacy work to improve patient access, equity, and outcomes. This is a victory for Medicare beneficiaries and providers.
This week’s regulatory move by the government is a significant step toward increasing the scope of dental services covered by Medicare. Along with the significant benefits for beneficiaries starting as early as 2023, this regulation provides a yearly procedure that is anticipated to result in an additional expansion of the range of dental services that are covered by Medicare.
Coverage of dental services integrally tied to medical conditions
First, and most immediately, the Centers for Medicare & Medicaid Services will pay for dental services when those services are integral to treating a beneficiary’s medical condition and are inextricably linked to that treatment, such as dental examinations and infection control before and following organ transplantation, cardiac valve replacement or surgery, and head and neck cancer treatment.
Some services will be covered starting in 2023, including some cardiac procedures and the removal of infections before organ transplants. Dental services related to head and neck cancers will be covered starting in 2024.
Since July, the CDA Medicare Workgroup has been analyzing and commenting on the CMS’s plan, and it expressly backed the enhanced coverage that is currently being included in Medicare Parts A and B.
According to CDA President Ariane Terlet, DDS, “CDA is thrilled that Medicare recipients will now have additional coverage for many medically required and potentially life-saving dental treatments.” “The expanded coverage is especially important for underserved populations who face higher rates of chronic health conditions and medical challenges, as the lack of this dental coverage frequently prevents or delays the provision of covered medical treatments, increasing the risk of expensive medical complications,” says the study.
Potential for additional covered services through review of clinical evidence
Second, the new legislation creates a yearly procedure for reviewing public comments and medical data on various medical situations that can justify the payment for dental treatments.
The annual process is a crucial avenue that will now be open for supplying additional documented proof that medically necessary treatment of oral health issues is crucial for fending off and preventing a variety of pricey chronic disorders. In the next months and through 2024, CMS will start publishing new recommendations.
And third, the regulation codifies current Medicare coverage for dental splints for covered treatment of specific medical conditions, oral or dental examinations related to renal transplant surgery, reduction of jaw fractures, tooth extraction in advance of radiation treatment of neoplastic disease, and wiring of teeth related to covered medical services.
According to Dr. Terlet, this week’s regulation action by the Biden administration “moves us toward a more fair system of care” by guaranteeing that more seniors may obtain dental care and enhance their results for greater health and well-being.
CDA’s recommendations on coding and fees are reflected in the regulation
In recent months, the CDA workgroup has also critically examined how to make an increase in dental services practical and useful for dentists and their patients. Most significantly, CDA suggested in its comments to CMS a precise and thorough approach to the fee structure that would exclude dentists from the physician fee rate setting process as well as the budget-neutral conditions that have kept Medicare physician prices down for the past 20 years. Additionally, the committee requested that dentists be compensated at a fair market rate rather than by benchmarking at Medicaid or other public program rates.
According to Terlet, “Our analysis of the payment structure referred to in the regulation shows that CMS is on the correct track concerning the payment structure and that CMS heard CDA’s input to not subject dental services to the physician fee schedule budget neutrality standards.” “Additional advice from CMS will be required to clarify the rate setting process, and CDA will continue to lobby with CMS to help ensure the implementation is practical and workable for Medicare dentists and their patients,” says the CDA.
The CDA will keep members updated on progress and developments in the coming months. CDA will continue working with the Biden administration to ensure that the increased coverage for patients and providers is successfully implemented and that the payments are practical and functioning.
