Medicare Part D (Opt-Out)
The ADA is working with lawmakers, regulators, and others to change a Center for Medicare and Medicaid Services (CMS) rule that requires prescribing dentists—who do not otherwise participate in Medicare—to enroll in (or formally opt-out of) the program before Medicare Part D will reimburse patients for any drugs prescribed. The rule is yet another administrative burden on dentists and an unnecessary restriction on coverage for Medicare Part D enrollees.
Though intended to prevent under qualified or even fraudulent individuals from enrolling in Medicare, there is scant evidence that Medicare Part D prescription fraud is being perpetrated by individuals posing as dentists. The vast majority of dentists do not even participate in Medicare. Moreover, other means already exist to validate that prescriptions are being written by appropriately licensed and credentialed dentists.
Take Action Now!
Tell your member(s) of Congress to cosponsor H.R. 4062, the Protecting Seniors Access to Proper Care Act. This bill will help Medicare Part D enrollees get reimbursed for prescriptions written by non-participating dentists.
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To help Medicare Part D enrollees get reimbursed for prescriptions written by non-participating dentists, the ADA is calling on CMS to:
- Eliminate the requirement for prescribing dentists—who do not otherwise participate in Medicare—to enroll in (or formally opt-out of) the program.
If CMS retains the requirement for dentists to enroll in (or formally opt-out of) Medicare, the agency should:
- Instruct Medicare contractors to recognize the eligibility of all dental specialties (plus general dentists) to enroll in (or formally opt-out of) the program.
- Amend the Medicare Provider Enrollment Form (Form CMS-855I) and Registration Form for Ordering and Referring Providers (Form CMS-855O) to include all ADA-recognized specialties, as well as general dentistry.
The Association's priorities are based on the major policies and positions (PDF) (Members Only) adopted by the ADA House of Delegates.
Letters and Testimony
- September 23, 2016—Letter (PDF) asking the Centers for Medicare and Medicaid Services (CMS) to delay enforcing the Medicare Part D prescriber enrollment rule until several issues are resolved.
- April 25, 2016—Letter (PDF) urging the Centers for Medicare and Medicaid Services (CMS) to exempt dentists from a proposed rule that would require health care providers who order, certify, refer, or prescribe any Part A or Part B service to be enrolled in Medicare or validly opted out.
- December 18, 2014—Letter (PDF) urging the Centers for Medicare and Medicaid Services (CMS) to simplify the process for dentists to enroll (or register) as Medicare Part D prescribers.
- September 2, 2014—Letter (PDF) commenting on the Centers for Medicare and Medicaid Services (CMS) proposed rule governing transparency in continuing education activities (i.e., Open Payments or "Sunshine Act") and access to identifiable patient data by the CMS Innovation Center.
- July 15, 2014—Letter (PDF) urging the House Small Business Committee to help mitigate the potential adverse impact of the Centers for Medicare and Medicaid Services (CMS) final rule governing Medicare Part D coverage for prescriptions written by non-participating dentists.
Letters and Testimony reflect the Association's position(s) on specific bills, regulations, and other policy issues, and are based on the major policies and positions (PDF) (Members Only) adopted by the ADA House of Delegates.
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