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Coalition urges support for bill removing requirement for Part D prescribers to enroll in Medicare

February 22, 2016

By Jennifer Garvin

Washington — To increase support for legislation that calls for removing the mandate that Part D prescribing health care providers be enrolled in Medicare, Organized Dentistry Coalition member organizations are urging lawmakers to sign on as cosigners to H.R. 4062.

The bill, formally called the Protecting Seniors Access to Proper Care Act, exempts dentists from a rule authorized under the Affordable Care Act that requires all health care providers who prescribe to a Part D beneficiary be enrolled in the Medicare program in order for pharmacists to be reimbursed. Dentists, chiropractors, optometrists and podiatrists would also be included in the exemption.

In a Feb. 22 letter, the coalition urged Congress to support the legislation so that senior patients can continue to have access to the dental care they pay for in their Medicare Advantage plan from the dentists of their choice or the prescription coverage they are promised when they enroll in Part D.  

Under the ACA, the Centers for Medicare and Medicaid Services requires all health care professionals who prescribe to Part D beneficiaries to enroll in or opt out of Medicare Part B, including those providers who do not receive reimbursements from Medicare.

"By enrolling, dentists agree to the rules, regulations, and guidelines of Medicare and must open their practices up to the government for audits, while not taking reimbursements from the program. On the other hand, dentists who elect to opt out of Medicare forfeit their ability to participate in Medicare Advantage plans," the coalition explains in the letter.

"In short, under the current CMS rule, there are no good options for dentists and their patients."

The letter also points out that there are no additional fraud enforcement requirements that "necessitate the inclusion of dentists who do not participate in Medicare under the CMS rule.

"State licensing boards grant the authority to practice and they maintain records on the identities of licensed dentists in good standing within each state. The boards are, and will continue to be, the main investigative and disciplining body for prescribing authority."

Enforcement of the rule is delayed until June 1.

The original sponsors of the bill are U.S. Reps. Kenny Marchant (R-Texas) and Earl Blumenauer (D-Ore.), who introduced the bill along with three original cosponsors: Diane Black (R-Tenn.), Devin Nunes (R-Calif.), and Mike Thompson (D-Calif.).