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ADA supports removing Part D requirement

November 01, 2017

By Jennifer Garvin

Washington — The ADA said Nov. 1 that it is "pleased" to support the Protecting Seniors Access to Proper Care Act of 2017, legislation that supports removing the mandate for dentists — and other providers who are low prescribers and do not participate in Medicare — requiring they be enrolled in or opted-out of Medicare Part B in order for their written prescriptions to be covered under Medicare Part D.

In a letter to House Committee on Ways and Means Chair Kevin Brady, R- Texas, and Ranking Member Richard Neal, D-Mass.,  ADA President Joseph P. Crowley and Executive Director Kathleen T. O'Loughlin said that if the mandate is not removed, "many seniors will not 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."

The Protecting Seniors Access to Proper Care Act of 2017, H.R. 4169, was introduced by Rep. Kenny Marchant, R-Texas. In addition to the committee letter, the Association also thanked Rep. Marchant in an Oct. 31 letter.

The ADA reminded legislators that under Section 6405(c) of the Affordable Care Act, the Centers for Medicare and Medicaid Services was provided the discretion to require 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, Drs. Crowley and O'Loughlin noted, "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." For dentists who elect to opt out of Medicare, they forfeit their ability to participate in Medicare Advantage plans.

"In short, under the current CMS rule, there are no good options for dentists and their patients," Drs. Crowley and O'Loughlin said.

Additionally, the ADA stressed that there are no "legitimate 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," Drs. Crowley and O'Loughlin said. "The boards are, and will continue to be, the main investigative and disciplining body for prescribing authority."

The Association has advocated for the removal of the mandate since it was introduced by the Centers for Medicare and Medicaid Services in 2014.

For information on all of the ADA's advocacy efforts, visit ADA.org/advocacy.