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Triad of dental organizations urge government to rescind Medicare Part C, Medicare Advantage requirement

September 06, 2017

By David Burger

Washington — The ADA, the National Association of Dental Plans and Delta Dental Plans Association urged the federal government to remove or delay an enrollment requirement for dentists who participate in Medicare Part C or Medicare Advantage Plans.

The Aug. 28 letter was sent directly to Demetrious Kouzoukas, principal deputy administrator for the Centers for Medicare & Medicaid Services and director of the Center for Medicare. It follows a similar letter sent to Tom Price, M.D., U.S. Department of Health and Human Services secretary, in April and a meeting in early August between Mr. Kouzoukas and representatives of the three groups.

The letter — signed by Dr. Gary Roberts, ADA president; Dr. Kathleen O’Loughlin, ADA executive director; Theresa McConeghey, National Association of Dental Plans chair; Evelyn Ireland, National Association of Dental Plans executive director; and Jason Daughn, Delta Dental Plans Association vice president, government relations — states that the rule requiring dentists to enroll in Medicare to provide supplemental services through Part C plans, or Medicare Advantage plans, is “inappropriate and places an unnecessary burden on dentists who do not otherwise perform Medicare-covered services.”

The letter continued: “While the rule is not scheduled to be enforced until Jan. 1, 2019, we urge you to withdraw the mandate in the rule as it concerns dentists or immediately delay the implementation of the rule and substantially modify its application to dentists.”

The three groups outlined recommendations “regarding how the Centers for Medicare & Medicaid Services can enforce the rule and maintain adequate oral health services for America’s seniors.”

According to the letter, without modifications to the requirement, 12-14 million Medicare Advantage beneficiaries — over 60 percent of the Medicare Advantage population — will experience disruption and loss of continuity of dental care. The groups believe enforcement of the rule could lead to large numbers of dentists choosing not to participate in Medicare Advantage plans.

The letter closed by saying that the “dental profession and the dental benefits industry believe that serious, negative consequences will result from full implementation of the rule with regard to dentists participating in networks providing supplemental dental benefits to Medicare Advantage beneficiaries.”