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Advocacy News

CMS 'Interim Final Rule' Pushes Medicare Opt-in/Opt-out Deadline to Jan. 1

May 12, 2015 The Center Medicare and Medicaid Services (CMS) published an "interim final rule" last week that, among other things, would extend to Jan. 1, 2016, the effective date by which dentists must have either enrolled or officially opted out of Medicare in order for prescriptions they write to be covered by Medicare Part D. This proposed rule would also require Part D plans to cover a "provisional supply" of up to 90 days of a medication prescribed by a doctor who has not enrolled or opted out. A Part D plan must notify the beneficiary in writing within three business days that the medication is being covered on a provisional basis because of the prescriber's current Medicare status. Part D plans must also make reasonable efforts to notify the prescriber. After covering the provisional supply and providing the notice to the beneficiary, the Part D plan would be required to reject future claims for the same medication for that beneficiary if the prescription is from the same prescriber.

For a dentist to meet the Jan 1, 2016 effective date, he or she must submit their application at least 90 days before this date to allow sufficient time for processing.