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Medicare Rule Requiring Dentists to Enroll or Officially Opt Out Before Prescribing Medication Unnecessary for Dentists, ADA Argues; Asks Small Business Administration to Intervene

October 21, 2014 The Small Business Administration (SBA) recently responded to an ADA request that the agency approach the Centers for Medicare and Medicaid Services (CMS) about problems associated with a new rule that requires dentists, before they can prescribe medicine to Medicare patients, either to enroll in the program or officially opt out. SBA Ombudsman Brian Castro has told the ADA that he has asked for a “high-level review of the information you submitted and a response describing the results of its review.”

The ADA is concerned about the rule—postponed until June 2015—because it would deny payment for a Medicare beneficiary’s medication if the prescribing provider had not either enrolled or opted out of the program. CMS has previously denied the ADA’s request for a “reg flex” cost analysis of the rule (as required by the Regulatory Flexibility Act of 1980), arguing that it is not necessary because most health care providers are already enrolled in Medicare, which is plainly not true for dentistry.

The ADA continues to fight against the rule on behalf of its members. The Association ultimately would like dentists excluded from the requirements of the rule, for the good of both the patients and the dentist/pharmacist relationship. It has argued that the rule would hurt Medicare patients by hindering dentists’ ability to effectively prescribe medication.