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State dental associations ask HHS to eliminate 'unnecessary' regulations

May 18, 2017

By Jennifer Garvin

Washington — State dental associations are asking the U.S. Department of Health and Human Services to rescind certain federal regulations that they believe adversely affect access to dental care across the nation.

In a May 4 letter to Tom Price, M.D., HHS secretary, the dental associations from all 50 states and Washington D.C. urged the agency to consider eliminating the Medicare mandate enrollment requirement for providers who don't perform Medicare-covered services and who are not reimbursed for these services. They also asked that HHS enforce Section 1557 of the Affordable Care Act as written without the promulgation of regulations.

"Our associations believe that [these regulations] unnecessarily contribute to the cost of providing care, making it more difficult for our members to deliver oral health care services at an affordable price," they wrote.

Regarding the CMS-mandated enrollment for all providers performing certain activities where a Medicare beneficiary is the patient, the coalition noted that these actions were initiated in an effort to "tamp down waste, fraud and abuse within the Medicare program."

Fewer than four percent of all dentists provide Medicare services and are enrolled in Medicare as full providers and others have enrolled or opted out in response to the mandate, the coalition noted.

Therefore, "we ask that you eliminate the enrollment mandates for those providers, including dentists, who do not perform Medicare-covered services and are not reimbursed for these services."

Per the current regulations, dentists must enroll in Medicare if they perform any of the following:

  • Ordering and referring. Providers who order covered clinical laboratory services or imaging services for Medicare-eligible patients must be enrolled in Medicare's Provider Enrollment, Chain and Ownership System, or opt-out of Medicare.
  • Medicare Part D. Dentists writing prescriptions to Medicare Part D beneficiaries are required to be enrolled in Medicare as a full provider or as a referring and prescribing physician, or opt-out of the program in order for a pharmacist to be reimbursed for the drugs prescribed and dispensed.
  • Medicare Advantage. All providers or suppliers that furnish health care items or services to a Medicare beneficiary with a Medicare Advantage plan must be enrolled in Medicare for the beneficiary to utilize the benefit.
Regarding Section 1557 and the HHS Office for Civil Rights' final rule on nondiscrimination in health care, the groups said that while they "strongly support nondiscrimination in health care and equal access to health care for all patients without regard to race, color, national origin, sex, age, religion or disability," it has proven "exceedingly difficult" to advise their members on compliance with the final rule because the final rule has increased confusion and costs for ADA members, many of whom own and operate small businesses.

"We believe the OCR rule is unnecessary, does not benefit patients and should be rescinded," the coalition wrote. "The statute is already in effect and regulations are not required to implement it. Instead, we recommend that OCR simply enforce Sec. 1557 as written without the promulgation of regulations."

"Thank you for your consideration of our requests," the letter concluded. "Addressing these issues will help free dentists from unnecessary administrative burdens and allow them to focus on getting care to patients who need it."