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ODC comments on proposed changes to Medicare Parts C, D

January 29, 2018

By Jennifer Garvin

Baltimore — The Organized Dentistry Coalition has filed comments on the proposed changes to the enrollment requirements for Medicare Part C and Part D following the Centers for Medicare and Medicaid Services' Nov. 16 announcement that it planned to rescind certain Medicare Part D and C requirements for providers.

The proposed changes include that dentists no longer need to enroll in or opt out of Medicare to continue to provide dental care and prescriptions for Medicare Advantage and Part D drug plan beneficiaries.

In a Jan. 12 letter to CMS, the coalition said it supports the "creation of the preclusion list as a substitute for the enrollment or opt-out requirement under Medicare Part D" and asked the agency to delete the "current regulations that require prescribers to enroll in or opt out of Medicare for a pharmacy claim (or beneficiary request for reimbursement) for a Part D drug prescribed by a physician or eligible professional to be covered.

"We also propose to generally streamline the existing regulations because, given that we would no longer be requiring certain prescribers to enroll or opt out, we would no longer need an exception for ''other authorized providers,'' the coalition said, adding that organized dentistry believes this would "better facilitate our dual goals of reducing prescriber burden and protecting the Medicare program and its beneficiaries from prescribers who could present risks."

The coalition also commented on the section in the Patient Protection and Affordable Care Act that requires physicians who order items or services under Medicare to enroll in Medicare or opt-out, saying, "in spite of the efforts of CMS and the coalition to publicize this to their members, many dentists have chosen not to enroll in or opt-out. We believe some of the same reasons that caused dentists to fail to comply with the Part D rule apply to the ordering and referring rule" and urged CMS to pursue efforts to rewrite the current rule.
They also noted that dentists who opted out are no longer eligible to provide dental services for Medicare beneficiaries enrolled in Medicare Advantage (Medicare Part C and that patients of those dentists are also precluded from filing a claim on their own behalf.

"Currently, a dentist who opts out is allowed to withdraw the opt-out affidavit within the first 90 days, thereafter they are opted out for two years," the coalition said. "Many dentists did not learn of the impact on their participation in Medicare Part C plans until after the initial 90-day period had passed. Complicating the issue even more, CMS changed the rule so that effective June 16, 2015, unless the provider took affirmative action to withdraw the affidavit 30 days before the anniversary date, the enrollment automatically renewed for two more years.

"Our organizations have received numerous calls from members who opted out in good faith trying to comply with the Medicare Part D rule only to learn later they were precluded for participating in Medicare Part C plans," the coalition said. "Previously, the coalition has suggested that since CMS has changed the enforcement date at least 5 times since the initial rule was published, CMS should permit dentists who opted out a second opportunity to reconsider and allow them to withdraw their affidavit.

"It is our understanding that only a few thousand dentists have opted out. Based on this new regulation and change in enforcement, the coalition again urges CMS to allow the Medicare Contractors to contact each dentist who has opted out giving them the opportunity to withdraw the affidavit. The coalition will work with CMS to publicize this effort to within the profession," the letter concluded.