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ADA asks CMS to prioritize expanding dentists’ participation in Medicaid

July 22, 2021

By Jennifer Garvin

Baltimore — The ADA is asking the Centers for Medicare & Medicaid Services to increase reimbursement and reduce administrative burden in order to increase the number of dentists who participate in the Medicaid program.

In a July 16 letter to Daniel Tsai, deputy administrator and director, Center for Medicaid and CHIP Services, ADA President Daniel J. Klemmedson, D.D.S., M.D., and Executive Director Kathleen T. O’Loughlin, D.M.D., said that easing the credentialing and audit processes and paying clean claims within 15 days would encourage more dentists to take Medicaid.

The ADA also anticipates working with CMS to:

• Require the CMS Center for Program Integrity to issue guidance to state Medicaid agencies concerning best practices in dental audits and developing standardized training for dental auditors.
• Provide guidance to state Medicaid agencies to streamline dentist credentialing by utilizing the ADA Council for Affordable Quality Healthcare credentialing service or equivalent.
• Establish the benchmark floor for all Medicaid dental fees at 75th percentile of regional dental fees based on ADA survey data.
• Work to enhance consistent adult dental benefits across all Medicaid Programs.
• Partner with the dental community to establish an appropriate Healthcare Common Procedural Coding System billing code to help address ongoing challenges regarding access to dental rehabilitative services in operating rooms in hospitals and ambulatory surgical centers.
• Increase oral health equity, including incentivizing dentists to practice in underserved communities across the United States and strengthening support for Action for Dental Health initiatives.

For more information on the ADA’s advocacy efforts, visit ADA.org/Advocacy.