Public Statement on Medicare Coverage of Medically Necessary Oral and Dental Health Therapies
Most Medicare beneficiaries are unable to receive oral and dental care even when it is medically necessary for the treatment of Medicare-covered diseases. Historically, Medicare coverage has extended to the treatment of all microbial infections except those of the teeth and periodontium. Believing there is no medical justification for this exclusion, in 2016 a consortium comprising numerous medical and dental associations, societies, and institutions was formed to express broad consensus that oral healthcare is integral to the management of several serious diseases and medical conditions.
On July 8, the Centers for Medicare & Medicaid Services announced its 2023 Physician Fee Schedule, in the form of a proposed rule, which would broaden reimbursement for medically necessary dental services and substantially expand access to dental care.
“This important announcement marks a new day in the health of Medicare beneficiaries,” said Dr. Michael Alfano, DMD, PhD, cofounder of the Santa Fe Group and the Consortium. “Thanks to the tireless work of literally hundreds of organizations and thousands of dedicated advocates, Americans will no longer lack access to medically necessary oral and dental treatment within the traditional Medicare program.”
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State Medicaid payor contracts for medical and dental beneficiaries should mirror this policy shift, as implementation is the key issue. In addition to changes in fee schedules for medically necessary dental services, state contracts would set minimal timeframes for turnaround times for approvals and reimbursements. This would increase physician, dentist and other healthcare provider participation in relevant CMS programs, along with increases in fees. In an inflationary, recessionary cycle, the delay between delivery of services and payment is a key reason that provider participation appears to be going down. What voices are at the table to articulate this? Margaret Scarlett DMD