CMS Proposes Expanding Medicare to Include Additional Dental Coverage
The Centers for Medicare & Medicaid Services (CMS) released
its unofficial proposed Calendar Year 2023 Physician Fee Schedule (PFS) rule.
This proposed rule is updated and released every year. However, unlike the previous
year’s rule, this new proposed rule seeks to expand access to dental care, as
well as to behavioral health services, Accountable Care Organizations (ACOs) and
cancer screening. The expansion is in line with CMS’s focus on health equity
and overall health—specifically on the evidence-based connection of oral health to whole body health.
Though President Biden and the Democrats were unable to legislatively
expand Medicare coverage to include dental, the Biden administration is attempting
to do so regulatorily. CMS would do this by expanding the definition of “medically
necessary” dental services. Currently, Medicare Part B pays for dental services
when that service is integral to medically necessary services required to treat
a beneficiary's primary medical condition, for example, covering reconstruction
of the jaw following accidental injury. But under the proposed rule, CMS would
pay for dental services, such as dental examinations and treatments preceding
an organ transplant because the dental services have been inextricability linked
to, and substantially related and integral to, the clinical success of clinically
related services, or furnished in connection with other covered medical services.
In the proposed rule, CMS seeks public comment on:
- Its proposal to clarify and interpret “medically necessary”
and codify certain current Medicare Fee-For-Service (FFS) payment policies for
medically necessary dental services;
- Its proposal on payment for other dental services, such as dental exams
and necessary treatments prior to organ transplants, cardiac valve replacements
and valvuloplasty procedures that may be inextricably linked to, and substantially
related and integral to, the clinical success of an otherwise covered medical service;
-
Other types of clinical scenarios
where dental services may be inextricability linked to, and substantially related
and integral to, the clinical success of clinically related services, or furnished
in connection with other covered medical services;
- The potential establishment of a process to review public
submissions of recommendations for identifying the circumstances when the policies may apply;
- Other potentially impacted policies; and
-
The potential future payment
models for dental and oral health care services and other impacted policies.
There will be a 60-day comment period on the proposed rule.
The comment period begins on the day of the publication of the official proposed
rule in the Federal Register. Though CMS released the unofficial proposed
rule last week, the official proposed rule will not be published in the Federal Register until Friday, July 29. |
