AGD Comments on CMS Rule to Expand Dental Coverage Under Medicare

  • by AGD Washington Advocacy Representative
  • Sep 28, 2022
The Centers for Medicare and Medicaid Services (CMS) recently proposed a rule that would update its Calendar Year 2023 Physician Fee Schedule to include expanded access to behavioral health services, Accountable Care Organizations, cancer screenings, and dental services deemed “medically necessary” under Medicare. AGD’s comments on the rule focused on CMS’ legal authority to expand dental services under Medicare.

In comment, AGD states that it would be inappropriate for CMS to use the rulemaking process to expand Medicare coverage of dental services without Congress first passing a law to grant the agency that authority. AGD referenced various letters and advocacy campaigns by some legislators as well as dental and medical groups that encouraged CMS to use the rulemaking process as an end around to expand dental benefits under Medicare since legislative proposals that seek to do so have not passed Congress.

AGD opposed the inclusion and codification of language in its final rule that would expand coverage of certain dental services under the guise that they are, “inextricably linked to, and substantially related and integral to the clinical success of, an otherwise covered medical service.” AGD stated that CMS failed to provide scientific justification for including these dental services and opposed other text on the grounds that it was too broad and not specific enough to apply to the rule.

Impact on General Dentistry: AGD remains opposed to the expansion of Medicare to include dental benefits. Recent legislative proposals to expand Medicare to include dental benefits do not address low-income seniors’ immediate oral health needs, could result in the setting of Medicare fee schedules that significantly undervalue dental services, and will likely diminish the overall quality of dental care. To date, none of those legislative proposals have passed Congress, leaving CMS without the expressed legal authority to act on its own to expand dental benefits under Medicare.