AGD Weighs in on CMS Medicare Part C/D Proposal

  • by AGD Washington Advocacy Representative
  • Jan 19, 2018

On Nov. 16, 2017, the Centers for Medicare and Medicaid Services (CMS) announced proposed changes to Medicare drug plans, including voiding the requirement that dentists enroll in or validly opt-out of Medicare in order for prescriptions written for their Medicare beneficiary patients to be covered. The proposed rule also contains changes to Medicare Part C, including a repeal of the current provision requiring dentists to be enrolled in Medicare in order to provide supplemental services to patients enrolled in Part C, also known as Medicare Advantage plans.

On Jan. 12, 2018, the AGD, in partnership with the Organized Dentistry Coalition (ODC), submitted comments in the form of a letter to CMS on the proposed Medicare Part C/D Rule. The letter endorses the proposed changes to the enrollment requirement for the Medicare Part C and Part D programs for providers who are not otherwise required to enroll and who do not submit claims to Medicare. Specifically, it expresses support for the creation of the preclusion list as a substitute for the enrollment or opt-out requirement under Medicare Part D. CMS' preclusion list would “consist of certain individuals and entities that are currently revoked from the Medicare program.”

The ODC letter also recommends that the same preclusion list rules be applied to the current rule requiring providers who order items or services under Medicare to enroll in or opt-out of the program. This will prevent any interruption in providing care to the patients of providers who have not taken action to opt-in or opt-out of Medicare. Further, the ODC letter suggests that because CMS has changed the enforcement date at least five times, CMS should permit dentists who opted out a second opportunity to reconsider and withdraw their affidavit. The ODC also asks CMS to allow the Medicare Contractors to contact each dentist who has opted out to let them know they can reverse their decision if they’d like.

Impact on General Dentistry: The AGD has actively pursued the removal of this requirement for dentists in the interest of its members and will continue to report on any new developments. Please visit the AGD’s updated Medicare FAQs Key Issues page or contact the AGD at if you have any additional questions.