Update: On November 16, 2017, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule titled, “Medicare Program: Contract Year 2019 Policy and Technical Changes to the Medicare Advantage, Medicare Cost Plan, Medicare Fee-for-Service, the Medicare Prescription Drug Benefit Programs, and the PACE Program”.
This proposed rule would “rescind the current provisions that require dentists to enroll in or validly opt-out of Medicare in order for a Part D drug to be covered”. In place of this requirement, the rule proposes that “a Part D plan sponsor must reject, or require its pharmacy benefit managers to reject, a pharmacy claim for a Part D drug if the individual who prescribed the drug is on the ‘preclusion list’”. Those on the preclusion list would include prescribers removed from the Medicare program by CMS due to various forms of misconduct, and is not referring to dentists who have not chosen to either enroll or opt-out.
The proposed rule is currently in an unpublished format and can be downloaded as a PDF. It is scheduled to be published in an official format on November 28, 2017. Comments are being accepted by CMS through January 16, 2018. It is expected that the ruling will be finalized following the comment period, in 2018.
According to a new federal rule, dentists who treat Medicare patients must either enroll in Medicare or opt out of the program in order to prescribe medication to their qualifying patients with Part D drug plans. To help you better understand the rule and what action is needed, the AGD has compiled the following list of frequently asked questions (FAQs).