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11/29/2022
Public Statement on Medicare Coverage of Medically Necessary Oral and Dental Health Therapies
Article Provided by Pacific Dental Services
Public Statement on Medicare Coverage of Medically Necessary Oral and Dental Health Therapies
Article Provided by Pacific Dental Services
The Consortium for Medically Necessary Oral Health Coverage is pleased to commend the Biden Administration for finalizing regulatory policy that will have a direct and meaningful impact on the lives of many Medicare beneficiaries. With this action, the Medicare program is taking an important step toward much-needed coverage of medically necessary oral and dental care.
Specifically, the final Physician Fee Schedule for 2023 codifies Medicare coverage for dental services that are inextricably linked and substantially related and integral to organ transplant surgery, cardiac valve replacement, valvuloplasty procedures, and head and neck cancers. The final rule also creates the opportunity for further coverage expansion by establishing “a process to identify for [the Medicare program’s] consideration and review submissions of additional dental services that are inextricably linked and substantially related and integral to the clinical success of other covered medical services.” Finally, the rule codifies Medicare coverage for the wiring of teeth related to covered medical services, the reduction of jaw fractures, the extraction of teeth in preparation for radiation treatment of neoplastic disease, dental splints for covered treatment of certain medical conditions, and oral or dental examinations relating to renal transplant surgery.
Founded in 2016, the Consortium has undertaken educational, community-building, and advocacy efforts for Medicare coverage of medically necessary oral and dental treatment. Our membership – which includes leading dental, medical, and nursing groups, patient and consumer advocates, and care delivery providers – is guided by documented evidence that medically necessary treatment of oral microbial infections is essential to combatting and preventing a wide range of costly chronic conditions. Just as important, Consortium members have been motivated in their efforts by the knowledge that the lack of medically necessary oral and dental coverage has precluded, delayed, and jeopardized the delivery of covered medical treatments, heightening the risk of costly medical complications and increasing the financial burden on Medicare, beneficiaries, and taxpayers.
We are grateful to the Biden Administration for recognizing these facts and taking this important step to extend Medicare coverage to dental services that are integral to the delivery of covered medical services. By broadening coverage of medically necessary dental services and opening an important opportunity for stakeholders to suggest clinical scenarios to which medically necessary oral and dental services should be extended in the future, the Physician Fee Schedule makes meaningful progress to improve the clinical success of covered medical services.
“This regulatory action is the start of a new era for integrated health in America,” said Dr. Michael Alfano, D.M.D., Ph.D., co-founder of the Santa Fe Group and the Consortium. “On behalf of the hundreds of organizations who have worked for this policy change, we thank the Administration for expanding access to Medicare-covered medically necessary oral and dental treatment.”
Dr. Cheryl Lee-Butler, President of the National Dental Association said, “This policy change represents significant progress on multiple fronts. It will greatly expand access to needed care, improve outcomes, reduce hospitalizations, achieve program savings, and promote a more equitable delivery system for a healthier future.”
“Medicare beneficiaries have long suffered from lack of access to medically necessary dental care,” said Center for Medicare Advocacy Executive Director Judith Stein. “Thanks to the determined efforts of so many advocates and the Administration’s thoughtful response, we look forward to a future of better health, improved quality of life, and greater program equity.”
In support of transformative change, more than 240 leading organizations joined as signatories of the Consortium’s Community Statement to urge Congress and the Administration to explore options for extending evidence-based coverage to all Medicare beneficiaries. The Consortium will now turn to the important process of expanding coverage of medically necessary oral and dental services to all medical conditions for which such services are documented to be of clinical, fiscal, and human value.
The signatories of the Consortium’s Community Statement are listed below:
AARP
ABLE NH (Advocates Building Lasting Equality in NH)
ACA Consumer Advocacy
Acuity Specialists
Adenoid Cystic Carcinoma Research Foundation
AIDS Foundation of Chicago
Alliance for Retired Americans
Allies for Independence
ALS Association
American Academy of Nursing
American Academy of Periodontology
American Association for Community Dental Programs
American Association for Dental, Oral, and Craniofacial Research
American Association of Clinical Endocrinologists
American Association of Colleges of Nursing
American Association of Diabetes Educators
American Association of Hip and Knee Surgeons
American Association of Kidney Patients
American Association of Oral and Maxillofacial Surgeons
American Association of Nurse Practitioners
American Association of Public Health Dentistry
American Association on Health and Disability
American Autoimmune Related Diseases Association
American College of Cardiology
American College of Emergency Physicians
American College of Gastroenterology
American College of Physicians
American College of Rheumatology
American Dental Assistants Association
American Dental Education Association
American Dental Hygienists’ Association
American Diabetes Association
American Geriatrics Society
American Head and Neck Society
American Heart Association
American Institute of Dental Public Health
American Kidney Fund
American Liver Foundation
American Medical Association
American Muslim Health Professionals (AMHP)
American Nephrology Nurses’ Association
American Network of Oral Health Coalitions
American Nurses Association
American Parkinson Disease Association
American Psychiatric Association
American Psychiatric Nurses Association
American Public Health Association
American Society for Radiation Oncology
American Society of Clinical Oncology
American Society of Nephrology
American Society of Transplant Surgeons
American Society of Transplantation
American Thoracic Society
Arcora Foundation
Arizona Oral Health Coalition
Arthritis Foundation
Association of Asian Pacific Community Health Organizations (AAPCHO)
Association of Community Cancer Centers
Association of Oncology Social Work
Association of State and Territorial Dental Directors
Autistic Self Advocacy Network
Be a Hero
Brain Injury Association of America
California Dental Association
California Medical Association
CareQuest Institute for Oral Health
Carlson Foley Enterprises
Catholic Health Association of the United States
Center for Advocacy for the Rights and Interests of the Elderly (CARIE)
Center for Elder Law & Justice
Center for Health Law and Policy Innovation
Center for Medicare Advocacy
Center for Popular Democracy
Champaign County Health Care Consumers
Children’s Dental Health Project
Coalition for Oral Health for the Aging
Coalition of Texans with Disabilities
Colgate Palmolive Company
Colorado Consumer Health Initiative
Community Catalyst
Community Dental Health NPO
Connecticut Oral Health Initiative
Cornerstone Dental Specialties
Crohn’s and Colitis Foundation of America
Culpeper Wellness Foundation
Davis Phinney Foundation for Parkinson's
Delaware Dental Hygienists' Association
Dental Lifeline Network
Dental Trade Alliance
Dentsply Sirona
Dialysis Patient Citizens
Dientes Community Dental Care
Disability Rights Education and Defense Fund
Eating Disorders Coalition
Elderly Housing Development & Operations Corporation
Epilepsy Foundation
EXCELth, Inc.
Families USA
504HealthNet
Florida Health Justice Project
Georgia AIDS Coalition
Georgians for a Healthy Future
Gerontological Advanced Practice Nurses Association
GlaxoSmithKline Consumer Healthcare
GLMA: Health Professionals Advancing LGBTQ Equality
Hartford Institute for Geriatric Nursing
Hawai‘i Oral Health Coalition
Hawaiʻi Children's Action Network Speaks!
Head and Neck Cancer Alliance
Health Care For All (MA)
Health Care Is a Human Right WA
Health Care Voices
Healthy Living and Learning Center
Heartland Alliance
Henry Schein Cares Foundation
HIV Medicine Association
Hispanic Dental Association
International Pemphigus and Pemphigoid Foundation
Island Liaison, Inc.
John A. Hartford Foundation
Jon C Burr Foundation
Justice in Aging
Kentucky Oral Health Coalition
Klamath Basin Oral Health Coalition
Lakeshore Foundation
Leukemia and Lymphoma Society
Louisiana Primary Care Association
Lupus and Allied Diseases Association, Inc.
Lupus Foundation of America
Maryland Dental Action Coalition
Massachusetts ME/CFS and FM Assoc
Medicaid|Medicare|CHIP Services Dental Association
Medicare Rights Center
Mended Hearts
Mental Health America
Metro New York Health Care for All
Michigan Primary Care Association
Minnesota Dental Therapy Association
myNEXUS
National Alliance of State & Territorial AIDS Directors
National Alliance on Mental Illness
National Association of Area Agencies on Aging
National Association of Chronic Disease Directors
National Association of Community Health Centers
National Association of Dental Plans
National Association of Nutrition and Aging Services Programs
National Association of Social Workers
National Association of States United for Aging and Disabilities
National Coalition of Dentists for Health Equity
National Comprehensive Cancer Network
National Committee to Preserve Social Security and Medicare
National Consumer Voice for Quality Long-Term Care
National Consumers League
National Council for Behavioral Health
National Council on Aging
National Dental Association
National Forum for Heart Disease and Stroke Prevention
National Hispanic Medical Association
National Health Law Program
National Interprofessional Initiative on Oral Health
National Kidney Foundation
National League for Nursing
National Medical Association
National Multiple Sclerosis Society
National Network for Oral Health Access
National Osteoporosis Foundation
National Rural Health Association
National Stroke Association
North American Transplant Coordinators Organization
Northwest Harvest
Nurses for America
Nursing Interventions for Health System Elders
NYU Rory Meyers College of Nursing
Ohio Alliance for Retired Americans Educational Fund
Oklahoma Policy Institute
Oncology Nursing Society
Oral Cancer Foundation
Oral Health Kansas
Oral Health Nursing Education and Practice Program
Oral Health Ohio
Oral Health Progress and Equity Network (OPEN)
Our Mother's Voice
PA Coalition for Oral Health
Pacific Dental Services Foundation
Parkinson’s Foundation
Patient-Centered Primary Care Collaborative
Pennsylvania Health Access Network
PEW Dental Campaign
Piedmont Regional Dental Clinic
PRC
Preventive Cardiovascular Nurses Association
Pride At Work - WA North, Mt. Kulshan Chapter
Procter & Gamble
ProHEALTH Dental
Project Accessible Oral Health
Puget Sound Advocates for Retirement Action (PSARA)
Renal Healthcare Association
Renal Physicians Association
Research!America
Santa Fe Group
School-Based Health Alliance
Scleroderma Foundation
Senior Charity Care Foundation
Senior Mobile Dental
Sepsis Alliance
Sjögren’s Foundation
Smiles To Go, LLC
Social Security Works
Society for Transplant Social Workers
Statewide Poverty Action Network
Support for People with Oral and Head and Neck Cancer
Texas Oral Health Coalition, Inc
Texas Parent to Parent
The AIDS Institute
The Arc of the United States
The Bingham Program
The CornerStone Community Development Center
The Gerontological Society of America
The Michael J. Fox Foundation
The National Forum of ESRD Networks
The Society for Thoracic Surgeons
The TMJ Association
Third Way
Tri-Area Community Health
Trust for America’s Health
United Health Organization
United Network for Organ Sharing
UUFHCT
Virginia Community Healthcare Association
Virginia Health Catalyst
Virginia Organizing
Virginia Rural Health Association
Washington Healthcare Access Alliance
Wayne County Oral Health Organization
Wesley Living Woodland Homes
West Central Initiative
Western Center on Law and Poverty
Winters Elder Day Council
WomenHeart, The National Coalition for Women with Heart Disease
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