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16 September 2022

California Dental Association, Academy of General Dentistry respond to proposed rule from CMS to expand Medicare

CDA supports changes, while the AGD says 'no'


Several of the country's top dental organizations recently weighed in on a proposed rule from the Centers for Medicare and Medicaid Services (CMS) to expand Medicare coverage for medically necessary dental provisions.

Leaders of the Academy of General Dentistry (AGD), including President Dr. Gerald J. Botko, said that the federal agency does not have the authority to expand coverage and accused CMS of trying to implement portions of a “Medicare for All” strategy, which is outside its purview.

On the flip side, the California Dental Association’s Medicare Workgroup submitted recommendations to the federal government on how to make an expansion of dental services feasible for dentists and patients. The association posted its comments online and said the changes will likely be finalized in November and implemented in 2023.

CDA past president Dr. Richard Nagy, a dentist and chair of the CDA Medicare Workgroup, said the association strongly believes that the expanded coverage will significantly improve patient care and outcomes for Medicare patients. 

“The proposed expanded coverage is especially important for underserved populations that face higher rates of the chronic health conditions and medical challenges discussed in the proposed rule,” he said. 

The California Dental Association (CDA)'s support for the proposed Medicare changes comes on the heels of the American Dental Association’s comments that back several of the rule’s proposals to include a dental benefit for Medicare beneficiaries who are highly vulnerable.

AGD leaders said in a letter that the CMS has not provided sufficient scientific justification for expanded indications to be included in the final rule. Somewhat surprisingly, they said many COVID-19 public health policies — including the use of masks and six-foot social distancing rules — were based on belief systems, not based in science. These policies “proved to be incorrect and caused great harm to people in America, particularly to children,” the AGD said. 

How it started

In June 2022, more than 100 members of the U.S. House Representatives sent a letter to CMS Administrator Chiquita Brooks-LaSure urging the use of the agency’s regulatory authority to increase Medicare’s coverage of some dental services. In the letter, the representatives indicated they would support the agency expanding its determination of “medically necessary” dental care. 

AGD leaders said in its letter that it is perceived that the agency is responding to the preferences of a single political party.

According to the AGD, CMS’s research must be verifiable and CDA past president Dr. Richard Nagy, a dentist and chair of the CDA Medicare Workgroup, said the association strongly believes that the expanded coverage will significantly improve patient care and outcomes for Medicare patients. “The proposed expanded coverage is especially important for underserved populations that face higher rates of the chronic health conditions and medical challenges discussed in the proposed rule,” he said. Learn more about the CDA’s support of the proposed changes on its website.   California Dental Association California Dental Association (CDA) https://www.cda.org Link to academy letter: Microsoft Word - AGD 2022 IPPS Final Link to news release AGD Submit Comments to Centers of Medicare and Medicaid Services reproducible and not based on low-quality evidence. The authors said that the “federal government must demonstrate the scientific basis for declaring medical necessity for dental indications and it has not yet done so.”

The entire letter can be accessed on its website.

About the Academy of General Dentistry

The Academy of General Dentistry (AGD) is a professional association of more than 40,000 general dentists dedicated to providing quality dental care and oral health education to the public. Founded in 1952, AGD is the largest association of general dentists.

About the California Dental Association

The California Dental Association (CDA) is the largest state association in the American Dental Association (ADA), with 27,000 members

Sources: www.agd.org and www.cda.org

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