ADEA Washington Update

Regulatory Focus: Two New Rules Affecting Oral Health

(Medicare and Medicaid Services, Dental Health, Oral Health) Permanent link   All Posts

LawsAndRegsADEA joined the Children’s Dental Health Project and other members of the Oral Health Community in responding to the 2019 Notice of Benefit and Payment Parameters rulemaking notice, which governs the state and federal health exchanges created by the Affordable Care Act (ACA).

The proposed rule would set forth payment parameters and provisions related to the risk adjustment programs, cost-sharing parameters and reductions, and user fees for the federal exchanges. It also provides additional standards for several other ACA programs, including essential health benefits (EHB).

ADEA and its partners urged the Centers for Medicare & Medicaid Services (CMS) to reconsider proposals that would reduce patient choice, affordable coverage, and access to dental care providers. Currently, dental services are provided to children enrolled in Medicaid and the Children’s Health Insurance Program. Proposed changes would allow states to limit EHB packages, including pediatric dental coverage.

Dental clinics that are part of federally qualified health centers (FQHCs) may see the cost of their drugs skyrocket in 2018, following a final rule by CMS. The Nov. 1 rule changes the terms of the longstanding 340B Drug Discount Program. Under the final rule, Medicare will cut $1.6 billion from the 340B program starting in 2018.

The program requires drug-makers to sell outpatient drugs at a discount to safety-net hospitals and other federally funded providers, including FQHCs. According to the American Dental Association, three-quarters of the nation’s 1,131 FQHCs had on-site dental services in 2009, and nearly 3.5 million patients received dental care that year from 2,577 dentists and 1,018 dental hygienists. 

Duggan ad 2013