July 8, 2022
Beginning in 2016, a consortium was formed among the undersigned dental and medical specialists, patient and consumer advocates, and care delivery providers to support and advocate for Medicare coverage of medically necessary oral and dental care. Today, the Consortium applauds the Biden Administration and Congressional champions for taking action that will have a direct and meaningful impact in the lives of tens of millions of Medicare beneficiaries.
It is well established that chronic diseases disproportionately impact Medicare beneficiaries and impose a substantial cost on the federal government. It is also well established that untreated oral microbial infections are closely linked to a wide range of costly chronic conditions, including diabetes, heart disease, dementia, and stroke. In addition, oral diseases have been documented by researchers and medical specialty societies as precluding, delaying, and even jeopardizing medical treatments such as organ and stem cell transplantation, heart valve repair or replacement, cancer chemotherapies, placement of orthopedic prostheses, and management of autoimmune diseases.
Despite these factors, most Medicare beneficiaries have been unable to receive oral/dental care even when medically necessary for the treatment of Medicare-covered diseases. Historically, Medicare coverage has extended to the treatment of all microbial infections except for those relating to the teeth and periodontium. Believing there is no medical justification for this exclusion, the Consortium formed to express broad consensus among health care providers that such care is integral to the medical management of numerous diseases and medical conditions and that the lack of medically necessary oral/dental care heightens the risk of costly medical complications, increasing the financial burden on Medicare, beneficiaries, and taxpayers.
In recognition of these facts, the Biden Administration has proposed transformative action to extend Medicare coverage to dental services that are integral to the delivery of covered medical services. Specifically, the Physician Fee Schedule for Fiscal Year 2023 issued yesterday by HHS Secretary Xavier Becerra and CMS Administrator Chiquita Brooks-LaSure proposes to meaningfully broaden reimbursement for medically necessary dental services. The proposed rule also opens an exciting opportunity for stakeholders to provide “comments on other types of clinical scenarios where dental services may be inextricably linked to, and substantially related and integral to the clinical success of, other covered medical services” as well as on a process for public submission of recommendations for identifying the circumstances when the policy may apply and the payment models that will support it.
“This important announcement marks a new day in the health of Medicare beneficiaries,” said Dr. Michael Alfano, D.M.D., Ph.D., cofounder of the Santa Fe Group and the Consortium. “Thanks to the tireless work of literally hundreds of organizations and thousands of dedicated advocates, Americans will no longer lack access to medically necessary oral and dental treatment within the traditional Medicare program.”
Dr. Cheryl Lee, President of the National Dental Association said, “We support this policy change as it represents significant progress towards a more equitable healthcare delivery system. Most importantly, it will expand access and improve outcomes while also reducing hospitalizations and Medicare program costs.”
Due to their conviction that the Medicare program and its beneficiaries should not be without the vital clinical and fiscal benefits of medically necessary oral/dental health therapies, more than 230 leading organizations joined as signatories of the Consortium’s Community Statement to urge Congress and the Administration to explore options for extending such evidence-based coverage for all Medicare beneficiaries.
“For too long Medicare beneficiaries have suffered due to a lack of coverage for medically necessary dental care crucial to treating other conditions,” said Center for Medicare Advocacy Executive Director Judith Stein. “Now, thanks to the determined efforts of this broad group of organizations, and the recognition of the administration, we look forward to a future of better health and quality of life, and greater program equity.”
In light of yesterday’s historic announcement, the Consortium will now turn to the important process of securing implementation of medically necessary coverage. Formal comments will be submitted, and community leaders will lend their expertise as the Administration works to formalize this policy in the manner best suited to meet the needs of Medicare beneficiaries.
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 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 |
The Center for Medicare Advocacy (https://www.medicareadvocacy.org) is a national, non-profit, law organization that works to advance access to comprehensive Medicare coverage, health equity, and quality health care for older people and people with disabilities. Founded in 1986, the Center focuses on the needs of people with longer-term and chronic conditions. The organization’s work includes legal assistance, advocacy, education, analysis, policy initiatives, and litigation of importance to Medicare beneficiaries nationwide. Our systemic advocacy is based on the experiences of the real people who contact the Center every day. Headquartered in Connecticut and Washington, DC, the Center also has attorneys in CA, MA, and NJ.