Austin News

Washington, D.C.– On May 2, U.S. Representatives Lloyd Doggett (D-TX), ranking member of the House Ways and Means Health Subcommittee, and Nanette Diaz Barragán (D-CA), member of the House Energy & Commerce Health Subcommittee, led a group of 113 Members in urging the Centers for Medicare and Medicaid Services (CMS) to use its existing executive authority to further improve coverage of medically necessary dental care.

Last year, Representatives Doggett and Barragán successfully pushed for CMS to expand Medicare dental coverage for treatment related to organ transplant surgery, cardiac valve replacement, valvuloplasty procedures, and head and neck cancers. This letter calls on CMS to build off this progress and provide oral health coverage to Medicare beneficiaries suffering from diabetes and kidney disease, autoimmune disorders, heart disease, cancer, and more.

As evidence mounts demonstrating oral health’s connection to overall physical wellness, the Members press for better coverage. An estimated 68% of African Americans and 61% of Hispanics have not seen a dentist in the past year, increasing the urgency of expanding care to reduce health inequities.

“Seniors and people with disabilities should not have to struggle to afford the care they need to stay healthy,” said Rep. Doggett. “With Republicans working to slash health care funding and access, progress on comprehensive legislation like my Medicare Dental, Vision, and Hearing Benefit Act will not happen this Congress—but there are important steps the Biden Administration can and should take to strengthen Medicare coverage for more patients. While pleased CMS made some modest improvements to dental coverage, Americans deserve a healthcare system that works for everyone.”

“Dental care is a critical aspect of our overall health, especially as we get older. Poor dental health can dramatically worsen conditions like Parkinson’s Disease, Multiple Sclerosis, and Diabetes. It can also interfere with cancer treatment and diminish quality of life,” said Rep. Barragán. “Poor oral health not only impacts nutrition, but also causes social and emotional problems. In California, nearly one third of seniors suffer from untreated tooth decay and nearly one in ten seniors have complete tooth loss. I am proud to lead this effort with Rep. Doggett in encouraging CMS to expand its dental coverage for Medicare recipients and save seniors thousands of dollars in costly visits and procedures that can result from poor dental health. I remain committed to adding full dental coverage as part of Medicare’s services.”

Read the full text of the letter here or below:

Dear Administrator Brooks-LaSure:

We are pleased that the Centers for Medicare and Medicaid Services (CMS) has taken a first step in clarifying medical coverage of medically necessary dental treatment under Medicare, consistent with the authority provided by Section 1862(a)(12) of the Social Security Act. As you have recognized, overall health is inextricably linked to oral health. And yet, dental care has long been inaccessible to millions of Medicare beneficiaries, including low-income Medicare beneficiaries and in communities of color, leading to an alarming situation in which two-thirds of Americans over age 65 have periodontal disease and one-fifth have lost all of their teeth. Untreated oral conditions have also increased Medicare beneficiaries’ risk of suffering chronic conditions such as diabetes, autoimmune disease, kidney disease, heart disease, and numerous forms of cancer, with the result being an increase in overall Medicare program costs.

Fortunately, the Physician Fee Schedule for 2023 took an important step forward by clarifying medical coverage for certain medically necessary dental treatment services and establishing an annual process for stakeholders to propose additional clinical scenarios for coverage. Beginning this year, the Medicare program is providing medical coverage for dental treatment that is necessary to the successful performance of organ transplant surgery, cardiac valve replacement, valvuloplasty procedures, and head and neck cancers. In addition, this year marks the first time stakeholders may offer for CMS’ consideration clinical evidence demonstrating other circumstances in which dental treatment may be inextricably linked and substantially related and integral to the clinical success of additional medical services covered by the Medicare program.

We are pleased that leading stakeholders in America’s medical, dental, and patient communities have utilized CMS’ nominations process to propose medical coverage for additional medically necessary services. Specifically, we understand nominations have been submitted for the following:

• Medical coverage of medically necessary dental treatment for beneficiaries diagnosed with diabetes mellitus, based on clinical evidence that non-surgical periodontal and preventive disease treatment is documented as achieving clinically significant reduction of blood sugar levels and, therefore, improves health outcomes and substantially reduces healthcare costs;
• Medical coverage of medically necessary dental treatment for beneficiaries diagnosed with blood and solid tumor cancers, due to the documented association of such cancers, cancer treatment, and immunosuppression with oral health-related complications during chemotherapy and radiation adjuvant therapies; and
• Medical coverage of medically necessary dental treatment for beneficiaries diagnosed with systemic autoimmune disease complications, which increase the risk of advanced dental decay, tooth loss, and gum disease, and to treat periodontitis, which is clinically linked to the development of rheumatoid arthritis and other autoimmune diseases.

We strongly encourage you to extend Medicare coverage for these conditions to continue progress in improving the health of Medicare beneficiaries. Further, CMS should also extend medically necessary dental coverage for additional conditions previously identified, including heart disease, stroke, Multiple Sclerosis, Parkinson’s Disease, gastrointestinal disease, rheumatologic disease, infected prosthesis, and chronic disease management.

We look forward to continuing to work with CMS to ensure that Medicare beneficiaries receive the treatment they need.

Original source can be found here.