U.S. Senators Debbie Stabenow and Gary Peters as well as 26 of their colleagues have called on the Department of Health and Human Services to take action to improve Medicare coverage of medically necessary oral and dental treatment.
Providing seniors in Michigan traditional Medicare coverage for medically necessary oral and dental care will improve oral health and overall wellness as well as potentially reduce costs to the Medicare program.
“We urge CMS to use existing regulatory authority, consistent with past precedent, to make available traditional Medicare coverage for those beneficiaries requiring medically necessary oral and dental care,” wrote the senators. “We look forward to working with you to save lives, improve health outcomes, and reduce Medicare costs by avoiding medical complications through delivery of medically necessary oral and dental treatment.”
The text of the letter:
Dear Secretary Azar and Administrator Verma:
As policymakers, we have a responsibility to find health care solutions that save lives, improve outcomes and reduce costs.
Given oral health’s proven connection to overall wellness, improving Medicare coverage of medically necessary oral and dental health will accomplish these objectives.
Therefore, we write to request that the Centers for Medicare and Medicaid Services (CMS) use existing regulatory authority to provide traditional Medicare coverage of medically necessary oral and dental treatment.
It is estimated that two thirds of all Medicare beneficiaries have periodontal disease.
Unfortunately, many Medicare beneficiaries face significant health risks because they do not have access to medically necessary oral and dental treatment.
Too often, the lack of such treatment is exacerbating beneficiaries’ health conditions and, thus, increasing Medicare’s costs for treating their illnesses.
In such instances, providing medically necessary oral and dental treatment has the potential to reduce costs to the Medicare program by improving patient outcomes.
For example, insurance companies have achieved significant medical savings by providing coverage for the treatment of periodontal disease for individuals with heart disease and diabetes.
An Avalere Health report estimates that such coverage could achieve net savings for the traditional Medicare program of $63.5 billion over ten years.
As you know, Section 1862(a)(12) of the Social Security Act excludes Medicare coverage of routine dental services.
However, that provision does not prohibit the CMS from authorizing coverage when the treatment is medically necessary.
In crafting the list of Medicare coverage exclusions, Congress’ intent was to ensure Medicare funds would not be used pay for items and services that beneficiaries utilize outside of the context of medical illness and injury – in other words, items and services that are not medically necessary.
Indeed, Senate Report No. 89-404 (1965) expressly provides that payment can be made when there is appropriate medical justification, such as when the item or service is necessary for the diagnosis or treatment of a Medicare-covered disease, illness, or injury.
There is ample precedent for CMS’ use of this discretionary authority.
For example, Medicare policy provides for the coverage of medically necessary podiatry services, even as routine foot care is expressly excluded from coverage by the Medicare statute.
In similar fashion, we believe CMS should use its authority to extend traditional Medicare coverage to oral and dental treatment that is medically necessary for the treatment of Medicare-covered diseases, illnesses, and injuries.
Below are a few representative examples that illustrate the clinical and fiscal utility of such coverage:
For these reasons, we urge CMS to use existing regulatory authority, consistent with past precedent, to make available traditional Medicare coverage for those beneficiaries requiring medically necessary oral and dental care.
Thank you for your attention to this matter. We look forward to working with you to save lives, improve health outcomes, and reduce Medicare costs by avoiding medical complications through delivery of medically necessary oral and dental treatment.