FYI

Dentist blog from Delta Dental

Tag: Medicare (Page 1 of 4)

Your dental policy brief: News updates as of August 2

From the latest on Medicare to recent court rulings affecting dentistry, FYI brings you the biggest dental policy stories.

CMS proposes Medicare dental coverage expansion after push from Congress

The U.S. Centers for Medicare and Medicaid Services (CMS) has released a proposed physician fee schedule rule for 2023 that would expand access to dental care services for Medicare beneficiaries. The proposal came after lawmakers in the U.S. House of Representatives and the U.S. Senate requested that the agency broaden the definition of medically necessary dental coverage as a way to expand access for Medicare recipients.

Currently, Medicare Part B only pays for dental services when it is deemed medically necessary to treat a recipient’s primary medical condition. The proposed changes for payments could become effective as early as January 1, 2023.

ADA says ransomware behind recent cyberattack, confirms data theft

The American Dental Association (ADA) has said that the cybersecurity incident it first reported in April was actually a ransomware attack, which ultimately led to the theft of member data. Although the ADA initially claimed that there was no data breach, a recent notice from the organization confirms that data theft occurred.

The notice does not share the precise data impacted, just that it was personal information tied to member names. Impacted members will receive complimentary credit monitoring and identity protection services. The ADA says it has assessed system security and reset relevant account passwords while it works to review and bolster existing policies and procedures.

Federal judge rejects Colorado inmate’s request for change in prison dental policy

A federal judge has denied an inmate’s request to order prison officials to halt their alleged unofficial policy of denying dental crowns to detainees. Beginning in November 2019, an inmate at the U.S. Penitentiary Administrative Maximum Facility in Florence, Colorado, sought treatment for broken and painful teeth. The prison dentist allegedly informed the inmate he needed a crown and teeth fillings, but the dentist could only “do one procedure per inmate per visit.”

The inmate, Peter George Noe, filed suit against the government and multiple medical personnel, claiming delayed and inadequate treatment. He asked for a preliminary injunction that would order the Bureau of Prisons to provide crowns generally, and to specifically perform his needed dental work. The district judge denied the motion, finding Noe had not shown he would suffer irreparable harm in the absence of a court order.

Supreme Court rejects dental hygienist’s medical marijuana workers’ comp case

The U.S. Supreme Court declined to hear the case of a Minnesota dental hygienist challenging denial of workers’ compensation for medical marijuana. The hygienist, Susan K. Musta, began purchasing cannabis to treat chronic pain due to work-related injuries in 2019 under Minnesota’s legal medical cannabis program and was not reimbursed for it under her workers’ compensation coverage for workplace injuries. Minnesota courts ruled that the federal Controlled Substances Act (CSA) prevented her insurer from paying for medical cannabis.

Musta appealed the decision to the U.S. Supreme Court alongside a similar Minnesota case. The U.S. Supreme Court indicated that fewer than four justices believed the legal challenge warranted the court’s consideration. State supreme courts in New Jersey and New Hampshire have ruled the CSA doesn’t preempt their workers’ compensation laws. However, like Minnesota, Maine’s high court reached the opposite conclusion.

Get to know Medicare Advantage

Every day for the next decade, about 10,000 Americans will turn 65. It’s estimated that by 2030, approximately 18% of the nation’s population will be 65 or older.

This means that every single day, more and more people become eligible for insurance coverage through Medicare and can purchase supplemental Medicare Advantage dental plans through approved vendors like Delta Dental. If you want your practice to serve this growing population of patients, joining Delta Dental’s Medicare Advantage network is the perfect place to start.

Why should you join Delta Dental’s Medicare Advantage network?

Joining Delta Dental’s Medicare Advantage network can provide a substantial boost to both attracting and keeping patients:

  • Enrollment in Medicare Advantage has more than doubled over the past decade, and enrollment continues to increase by as much as 9% a year.
  • Most Medicare Advantage groups offer a closed-panel benefit package. This means patients covered under these plans must see a dentist contracted in the Medicare Advantage network.
  • When you join our network, you’ll appear in our online Medicare Advantage directory, which can help new patients find you.
  • Being part of Delta Dental’s Medicare Advantage network can help you keep your existing patients as they reach age 65 and become eligible for Medicare.

What if you’ve already opted out of participation in Medicare?

You can still join our Medicare Advantage network.

Rules that prohibit payment to providers who have opted out of participation in Medicare don’t apply to supplemental benefits like dental, according to the Centers for Medicare & Medicaid Services (CMS). The policy became effective on January 1, 2022. Even if you’ve opted out of Medicare through CMS, you can still join the Delta Dental Medicare network and provide services to our Medicare Advantage members.

What about non-covered services?

If you’re contracted with Medicare Advantage networks, you can charge Medicare Advantage patients for any non-covered service. Members must simply give informed consent so they are aware of any out-of-pocket costs.

How do you join Delta Dental’s Medicare Advantage networks?

If you’re interested in joining, all you need to do is send us an email.

Email ProviderConcierge@delta.org for the DHMO Medicare Advantage network and medadv@delta.org for the PPO Medicare Advantage network. We’ll email you an application.

Reminder: Complete your annual General Compliance and FWA training

Are you a Medicare Advantage dentist? If so, remember to complete your annual General Compliance and Fraud, Waste and Abuse (FWA) training. This training is a Centers for Medicare and Medicaid Services requirement that allows you to participate in the Medicare Advantage network.

Who needs to complete this training?

You need to complete this training if you’re a Medicare Advantage contracted dentist with any of the following companies:

  • Delta Dental of California – CA
  • Delta Dental of the District of Columbia – DC
  • Delta Dental of Pennsylvania – PA & MD
  • Delta Dental of West Virginia, Inc. – WV
  • Delta Dental of Delaware, Inc. – DE
  • Delta Dental of New York, Inc. – NY
  • Delta Dental Insurance Company – AL, DC, FL, GA, LA, MS, MT, NV, TX and UT

Your training must be completed within 90 days of joining the network and then once annually.

What do I need to do to be compliant?

In addition to completing the FWA training, you’re required to have a written ethics guide and code of business conduct in place for your practice. To meet this requirement, you can incorporate a copy of Delta Dental’s Ethics Guide (PDF) into your practice guidelines.

If you still need to complete the FWA training, don’t forget to also incorporate Delta Dental’s Fraud in Federal Health Care Programs guide into your training.


For additional Medicare Advantage compliance and training information, see Delta Dental’s trainings and events for dentists.

Your dental policy brief: News updates as of April 6

From the latest on COVID vaccines and policy to new laws that could affect your practice, FYI brings you the biggest dental policy stories.

Millions of children could lose coverage when Medicaid requirement expires

Children in the U.S. currently insured through Medicaid or the Children’s Health Insurance Program (CHIP) have had stability in their coverage during the COVID-19 public health emergency due to a continuous coverage requirement mandated by Congress in March of 2020. This protection is likely to expire sometime in 2022, perhaps as soon as April. The Georgetown University Health Policy Institute estimates that at least 6.7 million children are likely to lose their Medicaid coverage, including dental care, and are at considerable risk for becoming uninsured.

ADA releases new resource for masking

In March, the American Dental Association (ADA) released Indoor Masking in Dental Practice Public Spaces, a new resource to guide dental practices in light of the latest masking recommendations from the Centers for Disease Control and Prevention (CDC). The CDC indicated in February that communities should now take into account new COVID-19 hospitalizations, hospital capacity and new COVID-19 cases to determine risk level and masking requirements in shared spaces. The ADA resource outlines steps dental practices can follow to align their practice with CDC recommendations.

Lawmakers in New York consider health benefits for uninsured immigrants

New York lawmakers are considering expanding the state’s Essential Plan, which offers free or inexpensive health insurance to low-income citizens, to cover undocumented immigrants. The program includes preventive care, prescription drugs and vision and dental benefits. The expansion would follow the lead of California and Illinois, which have recently offered health insurance to older low-income undocumented residents, but New York would be the first state to offer such coverage regardless of age. An estimated 46,000 people in New York who are currently ineligible for public health care programs due to immigration status would gain access to health insurance coverage, including dental benefits, under the proposed legislation.

Medicare Advantage DHMO updates for 2022

It’s a new year, and that means there’s a new crop of partners joining Medicare Advantage. If you’re part of Delta Dental’s Medicare Advantage DHMO network, members of these groups with a Delta Dental Medicare Advantage DHMO plan can choose your practice as their primary care facility. If you don’t currently participate in this network, we still encourage you to review the following information.

Here’s a quick look at the new Medicare Advantage DHMO partners for 2022.

  • Bright Health covers approximately 7,500 members in Arizona, Illinois, Florida and New York.
  • Brand New Day has over 50,000 members throughout the state of California, from Placer and Sacramento counties in the north all the way down to San Diego and Imperial counties.
  • InterValley Health Plan serves about 17,000 members in the greater Los Angeles metropolitan area, with members in Los Angeles, Orange, Riverside and San Bernardino counties.
  • Western Health Advantage covers about 2,300 members in California’s wine country, including Marin, Napa, Sacramento, Solano, Sonoma and Yolo counties.

Additionally, the following Medicare Advantage partnerships are continuing in 2022. Some partners are making changes that may affect the coverage available to your patients. For partners who are updating their benefits, be sure to use Provider Tools to see details!

  • Central Health Medicare Plan in California has expanded to San Mateo County and enhanced their benefits for all divisions.
  • WellCare in California’s Orange and San Diego coverage is continuing DHMO coverage for its members.
  • SCAN Health Plan is expanding to San Mateo and Alameda counties in California.
  • Kaiser California Medicare is adding a new diagnostic and preventive benefit in California counties.
  • Kaiser Georgia Medicare is enhancing benefits and expanding to Newton, Rockdale, Spalding, Walton, Barrow and Butts counties in Georgia.
  • Stanford Healthcare Advantage in California is updating its website but making no changes to its DHMO offering at this time.

Nearly a million members nationwide have access to a Medicare Advantage plan through Delta Dental, and every day for the next decade, about 10,000 Americans will turn 65. By 2030, approximately 18% of the nation’s population will be 65 or older. Joining the Medicare Advantage DHMO network represents an incredible opportunity to expand your business by serving this growing market!

By joining the Medicare Advantage DHMO network, you’ll enjoy the following benefits:

  • Your practice will be listed in our Medicare Advantage network directory.
  • You’ll retain patients who are joining a Medicare Advantage plan. Their DHMO plans require that they visit Medicare Advantage network dentists.
  • You’ll grow your business with new Medicare Advantage patients looking for an in-network dentist.

Interested? To apply for participation in the Delta Dental Medicare Advantage DHMO network, please email medadv@delta.org. We’ll send you an application and contract.

Your dental policy brief: News updates as of February 7

From the latest on COVID vaccines and policy to recent court rulings, FYI brings you the biggest dental policy stories.

1. California law may expand dental coverage

A new law may open the door for some California adults and seniors to obtain dental insurance.

Set to take effect in 2023, California Assembly Bill 570, or the Parent Healthcare Act, will allow adult children to add their dependent parents and stepparents to their individual major medical insurance plans. The state estimates that as many as 15,000 people might be covered under the new law, which has no age limitations.

The law applies only to individual medical plans, including those that offer dental coverage, and doesn’t apply to specialized health care service plans that cover only dental. Employer-sponsored plans and Medicare supplement insurance are also excluded.

2. New federal law requires dentists to provide cost estimates to certain patients

The No Surprises Act, which went into effect Jan. 1, gives uninsured and self-pay consumers certain billing protections. Most notably for dentists, the act requires that many dentists, including those who practice in private dental offices, provide good faith estimates for the cost of care to these patients if they request them or schedule service.

  • After the request is made or service is scheduled, dentists and facilities must provide the good faith estimate in writing within three business days. Either a paper or printable electronic copy of the estimate is required.
  • If the actual charges exceed the estimate by $400 or more, the patient or an authorized representative can initiate a patient-provider dispute resolution process and seek a determination from an independent third-party certified by the United States Department of Health and Human Services.

There are no specific specialties, facilities or service sites that are exempt from this requirement, according to the Centers for Medicare & Medicaid Services (CMS). However, the requirement doesn’t apply to patients with coverage through Medicare, Medicaid, the Indian Health Service, Veterans Affairs Health Care or TRICARE.

For questions about good faith estimates and the dispute resolution process, CMS has provided this guidance to dentists and facilities.

3. Court blocks large-employer vaccine mandate, upholds mandate for federal facilities

Two recent decisions by U.S. Supreme Court concerning the COVID-19 vaccine may affect dental offices. The court ruled on Jan. 13 to block a federal mandate that required large employers (such as dental practices with 100 or more employees) to ensure that all their employees either received the COVID-19 vaccine or wear facemasks and submit to weekly tests.

Conversely, the court upheld a mandate that requires staff at federally funded health care facilities to receive the COVID-19 vaccine. The rule affects certain dentists, including those who work in Medicare or Medicaid facilities such as nursing homes, surgical centers and hospitals. However, the ruling excludes private dental practices that serve Medicare or Medicaid patients.

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