Biden Administration Proposals Would Expand Access to Vital Health Care Services

This week, Medicare Rights submitted comments in response to a proposed rule that would extend Medicare coverage of dental and behavioral health services. If finalized, these policies would broaden the current availability of “medically necessary” dental coverage and expand the number of Medicare mental health and substance use disorder providers.

Currently, CMS interprets Medicare law as not allowing the program to pay for comprehensive dental care, leaving millions of older adults and people with disabilities without this vital coverage. While some Medicare Advantage plans cover dental, this coverage tends to be extremely limited. All Medicare beneficiaries can face high out-of-pocket costs when they need serious oral health care.

Medicare Part B pays for some dental services under very narrow circumstances when that service is integral to medically necessary services needed to treat a beneficiary’s primary medical condition. In coalition, we have argued that CMS has more authority to cover a wider scope of medically necessary care than it has previously asserted. This proposed rule is the result of CMS reconsidering its previous position and determining it was too narrowly framed. If finalized, the new framing would allow Medicare to pay for dental services under various clinical scenarios, including surgical procedures, transplants, cancer treatments, diabetes and other chronic disease management, immunosuppression, heart disease treatments, and other circumstances. We applaud this decision and believe that a broadened definition would help mitigate some of the current issues beneficiaries have in accessing needed care.

In addition, the proposed rule would expand behavioral health provider availability by allowing marriage and family therapists, licensed professional counselors, addiction counselors, and certified peer recovery specialists to provide behavioral health services under more circumstances. This is a small step toward mitigating an extreme shortage in mental health and substance use disorder providers. Expanding this workforce by enabling these providers to work to the full extent of their scope of practice is essential to meet the needs of Medicare beneficiaries.

While we will continue to advocate for Congressional action on comprehensive dental coverage and greater access to mental health and substance use disorder treatments, these proposals by CMS would help Medicare beneficiaries access the care they need.

Read our comments.

Read more about the need for comprehensive dental coverage.

Read more about the need for expanded access to mental health and substance use disorder care.