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NADP provided comments to the Center for Medicare and Medicaid Services (CMS) on the proposed rule “Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2023 (CMS-9911-P)”, which would introduce new network adequacy requirements for standalone dental plans (SADPs) and medical Qualified Health Plans (QHPs) participating on marketplace platforms, increase disclosures for downstream entities, and make other changes that effect dental coverage. In summary, NADP provided the following recommendations on the rule:
Network Adequacy Requirements (§ 156.230)
- Time and Distance Requirements: NADP seeks clarification that the requirements for medical QHPs to include dental providers in their networks are only applicable if the medical QHP provides an embedded pediatric dental essential health benefit (EHB). Under the Affordable Care Act (ACA), medical QHPs are not required to include the dental EHB if there is a standalone dental plan (SADP) offering coverage in the same area.1 Adding a requirement that medical plans not offering an embedded dental benefit must include dental providers in their networks or justify their absence would create redundancies, which could confuse dental coverage requirements and the role of SADPs on the marketplaces.
- Reporting on Telehealth: Due to the highly limited utilization of teledentistry by dental providers and the significant administrative burden associated with telehealth data collection, SADPs should be exempt from reporting on telehealth services through the Essential Community Provider/ Network Adequacy (ECP/NA) template.
- Waited Period Requirements: NADP seeks affirmation that the scope of waiting period requirements includes only dentists currently classified as dental specialists on ECP/ NA reporting forms providing care in a non-emergency setting. Additionally, to match the standard working calendar of most dental practices the waiting period should be measured in business days instead of calendar days.
- Administrative Burden Calculation: NADP believes that the estimated burden on SADPs for network adequacy data collection underestimates the cost of collection and should be reassessed. In particular, the telehealth data collection requirements would substantially increase costs, as dental plans do not currently collect data on who is offering teledentistry services.
- Essential Community Providers: NADP suggests the increase in the essential community provider (ECP) requirements for SADPs be altered to 25% in PY2023 and reevaluated in future rulemaking. While dental plans actively recruit ECPs and participate in federal programs to offer dental coverage to underserved communities, there are significant barriers to recruitment and maintenance of ECP providers in dental networks. Dental ECPs often work part time at a facility and focus on care for the uninsured or those enrolled in government programs instead of private insurance. Furthermore, NADP also requests the time between contact attempts for ECP justification for dental providers be extended from 90 days to 180 days, as the current frequency of contacts has not proven successful in increasing ECP participation.
Downstream Entities (§ 156.340): NADP requests an extension of the timeline for implementation of the requirements for delegated entities to retain information until PY2024. The requirements would apply to dental plans operating as downstream entities for medical QHPs offering embedded dental benefits and could require an expansion of administrative capacity and data storage resources that would be challenging to implement in the proposed timeframe.
User Fee: NADP supports maintaining the user fee at 2.75% on Federally Facilitated Exchange (FFEs) and 2.25% on SBE-FPs (State Based Exchange on Federal Platform) as stated in the proposed rule.
Independent Purchase of SADPs on Marketplaces: NADP recommends the Centers for Medicare and Medicaid Services (CMS) allow individuals to purchase an SADP on the marketplace without purchasing a medical FFE, expanding access to dental coverage through a trusted, centralized platform for those who may have medical coverage through other means including employment or Medicare.
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Please contact Director of Government Relations Owen Urech with any thoughts or questions.
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