NADP submitted comments in response to proposed rules
on Medicaid programs that have far-reaching impacts to states, carriers
and the delivery of dental services via managed care. This is also
critical to all dental insurance carriers, as regulators are known to
apply public program requirements to the commercial market.

NADP expressed
concern with how the proposed rule sweeps in dental managed care and
Prepaid Ambulatory Health Plans (PAHP) (sometimes considered a capitated
“carve out” from the global managed care arrangement) without
consideration of the impact on a state’s managed dental care policies.
One of the proposed rule’s expressed goals is to align standards across
public programs (e.g. Medicare Advantage, Exchanges, etc.) for ease of
state/federal regulators but also issuers working in those programs.
NADP recommended a more thorough review of public program regulations,
their current application to dental plans and the impact the proposals
would have on dental specifically. If the findings conclude that
standards do not align or are not appropriate for dental, Centers for
Medicare and Medicaid Services (CMS) should consider exempting dental
PAHPs from the proposed rule.

Across several
regulatory topics, NADP provided ample background to support further
study and potential exceptins and urged CMS to allow state flexibility
to design and implement standards for their unique populations and
programs. Specific recommendations included:

  • Medical Loss Ratio:
    In response to a proposed 85% MLR across all state Medicaid managed
    care programs, CMS should allow states to set appropriate loss ratio
    levels, including lower levels for limited scope benefits, in
    consideration of their own program enrollees and administrative
  • Network Adequacy:
    The proposed rule requires states to establish time and distance
    standards for specified provider types, including pediatric dental. In
    response, CMS should allow states flexibility to determine appropriate
    standards and measurements for network adequacy given the geographic and
    provider availability they experience.
  • Quality Standards and Accreditation:
    Acknowledging that no CMS-designated accreditation company has
    standards designed for dental, CMS should not apply standards to dental
    PAHPs until such time when all industry stakeholders develop and
    implement standards that are appropriate for the delivery of dental

CMS should allow states to continue implementation of dental-specific
quality improvement programs, contractors that administer these programs
and validated enrollee survey tools for PAHPs until such time as
appropriate accreditation, quality ratings systems and dental-specific
survey tools are developed with all dental industry stakeholders.

Further, CMS should utilize the Dental Quality Alliance as the standard for future quality measures within the dental industry.

An ad-hoc
workgroup of NADP members and volunteers that administer dental benefits
as part of Medicaid/Children’s Health Insurance Program (CHIP) joined a
conference call to discuss the rule and consider draft comments. We
appreciate their time and help in developing industry comments.

The group may
continue the discussion after CMS releases additional guidance or a
final rule. Until then, NADP will post viewpoints from stakeholders,
including states, in Dental Interact (DI).

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