As we reported in the February 2016 issue of The Root, the Texas Dental Association’s legislative department continues to receive calls from members regarding Medicare opt-out. As of June 1, 2016, Medicare Part D plans will no longer cover prescriptions unless you (1) enroll in Medicare, (2) enroll as an ordering-referring provider, or (3) opt out. Details about the available options for dentists as well as electronic links to applicable forms are available on the TDA website. To learn more, visit tda.org and select Advocacy > Regulations > Regulations Spotlight
For dentists to meet the June 1, 2016 effective date, they must submit their application to the Centers for Medicare & Medicaid Services (CMS) by March 1, 2016
, to allow sufficient time for processing.
Three Options for Dentists
Enroll in Medicare. This can be done by completing paper form CMS-855I
and mailing it to Texas’ Medicare Administrative Contractor (MAC), or, by CMS’ internet Medicare Provider Enrollment, Chain, and Ownership System (PECOS)
Opt in as an ordering/referring provider. Dentists prescribing potentially covered medications should enroll as an ordering/referring provider. Also, if the dentist orders and refers other services such as laboratory, imaging, or DMEPOS (durable medical equipment, prosthetics, orthotics and supplies supplier) services, and isn’t enrolled to order and refer services, those potentially covered services will be denied. Dentists wishing to enroll strictly as an ordering/referring provider must complete form CMS-855O
and mail it to Texas’ MAC.
Texas Medicare Administrative Contractor
JH Provider Enrollment Services
PO Box 3095
Mechanicsburg, PA 17055-1813
855-252-8782, Option 4
Opt out of Medicare. Dentists may elect to opt out of the Medicare program and still provide Medicare-covered services by entering into written “Private Contracts” with their Medicare-eligible (generally, senior and disabled) patients and by filing an affidavit with Texas’ MAC. To find the opt-out affidavit and private contract forms, visit the American Dental Association’s Center for Professional Success
and search “Resources for Opting Out of Medicare.”
Dentists cannot sign private contracts with Medicare beneficiaries in need of emergency or urgent care services. Dentists cannot selectively opt out of Medicare for some Medicare beneficiaries but not others, or for some services and not others.
Opt-out affidavits filed after
June 16th, 2015, automatically renew every two years. Affidavits submitted before this date will need to be re-submitted after the two-year period expires.