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AAE Advocacy Win: Administration’s Allows Expansion of Adult Dental Coverage on ACA Marketplace

In April, the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid (CMS) released the Affordable Care Act (ACA) Notice of Benefit and Payment Parameters for the 2025 Final Rule. The AAE was an early advocate for this final rule and lobbied the Administration in December in support of two key provisions that would facilitate the expansion of adult dental coverage by state exchanges and strengthen network adequacy standards.

The AAE was pleased to witness the Administration adopt policies that grant states the option to designate adult dental services as an Essential Health Benefit (EHB) for individuals enrolling in the Affordable Care Act exchanges. This rule marks a significant departure from past federal policy, which explicitly prohibited non-pediatric dental services from being categorized as an EHB on ACA exchange plans. Historically, this discrepancy has resulted in unequal access to dental care between patients on the ACA exchanges and those in the private employer marketplace, where dental benefits are typically provided. The AAE commends this policy shift as it promises to enhance access to quality oral health care, particularly for low-income and minority populations.

Furthermore, the Association called on CMS to continue to conduct oversight of insurers on the ACA exchanges to ensure that dental providers receive fair reimbursement and patients have timely access to a broad network of providers as intended by the law. The Administration demonstrated its commitment to ensuring the ACA increases access to care by requiring that State-based Marketplaces establish quantitative and distance network adequacy standards are as stringent as the Federally-facilitated Marketplaces. This new mandate will incentivize more equitable network contract negotiations between insurers and dentists, including endodontists.

One month later, the Administration finalized a different rule prohibiting federally funded health programs and services under the Affordable Care Act from discriminating based on race, color, national origin, age, disability, or sex. Dental practices participating in HHS-administered health programs, State and Federally-Facilitated Exchanges, and those receiving federal financial assistance will also be responsible for informing patients that language assistance services and auxiliary aids are available if needed. HHS requires that the notice be “provided in English and in at least the 15 most common languages spoken by people with limited English proficiency (LEP) in the State(s) served.” The non-discrimination final rule goes into effect on July 5, 2024.