Proposed rule follows ASN advocacy to cover individuals with End Stage Renal Disease.
ASN is delighted that the Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule for calendar year 2025 that includes Medicare coverage for individuals with End Stage Renal Disease (ESRD).
The proposed rule would allow Medicare to pay for “dental or oral examination in the inpatient or outpatient setting prior to Medicare-covered dialysis services for beneficiaries with ESRD,” as well as “medically necessary diagnostic and treatment services to eliminate an oral or dental infection prior to, or contemporaneously with, Medicare-covered dialysis services for beneficiaries with ESRD.”
In a recent letter, ASN, together with the National Kidney Foundation (NKF), urged CMS “to use its existing authority or its broad waiver authority to allow Medicare payment for diagnostic and therapeutic dental services for Medicare ESRD beneficiaries receiving dialysis." This effort followed the recent successful advocacy of both organizations and others in kidney care to extend dental care for candidates for kidney transplantation.
In cases of immunosuppression, poorly controlled diabetes, heart disease, malnutrition, and other relevant comorbidities, dental treatment is vital and strongly related to the clinical success of various nephrology-related medical services, including dialysis circuit procedures, hemodialysis procedures, and physician or other qualified healthcare professional visits for ESRD.
“Identifying and resolving dental infections can be similarly integral and related to the clinical success of other covered medical services for co-morbidities frequently associated with ESRD,” ASN and NKF pointed out. “The lack of medically necessary oral/dental care in such circumstances heightens the risk of costly medical complications, increasing the financial burden on Medicare, beneficiaries, and taxpayers.”
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