CMS is proposing to reverse a recently added policy that allowed states to add adult dental services as an essential health benefit to their benchmark plans.
Five notes:
1. CMS issued a final rule in April 2024 that adds routine adult dental services as an essential health benefit under the Affordable Care Act.
2. The new rule allowed states to add these services as an essential health benefit in 2025, with coverage becoming effective Jan. 1, 2027.
3. CMS released its proposal Feb. 9 as part of the HHS Department’s Notice of Benefit and Payment Parameters for 2027, stating that the reversal better aligns with current statutory requirements.
4. Additionally, the proposed rule would lower the percentage of essential community providers that need to be within a stand-alone dental plan’s network from 35% to 20%.
5. CMS is accepting public comments on the proposal until March 13 and will release a final rule later this year.
