Increasing Medicare to Embrace Dental: A Path to Higher Oral Well being in Nursing Amenities

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Increasing Medicare to Embrace Dental: A Path to Higher Oral Well being in Nursing Amenities


Introduction

This difficulty temporary is the third in a sequence of papers that look at how you can handle boundaries in entry to care and oral well being outcomes amongst sure teams of Medicare enrollees, together with individuals of shade, individuals with disabilities, and older adults with dementia and cognitive impairments. These briefs construct on the difficulty temporary, Creating an Oral Well being Profit in Medicare: A Statutory Evaluation, the place Justice in Getting old supplied an evaluation of the statutory adjustments that might be wanted so as to add an oral well being profit to Medicare Half B.

Desk of Contents

Medicare is the first supply of well being protection for many older adults and lots of youthful people with disabilities. But, Authentic Medicare, also referred to as Conventional Medicare fee-for-service, explicitly excludes most dental providers, leaving tens of millions with out complete oral well being protection. Lately, the Facilities for Medicare & Medicaid Providers (CMS) has issued regulatory adjustments which have clarified when Medicare can pay for sure medically obligatory dental providers, however Medicare protection stays restricted. Whereas nearly all of Medicare Benefit plans supply some dental protection as supplemental advantages, the extent of protection varies plan to plan. Because of this, entry to important oral well being remedy is out of attain for a lot of Medicare enrollees – significantly nursing facility residents, who already face important boundaries to oral well being care.

Nursing facility residents constantly expertise poor oral well being outcomes and restricted entry to dental providers. This paper examines how including a dental profit to Medicare would scale back these disparities and handle these challenges. The paper begins with an outline of nursing facility residents enrolled within the Medicare program, adopted by an outline of the disparities in entry to oral well being protection, providers, and outcomes residents face. Subsequent, the paper examines how including a dental profit to Medicare would assist enhance entry and outcomes and concludes with coverage suggestions to handle boundaries past protection that impede entry to oral well being look after residents.

Medicare’s Protection of Dental

In legislation, Authentic Medicare explicitly excludes protection of most dental providers.[1] Since 2022, CMS started issuing regulatory adjustments which have clarified when Medicare fee may be made for dental providers which are inextricably linked to and considerably associated to the scientific success of a selected remedy of a person’s major medical situation. For instance, Medicare will now pay for dental examinations and wanted dental providers to deal with a Medicare-covered organ transplant, head and neck most cancers, most cancers previous to or throughout chemotherapy, cardiac valve substitute, or valvuloplasty process. These dental providers may be rendered in an inpatient setting coated underneath Medicare Half A and an outpatient setting paid underneath Half B.[2] Most just lately, CMS clarified that Medicare fee may be made for dental providers which are inextricably linked to Medicare coated dialysis providers for the remedy of end-stage renal illness.[3] Medicare Benefit plans, together with Twin Eligible Particular Wants Plans (D-SNPs), are required to offer all Medicare coated advantages, together with inextricably linked medically obligatory dental providers. [4] CMS accepts nominations for added clarification of this coverage on an annual foundation via the Medicare Doctor Price Schedule.[5]

Traits of Nursing Facility Residents

Roughly 1.2 million individuals stay in nursing amenities throughout the USA. The bulk—82%—are older adults aged 65 and over. Demographic information reveals that almost all of nursing facility residents are white (73%), 16% are Black, and 6% are Hispanic or Latino. Lengthy-term developments point out a rising variety of residents of shade—particularly in amenities that primarily depend on Medicaid.[6] Roughly 28% of nursing facility residents stay in rural areas, and residents in these amenities usually tend to be age 65 and over.[7]

Residents usually have a number of persistent circumstances and important care wants.[8] Practically half of all residents have been recognized with Alzheimer’s illness or one other type of dementia. As well as, 46% have coronary heart illness, greater than one-third have diabetes, and 74% stay with hypertension or hypertension.[9] Analysis reveals a robust, bidirectional hyperlink between oral well being and total well being: oral illness can enhance the danger of growing or worsening these persistent circumstances, and these circumstances can, in flip, negatively influence oral well being.[10] This connection highlights the pressing want for higher oral well being care in nursing amenities, as sustaining good oral well being is significant for managing and stopping these severe well being issues.

Who Pays for Nursing Facility Care

Nursing facility care is expensive, and Medicare’s protection—like protection of oral well being—is restricted. Medicare can pay as much as the primary 100 days of a nursing facility keep in cases the place a person has a qualifying hospital keep and is in want of expert care. Medicare’s definition of expert care is slim. It consists of providers supplied pursuant to a physician’s orders by “certified technical or skilled well being personnel resembling registered nurses, licensed sensible (vocational) nurses, bodily therapists, occupational therapists, and speech-language pathologists or audiologists.”[11] Past 100 days, Medicare will proceed to pay for medically obligatory providers for residents, like physician visits or bodily remedy via Medicare Half B, however is not going to cowl room and board.[12] Medicaid is the first payer of nursing facility stays, protecting about 62% of all nursing facility residents.[13] Roughly, 24% of nursing facility residents pay privately or via different protection, resembling long-term care insurance coverage.[14]

Disparities Impacting Oral Well being Look after Nursing Facility Residents

Analysis has constantly documented the distinctive boundaries nursing facility residents face in accessing oral well being care.[15] These boundaries may be understood via a multi-level framework: coverage, organizational, and particular person.

On the coverage degree, essentially the most basic barrier is the shortage of complete oral well being protection within the major insurance coverage packages nursing facility residents depend on—Medicare and Medicaid. On the organizational degree, amenities usually lack the sources and coaching wanted to assist enough oral well being care. Many amenities additionally face logistical challenges, resembling lack of a delegated bodily area to ship scientific dental care, restricted employees capability to help residents with oral hygiene or arrange dental providers, and a scarcity of expert geriatric oral well being care professionals working in these settings. On the particular person degree, residents usually tend to expertise bodily frailty, purposeful limitations, or behavioral well being points that make each performing and accessing oral care extra troublesome.[16]

On account of these boundaries, nursing facility residents have diminished entry to oral well being care and expertise poor oral well being outcomes. Whereas information immediately evaluating nursing facility residents with older adults residing in the neighborhood is restricted, a pivotal California examine performed by the Heart for Oral Well being gives perception. Preliminary information from the Heart’s present examine discovered simply over 30% of older adults residing in nursing amenities had untreated tooth decay in comparison with about 18% community-dwelling older adults. Equally, about 27% of older adults residing in nursing amenities had misplaced all their enamel in comparison with about 11% of older adults in the neighborhood. The examine additionally revealed that residents in rural nursing amenities have been 13% extra prone to have untreated tooth decay than their city counterparts. [17]

Inside nursing amenities, disparities additionally emerge by race, ethnicity, and well being standing. A current examine evaluating the oral well being of Medicare enrollees in nursing amenities discovered that Black residents have been 16% extra prone to don’t have any remaining pure enamel whereas American Indian or Alaskan Native residents have been 34% extra seemingly in comparison with white nursing facility residents.[18] American Indian or Alaskan Native residents have been 20% extra prone to have cavities and damaged enamel in comparison with white nursing facility residents. Once more, residents in rural amenities expertise worse oral well being issues, with residents in rural amenities 70% extra prone to expertise a number of dental points than residents in city amenities.[19]

Power circumstances additionally compound threat of oral well being illness. Residents with three or extra persistent circumstances face elevated odds of experiencing quite a few oral well being points—together with damaged or loosely becoming dentures, no pure enamel or tooth fragments, irregular mouth tissue, ache, discomfort, or problem chewing—in comparison with residents with out persistent circumstances.[20] Analysis on oral hygiene measures reveals that nursing facility residents with dementia or Alzheimer’s illness introduced with the bottom scores.[21] Black older grownup ladies face explicit threat, with information exhibiting they expertise the best prevalence of Alzheimer’s illness and associated dementias.[22]

With Black and Hispanic older adults going through larger charges of each oral well being and persistent illness, and in mild of analysis that reveals that nursing amenities in neighborhoods with predominantly Black and Hispanic/Latino residents present decrease high quality of care,[23] the poor outcomes famous above usually are not stunning. To deal with these disparities and enhance oral and well being outcomes for all nursing facility residents, complete reforms at each degree—coverage, organizational, and particular person—are wanted.

Including a Medicare Oral Well being Profit to Deal with Disparities for Nursing Facility Residents

Including an oral well being profit to Medicare Half B is a necessary step to handle long-standing disparities in oral well being entry amongst nursing facility residents. At present, with out Medicare protection, nursing facility residents should depend on different sources of protection or pay privately for dental care.

As famous beforehand, Medicaid is the first payer of nursing facility care. But, oral well being care protection just isn’t assured. It is because grownup dental protection in Medicaid is elective underneath federal legislation for states to cowl. Because of this, Medicaid grownup dental protection varies significantly each throughout states and inside states amongst completely different populations. As of 2022, eight states present emergency protection solely, whereas 14 states present restricted protection to adults.[24] Whereas half of states present extra intensive grownup dental advantages, there’s variability when it comes to what providers are coated.[25]

Medicaid reimbursement charges for dental providers usually don’t account for the extra time wanted for remedy or the added bills of delivering providers in a non-traditional setting somewhat than dental places of work or different scientific areas. Additional, as a result of these advantages are elective in Medicaid, states usually flip to reducing dental advantages or eliminating advantages completely throughout fiscal downturns—resembling what states are going through immediately because of the important cuts in federal Medicaid funding to states with the passage of the Price range Reconciliation Act of 2025 (H.R. 1).[26]

Including an oral well being profit in Half B would set up a standardized, nationwide profit for all 67.6 million Medicare enrollees, no matter whether or not they’re enrolled in Authentic Medicare or Medicare Benefit (MA).[27] Just like different Half B coated providers, oral well being care and dental providers could be primarily based on medical necessity and never tied to disease-specific standards or the requirement that providers be inextricably linked to the success of one other medical coated service, as is the case immediately. Importantly, in consequence, nursing facility residents would have protection of preventive and different medically obligatory dental care no matter illness prognosis, revenue, Medicaid standing, or whether or not their state Medicaid program consists of grownup dental advantages.

A Half B dental profit would additionally serve to broaden the community of taking part suppliers who might serve facility residents. Medicare reimbursement charges are typically larger than Medicaid’s, making it extra possible for dentists and different oral well being professionals to serve nursing facility residents. By addressing value boundaries for suppliers, Medicare protection would assist make sure that residents can obtain care in a well timed method. This may be significantly advantageous for amenities that serve excessive numbers of residents on Medicaid.[28] Including an oral well being profit to Medicare Half B would additionally reduce burden on facility employees, as it could simplify the method of accessing dental care. By establishing a standardized, nationwide profit via Medicare, employees would spend much less time managing entry, billing, and protection points.

Finally, a Medicare profit would enhance entry to oral well being care and, in consequence, scale back avoidable emergency division visits, hospitalizations, and issues associated to poor oral well being, bettering the general well being outcomes for nursing facility residents.[29]

Protection is Important, However Extra is Wanted to Deal with Obstacles to Oral Well being Care in Nursing Amenities

Oral well being protection is the most important determinant of whether or not a person can entry oral well being care. Subsequently, increasing protection is a necessary step in making certain entry and lowering boundaries to look after nursing facility residents, however it’s not the one step. As famous beforehand different coverage, organizational, and particular person components can impede entry to oral well being care. Under are further suggestions that may assist handle these boundaries:

Improve Oversight and Accountability of Nursing Amenities

Underneath federal rules, nursing amenities are required to guage oral well being wants and supply entry to look after residents. For instance, nursing amenities are required to evaluate resident’s oral well being wants upon admission and quarterly thereafter or when important change happens.[30] Moreover, amenities are immediately answerable for the oral well being wants of their residents.[31] This consists of offering residents entry to routine dental care, help with dental appointments, and arranging for transportation providers to and from these appointments.[32] For residents that require assist to carry out oral hygiene, amenities are required to offer providers resembling brushing of the enamel, cleansing dentures, and cleansing the mouth and tongue to keep up oral mucosa.[33]

Regardless of these necessities, compliance is inconsistent. Oral well being is usually deprioritized attributable to staffing shortages, lack of coaching, restricted sources, or competing calls for. Because of this, many residents’ primary oral well being wants go unmet.[34] Enhancing federal and state oversight and enforcement of those necessities would higher guarantee amenities meet their obligations. For instance, on the federal degree, surveyor steerage may very well be strengthened to make sure extra constant and efficient monitoring of compliance throughout annual facility inspections. States might additionally require amenities prepare their employees on the supply of oral well being and require an oral well being skilled to finish the oral well being evaluation portion of the Minimal Knowledge Set, the screening instrument that should be accomplished for each resident in Medicare and Medicaid amenities.[35]

Deliver Care to Nursing Facility Residents The place They Are

As was beforehand referenced, federal rules require nursing amenities to make appointments and preparations for transportation providers to and from dental appointments when residents want help. But, accessible information reveals restricted capability for nursing house employees to satisfy federal rules.[36] On the similar time, nursing amenities usually should not have devoted area to offer dental care.

Methods that assist to convey oral well being and dental providers on to nursing facility residents can serve to mitigate these boundaries. Fashions resembling tele-dentistry that use telecommunications know-how to attach sufferers to dental suppliers remotely by way of a wide range of completely different modalities together with stay video or by transferring well being info by way of safe platforms has proven the potential to bridge the oral well being fairness hole for older adults and different particular wants populations in long-term care.[37]

Equally, growth of dental well being groups educated to work in hard-to-reach communities and settings, together with, for instance, dental hygienists working with expanded scopes of apply, Dental Therapists, Neighborhood Well being Staff (CHWs), gives alternatives to successfully ship high quality oral well being care to nursing facility residents. For instance, analysis reveals that dental hygienists working with expanded scopes of apply have a constructive influence in offering preventive care providers and lowering the elimination of enamel attributable to oral illness.[38] In California, the place Registered Dental Hygienists in Various Apply (RDHAPs) serve a majority of sufferers who’re underserved together with medically compromised and institutionalized populations, analysis reveals enchancment in entry to preventive dental care providers, case administration, and referrals to dental suppliers.[39]

Combine Oral Well being into Rural Well being Care Supply

Rural communities regularly expertise poor oral well being care entry, utilization, and outcomes. Most rural areas are federally designated as Dental Well being Skilled Scarcity Areas, with residents reporting larger charges of tooth loss, fewer dental visits, and longer journey to dental suppliers in comparison with city and suburban populations.[40] These boundaries are much more acute in rural nursing amenities, the place residents usually current with untreated dental issues.[41]

Medical dental integration (MDI) fashions can assist to handle workforce shortages and broaden entry in rural communities by incorporating oral well being care as a part of the well being care supply system. Whereas MDI fashions can take numerous varieties resembling co-locating major care and dental suppliers in the identical website (e.g., neighborhood well being clinics, Federally Certified Well being Heart, and so forth.) or coaching major care suppliers to ship primary preventive dental providers (e.g., display screen for oral illness, conduct threat assessments and oral examinations, educate sufferers, apply fluoride, varnish, and so forth.), they promote a one-stop-shop strategy, lowering the burden on people to hunt oral well being care individually from their medical care.[42]

Analysis reveals that MDI pilot packages have demonstrated improved oral well being entry and total well being outcomes.[43] For rural nursing facility residents in remoted areas with restricted entry to public transportation providers, a one-stop-shop MDI strategy the place residents obtain preventive oral well being care providers by way of their major care supplier throughout their annual Wellness Go to or different Half B coated medical appointment has the potential for significant influence in stopping and lowering the development of superior oral illness.

Conclusion

Including an oral well being profit in Medicare Half B would set up an ordinary profit accessible to all enrollees, together with nearly all of nursing facility residents, no matter revenue, Medicaid standing, or whether or not their state gives protection of Medicaid grownup dental. Medicare protection would additionally lengthen entry to oral well being care supplied by their major care supplier, nurse practitioner, or different auxiliary personnel as a part of their total well being care with out having to depart the ability.

A number of payments have been launched in Congress this 12 months that might add a dental profit to Medicare.[44] If a Medicare oral well being profit package deal is in the end handed, it could be a significant step to handle protection and entry to oral well being look after nursing facility residents. Actions by advocates, well being suppliers, dental colleges, policymakers, and different stakeholders to handle systemic challenges past protection for facility residents would even have a big influence on addressing disparities and poor outcomes and bettering entry to oral well being care.

Endnotes

  1. 42 U.S.C. § 1395y(a)(12). ↑

  2. 42 C.F.R. § 411.15(i)(3). ↑

  3. 87 FR 69404. ↑

  4. 42 CFR 422.101(a); See additionally, Sec. 1852(a)(1) of the Social Safety Act [42 U.S.C. § 1395w-22(a)(1)]. ↑

  5. CMS established a course of to just accept and take into account submissions from the general public (the “public submission course of”) to determine further dental providers which are inextricably linked to, and considerably associated and integral to the scientific success of, different coated providers within the CY 2023 Doctor Price Schedule remaining rule. See 87 FR 69663 via 69688. ↑

  6. Shippee, Ttyana P., et al. “Addressing Racial and Ethnic Disparities in Nursing Properties,” AARP Public Coverage Institute, p. 4 and 10, (February 2024) (Accessed August 19, 2024); see additionally Travers, Jasmine L. et al., “A Profile of Black and Latino Older Adults Receiving Care in Nursing Properties: 2011- 2017,” JAMDA 23(11): 1833-1837 (2022) (Accessed Might 15, 2025). ↑

  7. Nationwide Rural Well being Affiliation, “The Rural Nursing House Panorama,” (February, 2024). ↑

  8. Heart for Illness Management, Nationwide Heart for Well being Statistics, “Desk 4: Submit-acute and Lengthy-term Care Person Demographic and Well being associated Traits: United States,” Nationwide Submit-acute and Lengthy-term Care Examine (2020) (Accessed July 30, 2025) ↑

  9. Id. ↑

  10. U.S. Division of Well being and Human Providers, Nationwide Institutes of Well being, “Oral Well being in America: Advances and Challenges,” § 3B at 13-16, (2021), (Accessed July 16, 2025); see additionally McMains, Vanessa, “Wholesome Mouth, Wholesome Physique: A long time of NIDCR-funded Analysis Reveal the Interconnectedness of the Mouth and Physique,” Nationwide Institute of Dental and Craniofacial Analysis (Might 8, 2024) (Accessed July 16, 2025). ↑

  11. See CMS, “Medicare Profit Coverage Guide,” chapter 8, §30.2.1 (October, 5, 2023) (Accessed September 23, 2025). ↑

  12. CMS, “Medicare Claims Processing Guide: chapter 7 SNF half B Billing (Together with Inpatient Half B and Outpatient Price Schedule),” §§10 – 10.1 (Reviewed August 6, 2021) (Accessed September 4, 2025). ↑

  13. Chidambaram, Priya et al., “5 Key Info About Nursing Amenities and Medicaid,” KFF (Might 28, 2025) (Accessed September 8, 2025). ↑

  14. Id. ↑

  15. U.S. Division of Well being and Human Providers, Nationwide Institutes of Well being, “Oral Well being in America: A Report of the Surgeon Basic,” p. 262-69 (2000) (Accessed April 30, 2025); see additionally Dolan, Teresa et al., “Entry to Dental Care Amongst Older Adults in the USA,” 69(9):961-74 Journal of Dental Training (Sept. 1, 2005) (Accessed April 30, 2025). ↑

  16. Sarab El-Yousfi, “A Fast Assessment of Obstacles to Oral Healthcare for Susceptible Individuals,” Desk 1. British Dental Journal (July 26, 2019) (Accessed August 16, 2024); see additionally Desk 1 Obstacles particular for various susceptible teams. ↑

  17. Heart for Oral Well being, “Oral Well being Evaluation of Older Adults in California Advisory Committee Assembly,” PowerPoint slides protecting examine information key findings (July 9, 2025) (Accessed July 9, 2025). Not accessible on-line. The Heart for Oral Well being will publish a report with examine findings by the tip of 2025. ↑

  18. Chamut, Steffany, et al, “Oral Well being Amongst Medicare Beneficiaries in Nursing Properties,” JAMA Community Open, 6(9) (September 12, 2023) (Accessed August 19, 2024). ↑

  19. Id. ↑

  20. Id. ↑

  21. Zimmerman, Sheryl, et al. “Readily Identifiable Threat Elements of Nursing House Residents’ Oral Hygiene: Dementia, Hospice, and Size of Keep,” J Am Geriatr Soc. 2017 Nov; 65(11): 2516–2521. (Accessed August 28, 2024). ↑

  22. Findley, Caleigh A. et al. “Well being disparities in getting old: Bettering dementia look after Black ladies,” Entrance Getting old Neurosci. vol. 15 (Feb. 2023) (Accessed August 28, 2024). ↑

  23. Shippee, supra notice 6, at 2. ↑

  24. Nationwide Academy for State Well being Coverage, “State Medicaid Protection of Dental Providers for Basic Grownup and Pregnant Populations,” (October 22, 2022). See additionally, CareQuest Oral Well being Institute, Medicaid Grownup Dental Protection Checker, (Accessed September 17, 2025). ↑

  25. Id. ↑

  26. For extra info on the influence of the H.R. 1 on low-income older adults, see the Justice in Getting old Medicaid Protection internet web page. ↑

  27. See Board of Trustees, Federal Hospital Insurance coverage and Federal Supplementary Medicare Insurance coverage Belief Funds, “2025 Annual Report of the Boards of Trustees of the Federal Hospital Insurance coverage and Federal Supplementary Medicare Insurance coverage Belief Funds,” p. 6 (June 18, 2025) (Accessed September 9, 2025). ↑

  28. For a sturdy dialogue on value boundaries and entry to suppliers for low-income adults in Medicaid, see Hedges, Ian et al., “Bettering Dental Care Entry for Susceptible Populations,” Well being Coverage Institute ADA (July 2024) (Accessed April 30, 2025). ↑

  29. Analysis analyzing the elimination of grownup dental advantages in state Medicaid packages gives a comparable lens to know impacts to state sources and what low-income older adults face with out dental protection. For a sturdy dialogue, see additionally Bhaumik, Deesha et al., “What Occurs if the Grownup Medicaid Dental Profit Goes Away,” p. 7 Well being Coverage Institute ADA (March 2025) (Accessed April 30, 2025). ↑

  30. 42 CFR 483.20(b)(1)(xi) ↑

  31. See Surveyor’s Guideline to 42 CFR 483.25, Appendix PP to CMS State Operations Guide; and 42 CFR 483.55(a)(4) ↑

  32. 42 CFR 483.55(a)(4) ↑

  33. Surveyor’s Guideline to 42 CFR 483.25, supra notice 31. ↑

  34. See Foiles Sifuentes, Adriana M. and Kate L. Lapane, “Oral Well being in Nursing Properties: What we Know and What we Have to Know ” (3-4), The Journal of Nursing House Analysis (January 2020) (Accessed June 26, 2025). ↑

  35. For extra info on the Minimal Knowledge Set, see CMS, “Lengthy-Time period Care Facility Resident Evaluation Instrument 3.0 Person’s Guide,” § 2.1, v. 1.15 (October 2017) (Accessed September 9, 2025). ↑

  36. Folies Sifuentes and Lapane, supra notice 34. ↑

  37. Kandala, Karthika, et al., “Comparability of Preliminary Dental Therapy Choices Between In-Individual and Asynchronous Teledentistry Examinations for Individuals with Particular Well being Care Wants,” JADA 155(8): 687-698, (August 2024) (Accessed July 14, 2025). ↑

  38. Langelier Margaret, et al., “Growth of a New Dental Hygiene Skilled Apply Index by State, 2016,” Oral Well being Workforce Analysis Heart, Heart for Well being Workforce Research, College of Public Well being, SUNY Albany (November 2016) (Accessed July 14, 2025); see additionally Langelier Margaret, et al., “Expanded Scopes of Apply for Dental Hygienists Related to Improved Oral Well being Outcomes for Adults,” Well being Affairs 35:12 (December 2016) (Accessed July 14, 2025). ↑

  39. Mertz, Elizabeth and Paul Glassman, “Various Apply Dental Hygiene in California: Previous, Current, and Future,” Journal of the California Dental Affiliation 39:1 (January 2011) (Accessed July 14, 2025). ↑

  40. Martin, Paige et al.,“Nonetheless Looking: Assembly Oral Well being Wants in Rural Settings,” p.6 CareQuest Institute for Oral Well being (Nov. 2023) (Accessed July 7, 2025). ↑

  41. Chamut et al., supra notice 18, at 4. ↑

  42. Tiwarei, Tamanna et al., “Medical-Dental Integration Fashions,” Delta Dental Institute (2022) (Accessed July 9, 2025). ↑

  43. Heaton, Lisa J., et al., “Oral-Systemic Interactions and Medical-Dental Integration: A Life Course Strategy,” CareQuest Institute for Oral Well being p.9 (September 2023) (Accessed July 8, 2025); see additionally Tiwarei, supra notice 42 at 5-6. ↑

  44. H.R.2045 – Medicare Dental, Imaginative and prescient, and Listening to Profit Act of 2025; S.939 – Medicare Dental, Listening to, and Imaginative and prescient Growth Act of 2025. ↑



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