Louisiana Administrative Code
Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE
Part I - Administration
Subpart 3 - Managed Care for Physical and Behavioral Health
Chapter 21 - Dental Benefits Prepaid Ambulatory Health Plan
Section I-2107 - Network Access Standards and Guidelines

Universal Citation: LA Admin Code I-2107

Current through Register Vol. 50, No. 9, September 20, 2024

A. The DBPM must maintain and monitor a provider network that is supported by written agreements and is sufficient to provide adequate access to enrollees as required by federal law and the terms as set forth in the contract. The DBPM shall adhere to the federal regulations governing access standards, as well as the specific requirements of the contract and all department-issued guides.

B. The DBPM shall cover all necessary services to treat an emergency dental condition.

1. Emergency Dental Condition - a dental or oral condition that requires immediate services for relief of symptoms and stabilization of the condition. Such conditions include:
a. severe pain;

b. hemorrhage;

c. acute infection;

d. traumatic injury to the teeth and surrounding tissue; or

e. unusual swelling of the face or gums.

2. Emergency dental services are those services necessary for the treatment of any condition requiring immediate attention for the relief of pain, hemorrhage, acute infection, or traumatic injury to the teeth, supporting structures (periodontal membrane, gingival, alveolar bone), jaws, and tissue of the oral cavity.

C. The DBPM must maintain a provider network and in-area referral providers in sufficient numbers, as determined by the department, to ensure that all of the required core dental benefits and services are available and accessible in a timely manner in accordance with the terms and conditions in the contract and department issued guide.

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.

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