Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 2
Subtitle 09 - MEDICAL CARE PROGRAMS
Chapter 10.09.05 - Dental Services
Section 10.09.05.01 - Definitions

(1) "Adverse action" means any action taken by the dental benefits administrator (DBA) to deny, reduce, terminate, delay, or suspend a covered service.

(2) "Aftercare" means the period of follow-up care after initial services are rendered, during which any additional related services rendered by the same provider are included in the payment for the original services.

(3) "Ambulatory surgical center (ASC)" means any Medicare-certified entity that operates exclusively for the purpose of providing surgical services to patients not requiring hospitalization.

(4) "Appeal" means the process:

(5) "Benefits" means a schedule of dental services to be administered by the DBA to Medical Assistance participants pursuant to this chapter.

(6) "Claim" means an itemized statement requesting payment for services rendered by health care providers, such as dentists, billed:

(7) "Consultation" means written opinion or advice rendered by a dentist, upon request by the patient's attending physician or dentist, for the further evaluation or management of the patient by the attending physician or dentist. If the consultant dentist assumes responsibility for the continuing care of the patient, a subsequent service rendered by the consultant is not a consultation.

(8) "Dental benefits administrator (DBA)" means an entity with which the Department contracts to administer dental benefits by performing some or all of the following functions:

(9) "Dental services" means emergency, preventive, or therapeutic services for oral diseases which are administered by or under the general supervision of a dentist in the practice of the profession.

(10) "Department" means the State Department of Health and Mental Hygiene, the single State agency designated to administer the Maryland Medical Assistance Program under Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq., or the Department's designee.

(11) "Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)" means comprehensive and preventive health care pursuant to 42 U.S.C. § 1396d(e) as amended by OBRA 1989.

(12) "Emergency services" means 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 (that is, periodontal membranes, gums, and alveolar bone), the jaws, and tissues of the oral cavity.

(13) "EPSDT certified provider" means a physician, physician assistant, or nurse practitioner certified by the Department to provide EPSDT services.

(14) "Free-standing clinic" means a health care facility approved for participation in the Maryland Medical Assistance Program that is not licensed as a hospital or as part of a hospital or nursing home and that is not administratively part of a health maintenance organization or physician's, dentist's, or osteopath's office, but which has a separate staff functioning under the direction of the clinic administrator (as defined in 42 CFR § 405.1801) or a health officer and which is organized and operated to provide clinic services.

(15) "General supervision" has the meaning stated in COMAR 10.44.21 and 10.44.27.

(16) "Hospital" has the meaning stated in Health-General Article, Title 19, Subtitle 3, Annotated Code of Maryland.

(17) "Maryland Healthy Smiles Dental Program" means the Maryland Medicaid dental program.

(18) "Medical Assistance Program" means the program of comprehensive medical and other health-related care for indigent and medically indigent persons.

(19) "Medically necessary" means that a service or benefit is:

(20) "Medicare" means the insurance program administered by the Federal government under Title XVIII of the Social Security Act, 42 U.S.C. § 1395 et seq.

(21) "Mobile dental unit" means any self-contained facility in which dentistry will be practiced and which may be moved, towed, or transported from one location to another.

(22) "Network provider" means a health care entity or health care professional that has executed a provider agreement with Maryland Medicaid.

(23) "Participant" means an individual who is certified as eligible for, and is receiving, Medical Assistance benefits.

(24) "Preauthorization" means an approval required from the Department or its designee before the provision of dental or oral health care services.

(25) "Primary dental office" means the fixed and permanent location where the mobile dental unit:

(26) "Program" means the Maryland Medical Assistance Program.

(27) "Provider" means:

(28) "Referral" means a transfer of the patient from a physician or dentist to a dentist for diagnosis and treatment of the condition for which the referral was made. The dentist to whom the referral is made will no longer be considered the consultant.

(29) "REM" means the fee-for-service managed care program for individuals who have certain rare and expensive health care conditions set forth in COMAR 10.09.69.

(30) "Self-ligating braces" means braces which utilize a permanently installed, moveable component to secure the archwire without the use of ligatures.

(31) "Traditional comprehensive orthodontic treatment" means a coordinated diagnosis and treatment to improve craniofacial dysfunction or dentofacial deformity which may utilize fixed and removable orthodontic appliances and focus on specific objectives at various stages of dentofacial development.