Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 420.000 - Dental Services
Section 420.405 - Provider Eligibility: In-state and Out-of-state
Universal Citation: 130 MA Code of Regs 130.420
Current through Register 1531, September 27, 2024
(A) In-state Providers. The following requirements apply when the dental provider's practice is located in Massachusetts.
(1)
Dental
Practitioner. A dentist engaged in private practice is eligible to
participate in MassHealth as a dental provider if licensed to practice by
BORID. Private practices may include, but are not limited to, solo,
partnership, or group practices.
(2)
Community Health
Center. A licensed community health center with a dental clinic is
eligible to participate in MassHealth as a provider of dental
services.
(3)
Dental
School. A teaching clinic of a dental school accredited by CODA is
eligible to participate in MassHealth as a provider of dental
services.
(4)
Acute
Hospital Outpatient Department, Hospital-licensed Health Center, or Other
Satellite Clinic. An acute hospital's outpatient department,
hospital-licensed health center, or other satellite clinic that participates in
MassHealth pursuant to the Executive Office of Health and Human Services
(EOHHS) Acute Hospital Request for Applications (RFA) and contract is eligible
to provide services designated as dental clinic services in Subchapter 6 of the
MassHealth Dental Manual for providers under 130 CMR
420.000.
(5)
Dental
Clinic. A dental clinic must be licensed by the Massachusetts
Department of Public Health (DPH) to be eligible to participate in MassHealth
as a dental provider. A DPH license is not required for a state owned and
operated dental clinic. A dental clinic that limits its services to education
and diagnostic screening is not eligible to participate in MassHealth as a
dental provider.
(6)
Specialist in Orthodontics. A dentist who is a
specialist in orthodontics must have completed a minimum of two years training
in a CODA advanced-education program in orthodontics that fulfills all
educational requirements for eligibility for the examination by the American
Board of Orthodontists.
(7)
Specialist in Oral Surgery. A dentist who is a
specialist in oral surgery must have completed a minimum of four years training
in an oral and maxillofacial surgery advanced-education program, fulfilling the
requirements for advanced training in oral and maxillofacial surgery as
outlined by CODA and leading to a Certificate of Advanced Graduate Studies
(CAGS).
(8)
Other
Dental Specialists. A dentist who is a specialist in any other
area of dentistry (for example, pedodontics, anesthesiology, endodontics,
periodontics, or prosthodontics) must have completed the appropriate
CODA-accredited certificate program that satisfies eligibility requirements for
the specific specialty board.
(9)
Public Health Dental Hygienist. A dental hygienist
engaged in private practice is eligible to participate in MassHealth as a
dental provider and claim payment for certain services without the direct
supervision of a dentist if he or she is licensed to practice as a registered
dental hygienist by BORID and also meets the board's requirements to practice
in a public health setting pursuant to 234 CMR 2.00: General Rules and
Requirements. Private practices may include, but are not limited to,
solo, partnership, or group practices.
(10)
Mobile Dental Facility (MDF)
or Portable Dental Operation (PDO). A dentist or public health
dental hygienist is eligible to participate in MassHealth as a dental provider
and claim payment for certain services provided through a MDF or PDO only if
the provider satisfies the requirements of 234 CMR 7.00: Mobile and
Portable Dentistry and has obtained a valid permit as a MDF or PDO
from BORID.
(B) Out-of-state Providers. A dental provider whose practice is located outside of Massachusetts is eligible to participate in MassHealth as a dental provider and to be paid for dental services provided to MassHealth members only if the provider is licensed or certified by the state in which the provider practices, meets the specific provider eligibility requirements listed in 130 CMR 420.404, and meets the conditions set forth in 130 CMR 450.109: Out of State Services.
(C) Enhancement Fee for Community Health Centers and Hospital-licensed Health Centers.
(1) To qualify
for an enhancement fee for dental services, community health centers and
hospital-licensed health centers must commit to undertaking efforts that
include, but are not limited to, increasing access to dental-covered services
by implementing and reporting on measures to increase the capacity and volume
of dental services they deliver, either directly or through subcontracts with
private dental providers.
(2) The
dental enhancement fee is set by the Executive Office of Health and Human
Services (EOHHS) (see 101 CMR 314.00: Dental
Services).
Disclaimer: These regulations may not be the most recent version. Massachusetts may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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