New Mexico Administrative Code
Title 13 - INSURANCE
Chapter 10 - HEALTH INSURANCE
Part 6 - PREPAID DENTAL PLANS
Section 13.10.6.10 - PREPAID DENTAL PLAN CERTIFICATION
Universal Citation: 13 NM Admin Code 13.10.6.10
Current through Register Vol. 35, No. 18, September 24, 2024
A. The prepaid dental plan shall submit a statement describing its proposed dental care plan, facilities, and personnel to the director of the health services division for certification. The statement shall indicate the manner which the prepaid dental plan will comply with the following requirements:
(1) The
prepaid dental plan shall have an organized system for the delivery of those
dental care services. The system shall include general dentists, and may
include specialists, licensed dental hygienists and other professional and
technical personnel. The system shall include a procedure which promotes a
continuing relationship to be established between a member and the same general
dentist and a procedure for effective referrals to assure continuity of care to
members.
(2) The prepaid dental
plan shall list (using full-time equivalents for providers) the proposed or
actual:
(a) names of members enrolled and
whether they have elected dependent coverage;
(b) dentist staffing for the projected
enrollment, identifying board of eligibility or certification of each dentist
listed when such identification exist; in lieu of such identification all staff
dentists will be considered general dentists;
(c) dental support staff by number and
type;
(d) provision for providing
specialty dental services.
(3) All care provided by the prepaid dental
plan whether provided by its own personnel or on a contract basis shall be by
licensed practitioners of the healing arts when such licensure is required by
law and shall otherwise be in accordance with applicable laws and
rules.
(4) Emergency dental
services described in 13 NMAC 10.6.11.1 [now Subsection A of 13.10.6.11 NMAC]
shall be available for enrolled members on a seven day per week and 24 hours
per day basis.
B. Dental services provided on a continuing basis by other than organization employees shall be covered by written service agreements which specify the terms and conditions upon which they will provide any or all of those dental services contained in 13 nmac 10.6.11 [now 13.10.6.11 NMAC].
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