Current through Register Vol. 46, No. 39, September 25, 2024
(a) Identification card as authorization. The
identification card issued to persons eligible for medical assistance shall
constitute full authorization for providing any of the following dental
services and supplies and no special or prior authorization shall be required
therefor:
(1) dental services required for
emergency care and/or the relief of pain or acute infection;
(2) oral examination, including treatment
plan, if necessary;
(3) periapical,
bitewing, occlusal and extraoral radiograps, as required;
(4) oral propylaxis, including cleaning,
supra and subgingival scaling and polishing of teeth;
(5) topical fluoride applications for persons
13 years of age and under;
(6)
restoration of carious permanent and primary teeth with:
(i) silver amalgam;
(ii) silicate cement;
(iii) plastic materials;
(iv) stainless steel crowns when supported by
adequate justification;
(7) pulpotomy for permanent or primary
teeth;
(8) endodontic therapy for
incisor or cuspid teeth; however, prior authorization shall be required if
complete endodontic therapy is required for more than one tooth, or if a crown
is required to supplement endodontic therapy on one or more teeth;
(9) extraction of infected or nonrestorable
teeth; however, prior authorization shall be required if one or more
extractions will require the construction of a dental prosthetic appliance to
alleviate a serious health condition or one which affects
employability;
(10) repair of full
or partial dentures, recementing crowns and fixed bridges, or replacing facings
on bridges.
(b) Prior
approval and prior authorization required. In addition to the medical
assistance identification card, prior approval of the dental director and prior
authorization of the social services official shall be required for the
following:
(1) all preventive, prophylactic,
and other routine dental care, services, treatment and supplies not
specifically set forth in subdivision (a) of this section;
(2) all dental prosthetic appliances which
shall be furnished only if required to alleviate a serious health condition
including one which affects employability.
(c) The provisions of this section shall
apply to all dental services and supplies provided to eligible applicants for
and recipients of medical assistance on and after July 1, 1969.
