New York Codes, Rules and Regulations
Title 18 - DEPARTMENT OF SOCIAL SERVICES
Chapter II - Regulations of the Department of Social Services
Subchapter E - Medical Care
Article 4 - Fees and Reimbursement
Part 535 - State Reimbursement For Payment To Dentists
Section 535.3 - State reimbursement
Universal Citation: 18 NY Comp Codes Rules and Regs ยง 535.3
Current through Register Vol. 46, No. 12, March 20, 2024
[Additional statutory authority: Social Welfare Law, §§ 365-b, 368-a]
(a) State and local charges.
(1) State reimbursement
for local charges shall be based on payments actually made, except that in no
case shall reimbursement be available for amounts paid in excess of the maximum
reimbursable allowance hereinafter prescribed.
(i) If a service or procedure, which is not
listed in section
535.5
of this Part, is necessarily performed, reimbursement shall be based on the
expenditures actually made therefor, in accordance with applicable rules of the
board and regulations of the department.
(2) The full amount paid for dental care for
State charges shall be eligible for reimbursement, provided that such payment
is the same as that which would be made for local charges in similar
circumstances.
(b) Reimbursement for payment of dental fees.
(1)
Payments for dental services under the medical assistance program shall be
reimbursable by the State only when the services were rendered by a general or
specialist practitioner of dentistry meeting the qualifications therefor as set
forth in section
506.1
of the regulations of the department or when the services were provided in a
dental clinic affiliated with State University of New York at Buffalo School of
Dentistry, Columbia University School of Dental and Oral Surgery or New York
University College of Dentistry and performed under the supervision of a
general or specialist practitioner of dentistry meeting the qualifications
therefor as set forth in section
506.1
of the regulations of the department.
(2) Reimbursement for consultation fee
expenditures shall be available only when an examination is made by an
accredited specialist within the scope of his specialty upon the request of the
attending dentist who is treating the dental problem for which consultation is
required. The attending dentist shall certify that he requested the
consultation and that it was necessary for the further care of the patient.
(i) When the consultant dentist assumes the
continuing care of the patient, any subsequent services rendered by him shall
not be considered as consultation.
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