South Dakota Administrative Rules
Title 67 - Department of Social Services
Article 67:16 - Covered medical services
Chapter 67:16:11 - Early and periodic screening
Section 67:16:11:03.06 - Orthodontic treatment
Current through Register Vol. 51, page 43, September 23, 2024
Orthodontic treatment is subject to prior authorization. The authorization is based on the results of an orthodontic evaluation and assessment completed by the treating dentist or orthodontist. In addition, the following requirements must be met:
(1) The treatment is medically necessary to correct a handicapping malocclusion;
(2) There are reasonable assurances that the teeth are in good condition and will remain in good condition for a considerable length of time; and
(3) There is reason to anticipate that the recipient will be compliant with scheduled appointments and the treating dentist's or orthodontist's treatment plan.
General Authority: SDCL 28-6-1.
Law Implemented: SDCL 28-6-1.
Covered services must be medically necessary, § 67:16:01:06.02;
