Current through Register Vol. 24-18, September 15, 2024
The access to baby and child dentistry (ABCD) program
increases access to dental services for certain medicaid-eligible
clients.
(1) A client is eligible for
the ABCD program if the client is:
(a)
Eligible for one of the following medical assistance programs:
(i) Categorically needy program
(CNP);
(ii) Limited casualty
program-medically needy program (LCP-MNP);
(iii) Children's health program; or
(iv) State children's health insurance
program (SCHIP); and
(b)
Follow the age requirements:
(i) Under age
six; or
(ii) Under age 13 and has
one or more disabilities as defined by
RCW
74.09.390.
(2) If the eligible client is enrolled in an
agency-contracted managed care organization (MCO):
(a) Dental providers must bill the agency's
fee-for-service payment system for ABCD program services.
(b) Medical providers must bill the MCO for
ABCD program services.
(3) If the eligible client is not enrolled in
an agency-contracted managed care organization (MCO):
(a) Dental providers must bill the agency's
fee-for-service payment system for ABCD program services.
(b) Medical providers must bill the agency's
fee-for-service payment system for ABCD program services.
(4) Health care providers and community
service programs identify and refer eligible clients to the ABCD program. If
the eligible client is treated by an ABCD certified provider, the client and an
adult family member may receive:
(a) Oral
health education;
(b) "Anticipatory
guidance" (expectations of the client and the client's family members,
including the importance of keeping appointments); and
(c) Assistance with transportation,
interpreter services, and other issues related to dental services.
(5) Only ABCD-certified dental
providers and primary care providers certified in ABCD are paid an enhanced fee
for furnishing ABCD program services. ABCD program services include, when
appropriate:
(a) Family oral health education.
An oral health education visit:
(i) Is limited
to one visit per day per family, up to two visits per client in a 12-month
period, per provider or clinic; and
(ii) Must include all of the following
services, provision of which must be documented in the client's record:
(A) "Lift the lip" training;
(B) Oral hygiene training;
(C) Risk assessment for early childhood
caries;
(D) Dietary counseling;
and
(E) Benefits of fluoride.
(b)
Comprehensive oral evaluations as defined in WAC
182-535-1050, once
per client, per provider or clinic, as an initial examination. The agency
covers an additional comprehensive oral evaluation if the client has not been
treated by the same provider or clinic within the past five years;
(c) Periodic oral evaluations as defined in
WAC
182-535-1050, once
every six months. Six months must elapse between the comprehensive oral
evaluation and the first periodic oral evaluation;
(d) Topical application of fluoride
varnish;
(e) Amalgam, resin, and
glass ionomer restorations on primary teeth, as specified in the agency's
current published documents;
(f)
Interim therapeutic restorations (ITRs) for primary teeth. The agency pays an
enhanced rate for these restorations to ABCD-certified, ITR-trained dentists as
follows:
(i) A one-surface, resin-based
composite, or glass ionomer restoration with a maximum of five teeth per visit;
and
(ii) Restorations on a tooth
can be done every 12 months or until the client can be definitively treated for
a restoration.
(g)
Therapeutic pulpotomy;
(h)
Prefabricated stainless steel crowns on primary teeth, as specified in the
agency's current published documents;
(i) Resin-based composite crowns on anterior
primary teeth; and
(j) Other
dental-related services, as specified in the agency's current published
documents.
11-14-075, recodified as §182-535-1245, filed
6/30/11, effective 7/1/11. Statutory Authority:
RCW
74.04.050,
74.08.090. 08-16-009, §
388-535-1245, filed 7/24/08, effective 8/24/08. Statutory Authority:
RCW
74.08.090,
74.09.500,
74.09.520. 07-06-042, §
388-535-1245, filed 3/1/07, effective 4/1/07. Statutory Authority:
RCW
74.08.090,
74.09.035,
74.09.500,
42 U.S.C.
1396 d(a),
42 C.F.R.
440.100 and .225. 02-11-136, §
388-535-1245, filed 5/21/02, effective
6/21/02.
