WSR 99-01-169

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES

(Medical Assistance Administration)

[Filed December 23, 1998, 10:46 a.m.]



Original Notice.

Preproposal statement of inquiry was filed as WSR 98-08-074.

Title of Rule: Chapter 388-535 WAC, Dental-related services.

Purpose: The department is amending these rules per the Governor's Executive Order 97-02 which requires rules to be rewritten for clarity, concision, foundation in law, fairness, readability, and with public involvement. In addition, the department is expanding the geographic of the access to baby and child dentistry (ABCD) program, and requiring more prior authorization requirements of certain high-cost crowns for back teeth.

Statutory Authority for Adoption: RCW 74.08.090, 74.09.035, 74.09.520, and 74.09.700; 42 USC 1396d(a); 42 CFR 440.100 and 42 CFR 440.225.

Statute Being Implemented: RCW 74.09.035, 74.09.520, and 74.09.700; 42 USC 1396d(a); 42 CFR 440.100 and 42 CFR 440.225.

Summary: Medicaid clients may receive dental-related services, under limitations, including evaluations, cleaning, extractions, crowns, dentures, orthodontics, and referrals. Dentists, denturists, dental laboratories, and related professionals are paid for these services under specific limitations including medical/dental necessity, prior authorization from MAA in some cases, adequate record keeping, and post-pay reviews. State-funded clients receive a more limited range of services, including dentures and hospital-based dental services for emergencies and major trauma. Preventive services are offered to children.

Reasons Supporting Proposal: Congress and the state legislature authorized the department to offer these services, to protect the general health of Washington's noninsured population that is eligible for Medicaid or state-funded medical programs.

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Carree Moore, DSHS/MAA/Family Services, Mailstop 45530, (360) 586-2763.

Name of Proponent: Department of Social and Health Services, Medical Assistance Administration, governmental.

Rule is not necessitated by federal law, federal or state court decision.

Explanation of Rule, its Purpose, and Anticipated Effects: Medicaid clients may receive dental-related services, under limitations, including evaluations, cleaning, extractions, crowns, dentures, orthodontics, and referrals. Dentists, denturists, dental laboratories, and related professionals are paid for these services under specific limitations including medical/dental necessity, prior authorization from MAA in some cases, adequate record keeping, and post-pay reviews. State-funded clients receive a much more limited range of services, including dentures and hospital-based dental services for emergencies and major trauma. Preventive services are offered to children.

Proposal Changes the Following Existing Rules: Expands the access to baby and child dentistry (ABCD) program for infants and toddlers from just Spokane County, to any area targeted by MAA as needing that program.

Requires prior authorization from MAA for crowns, except for stainless steel crowns (any teeth) and resin crowns (for primary teeth).

No small business economic impact statement has been prepared under chapter 19.85 RCW. The department has determined that no small businesses will be significantly affected.

RCW 34.05.328 applies to this rule adoption. A cost-benefit analysis (CBA) was prepared. A copy of that CBA is available from Allen Richards, Regulatory Improvement, Medical Assistance Administration, P.O. Box 45530, Olympia, WA 98504-5530, phone (360) 586-1008, fax (360) 753-7315, e-mail richaa@dshs.wa.gov.

Hearing Location: Lacey Government Center (behind Tokyo Bento Restaurant), 1009 College Street S.E., Room 104-B, Lacey, WA 98503, on February 9, 1999, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact Paige Wall by January 29, 1999, phone (360) 902-7540, TTY (360) 902-8324, e-mail pwall@dshs.wa.gov.

Submit Written Comments to: Identify WAC Numbers, Paige Wall, Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 902-8292, by February 9, 1999.

Date of Intended Adoption: February 24, 1999.

December 18, 1998

Marie Myerchin-Redifer, Manager

Rules and Policies Assistance Unit



Reviser's note: The material contained in this filing exceeded the page-count limitations of WAC 1-21-040 for appearance in this issue of the Register. It will appear in the 99-02 issue of the Register.

Legislature Code Reviser 

Register

Washington State Code Reviser's Office