Effective Date of Rule: Thirty-one days after filing.

     Purpose: This amendment updates and clarifies that the department pays enhanced fees only to access to baby and child dentistry (ABCD)-certified dentists and other department-approved certified providers for furnishing ABCD program services; removes language that an oral health education visit must have a duration of at least twenty minutes; clarifies that an oral health education visit is limited to one visit per day per family, up to two visits per child in a twelve-month period; removes language that an oral health education visit must include topical application of gel or varnish; and clarifies what ABCD program services include.

     Citation of Existing Rules Affected by this Order: Amending WAC 388-535-1245.

     Statutory Authority for Adoption: RCW 74.04.050, 74.08.090.

      Adopted under notice filed as WSR 08-12-074 on June 3, 2008.

     A final cost-benefit analysis is available by contacting Dr. John Davis, P.O. Box 45506, Olympia, WA 98504-5506, phone (360) 725-1748, fax (360) 586-1590, e-mail davisjd@dshs.wa.gov.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 1, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.

     Date Adopted: July 16, 2008.

Robin Arnold-Williams

Secretary

     (1) Client eligibility for the ABCD program is as follows:

     (a) Clients must be age five and younger. Once enrolled in the ABCD program, eligible clients are covered until their sixth birthday.

     (b) Clients eligible under one of the following medical assistance programs are eligible for the ABCD program:

     (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).

     (c) ABCD program services for eligible clients enrolled in a managed care organization (MCO) plan are paid through the fee-for-service payment system.

     (2) Health care providers and community service programs identify and refer eligible clients to the ABCD program. If enrolled, 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.

     (3) ((Dentists must be certified through the continuing education program in the University of Washington School of Pediatric Dentistry to furnish ABCD program services.

     (4))) The department pays enhanced fees only to ABCD-certified ((participating)) dentists and other department-approved certified providers for furnishing ABCD program services. ABCD program services include, when appropriate:

     (a) Family oral health education. An oral health education visit:

     (i) ((Must have a duration of at least twenty minutes for each visit;

     (ii))) Is limited to one visit per day per family, up to two visits per ((calendar year)) child in a twelve-month period, per provider or clinic; and

     (((iii))) (ii) Must include all of the following:

     (A) "Lift the lip" training;

     (B) Oral hygiene training;

     (C) Risk assessment for early childhood caries;

     (D) Dietary counseling;

     (E) ((Topical application of gel or varnish;

     (F))) Discussion of fluoride supplements; and

     (((G))) (F) Documentation in the client's file or the client's designated adult member's (family member or other responsible adult) file to record the activities provided and duration of the oral education visit.

     (b) ((Comprehensive and)) Periodic oral evaluation, up to two visits per client, per calendar year, per provider or clinic;

     (c) Topical application of fluoride varnish;

     (d) Amalgam ((and)), resin, and glass ionomer restorations on primary teeth, as specified in current department-published documents;

     (((d))) (e) Therapeutic pulpotomy;

     (((e))) (f) Prefabricated stainless steel crowns on primary teeth, as specified in current department-published documents;

     (((f))) (g) Resin-based composite crowns on anterior primary teeth; and

     (((g))) (h) Other dental-related services, as specified in current department-published documents.

     (((5))) (4) The client's file must show documentation of the ABCD program services provided.

[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. 1396d(a), 42 C.F.R. 440.100 and .225. 02-11-136, § 388-535-1245, filed 5/21/02, effective 6/21/02.]

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