HEALTH CARE AUTHORITY
[Filed December 19, 2019, 9:19 a.m.]
Preproposal statement of inquiry was filed as WSR 19-22-031.
Title of Rule and Other Identifying Information: WAC 182-535-1245 Access to baby and child dentistry (ABCD) program.
Hearing Location(s): On February 4, 2020, at 10:00 a.m., at the Health Care Authority (HCA), Cherry Street Plaza, Sue Crystal Room 106A, 626 8th Avenue, Olympia, WA 98504. Metered public parking is available street side around building. A map is available at https://www.hca.wa.gov/assets/program/Driving-parking-checkin-instructions.pdf or directions can be obtained by calling 360-725-1000.
Date of Intended Adoption: Not sooner than February 5, 2020.
Submit Written Comments to: HCA Rules Coordinator, P.O. Box 42716, Olympia, WA 98504-2716, email firstname.lastname@example.org, fax 360-586-9727, by February 4, 2020.
Assistance for Persons with Disabilities: Contact Amber Lougheed, phone 360-725-1349, fax 360-586-9727, telecommunication relay services 711, email email@example.com, by January 24, 2020.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The agency is amending subsection (1)(c) to clarify ABCD program services provided by a dental provider for eligible clients who are enrolled in an agency-contracted managed care organization (MCO) are paid through the fee-for-service payment system. The agency is adding subsection (1)(d) to reflect that ABCD program services provided by a nondental provider for eligible clients who are enrolled in an agency-contracted MCO must be billed directly through the client's MCO.
Reasons Supporting Proposal: See purpose.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: HCA, governmental.
Name of Agency Personnel Responsible for Drafting: Valerie Freudenstein, P.O. Box 42716, Olympia, WA 98504-2716, 360-725-1344; Implementation and Enforcement: Pixie Needham, P.O. Box 45506, Olympia, WA 98504-5506, 360-725-9967.
A school district fiscal impact statement is not required under RCW 28A.305.135
A cost-benefit analysis is not required under RCW 34.05.328
. RCW 34.05.328
does not apply to HCA rules unless requested by the joint administrative rules review committee or applied voluntarily.
The proposed rule does not impose more-than-minor costs on businesses. Following is a summary of the agency's analysis showing how costs were calculated. The proposed rule does not impose any costs on businesses.
December 19, 2019
AMENDATORY SECTION(Amending WSR 19-20-047, filed 9/25/19, effective 10/26/19)
WAC 182-535-1245Access to baby and child dentistry (ABCD) program.
The access to baby and child dentistry (ABCD) program is a program established to increase access to dental services for medicaid-eligible clients ages five and younger.
(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)((; or)).
(c) ABCD program services provided by a dental provider for eligible clients who are enrolled in ((a))an agency-contracted managed care organization (MCO) ((plan)) are paid through the fee-for-service payment system.
(d) ABCD program services provided by a nondental provider for eligible clients who are enrolled in an agency-contracted managed care organization (MCO) must be billed directly through the client's MCO.
(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) Only ABCD-certified dentists and other agency-approved certified providers 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 child in a twelve-month period, per provider or clinic; and
(ii) Must include documentation of all of the following in the client's record:
(A) "Lift the lip" training;
(B) Oral hygiene training;
(C) Risk assessment for early childhood caries;
(D) Dietary counseling;
(E) Discussion of fluoride supplements; and
(F) Documentation in the client's record to record the activities provided and duration of the oral education visit.
(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, only for clients age five and younger. The agency pays an enhanced rate for these restorations to ABCD-certified, ITR-trained dentists as follows:
(i) A one-surface, resin-based composite restoration with a maximum of five teeth per visit; and
(ii) Restorations on a tooth can be done every twelve months through age five, 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.
(4) The client's record must show documentation of the ABCD program services provided.