Proposed/Adopted	WAC Subsection	Reason
Original WAC 182-552-0450 (2)(a).
Proposed	"(2) For clients: (a) Age twenty and younger, if this device is recommended during the early and periodic screening, diagnosis, and treatment (EPSDT) exam and then ordered by a provider, the agency evaluates the health care service according to WAC 182-534-0100. (b) Age twenty-one and older who have natural dentition, the agency pays for one custom-made mandibular advancement device every five years. The client must: … … (iii) Either meet the sleep testing criteria described in WAC 182-552-0400 or score above thirty on the apnea-hypopnea index (AHI) or respiratory disturbance index (RDI)."	The agency struck subsection (2)(a) to remove the requirement that a formal screening under [an] EPSDT exam is needed to trigger an evaluation of whether a mandibular advancement device is covered under EPSDT. EPSDT coverage criteria is now outlined in subsection (2)(b) of the adopted rule.
Adopted	"(2) For clients: (a) Who have natural dentition, the agency pays for one custom-made mandibular advancement device every five years. The client must: … … (iii) Meet the sleep testing criteria described in WAC 182-552-0400. (b) For clients age twenty or younger, the agency evaluates requests for a mandibular advancement device according to the early periodic screening, diagnosis, and treatment (EPSDT) criteria found in WAC 182-534-0100. Under EPSDT, the agency will pay for a service if it is medically necessary, safe, effective, and not experimental."
Original WAC 182-552-0450 (2)(b)(iii).
Proposed	"(2) For clients: (b) Age twenty-one and older who have natural dentition, the agency pays for one custom-made mandibular advancement device every five years. The client must: … … (iii) Either meet the sleep testing criteria described in WAC 182-552-0400 or score above thirty on the apnea-hypopnea index (AHI) or respiratory disturbance index (RDI)."	The agency revised subsection (2)(b)(iii) of the proposed rule because the proposed language created a separate standard for coverage of continuous positive airway pressure than the standard listed in WAC 182-552-0400. The change reflected in the adopted rule corrects this issue.
Adopted	"(2) For clients: (a) Who have natural dentition, the agency pays for one custom-made mandibular advancement device every five years. The client must: … … (iii) Meet the sleep testing criteria described in WAC 182-552-0400."
Original WAC 182-552-0450(3).
Proposed	"(3) The provider must keep the following in the client's record:"	The agency revised subsection (3) of the proposed rule to clarify who is responsible for keeping the listed documentation in the client's record.
Adopted	"(3) The prescriber must keep the following in the client's record:"
Original WAC 182-552-0450 (5)(c).
Proposed	"(c) Has completed agency-recognized continuing education in dental sleep medicine provided by the ABDSM or a comparable organization within two years prior to ordering the mandibular advancement device."	The agency revised subsection (5)(c) of the proposed rule to correct terminology.
Adopted	"(c) Has completed agency-recognized continuing education in dental sleep medicine provided by the ABDSM or a comparable organization within two years prior to providing the mandibular advancement device."
Original WAC 182-552-0450.
Proposed	N/A	The agency added subsection (6) to the rule to outline the agency's process for evaluating authorization requests that exceed the limitations in this section.
Adopted	"(6) The agency evaluates requests for authorization for mandibular advancement devices that exceed the limitations in this section on a case-by-case basis in accordance with WAC 182-501-0169."

The agency covers the purchase of a mandibular advancement device for a client when the provider determines that the use of a continuous positive airway pressure (CPAP) device is medically contraindicated or the client cannot medically tolerate a CPAP device. Prior authorization is required for all eligible clients.

(1) The agency considers a mandibular advancement device to be medical equipment subject to the same billing requirements, restrictions, and limitations as other medical equipment according to chapter 182-543 WAC.

(2) For clients:

(a) Who have natural dentition, the agency pays for one custom-made mandibular advancement device every five years. The client must:

(i) Complete a face-to-face evaluation with a sleep medicine physician in an agency-designated center of excellence (COE) prior to sleep testing;

(ii) Be diagnosed with obstructive sleep apnea (OSA) using a clinical evaluation and positive attended polysomnogram (PSG); and

(iii) Meet the sleep testing criteria described in WAC 182-552-0400.

(b) For clients age twenty or younger, the agency evaluates requests for a mandibular advancement device according to the early periodic screening, diagnosis, and treatment (EPSDT) criteria found in WAC 182-534-0100. Under EPSDT, the agency will pay for a service if it is medically necessary, safe, effective, and not experimental.

(3) The prescriber must keep the following in the client's record:

(a) Documentation of a CPAP trial lasting at least six consecutive months; and

(b) A description of why CPAP failed or an explanation of why CPAP is not the appropriate treatment.

(4) The mandibular advancement device must be titrated by a licensed provider who has documented experience in titrating these devices.

(5) The mandibular advancement device must be provided and billed by a licensed dentist who:

(a) Holds a certification in dental sleep medicine from the American Board of Dental Sleep Medicine (ABDSM); or

(b) Is the dental director of a dental sleep medicine facility accredited by the ABDSM; or

(c) Has completed agency-recognized continuing education in dental sleep medicine provided by the ABDSM or a comparable organization within the two years prior to providing the mandibular advancement device.

(6) The agency evaluates requests for authorization for mandibular advancement devices that exceed the limitations in this section on a case-by-case basis in accordance with WAC 182-501-0169.