WSR 21-05-010
PREPROPOSAL STATEMENT OF INQUIRY
HEALTH CARE AUTHORITY
[Filed February 4, 2021, 2:09 p.m.]
Subject of Possible Rule Making: Chapter 182-535 WAC, Dental-related services; other related rules as appropriate.
Statutes Authorizing the Agency to Adopt Rules on this Subject: RCW 41.05.021, 41.05.160.
Reasons Why Rules on this Subject may be Needed and What They Might Accomplish: The agency is amending these rules to:
Add and remove definitions.
Remove "including periodontal charting" from the comprehensive oral evaluation definition.
Remove diagnostic casts from covered diagnostic tests and examination.
Add "and implants" to prophylaxis covered services.
Remove tobacco cessation as a covered service under the dental program.
Add "glass ionomer" to sealant covered preventative services.
Change limitations for replacement of restorations by clarifying "replacement of a cracked or broken restoration within a six-month period by the same provider is considered part of the global payment of the initial restoration and will not pay separately."
Change stainless steel crowns for permanent posterior teeth [to] no longer have age limitations or require prior authorization.
Add clarification that all replacement dentures and replacement partial dentures require prior authorization and the need for the replacement must be medically necessary.
Add language for coverage of alveoloplasty to include "only in conjunction with the preparation of dentures or partials" and remove "prior authorization is not required."
Add limitation for full mouth scaling to a twelve-month period.
Change nondental providers to medical providers and other housekeeping updates as necessary.
During the course of this review, the agency may identify additional related changes that are required in order to improve clarity or update policy.
Other Federal and State Agencies that Regulate this Subject and the Process Coordinating the Rule with These Agencies: The Center[s] for Medicare and Medicaid Services.
Process for Developing New Rule: The agency welcomes the public to take part in developing this rule. If interested, contact the person identified below to receive an early rule draft to review. After the early review, the agency will send a notice of proposed rule making (CR-102) to everyone receiving this notice and anyone who requests a copy.
Interested parties can participate in the decision to adopt the new rule and formulation of the proposed rule before publication by contacting Valerie Freudenstein, Rulemaking Questions, P.O. Box 42716, Olympia, WA 98504-2716, phone 360-725-1344, fax 360-586-9727, telecommunication[s] relay service (TRS) 711, email valerie.freudenstein@hca.wa.gov, website www.hca.wa.gov/about-hca/rulemaking; or Pixie Needham, Program Questions, P.O. Box 45506, Olympia, WA 98504-5506, phone 360-725-9967, fax 360-586-9727, TRS 711, email pixie.needham@hca.wa.gov, website www.hca.wa.gov/about-hca/rulemaking.
February 4, 2021
Wendy Barcus
Rules Coordinator