SOCIAL AND HEALTH SERVICES
(Health and Recovery Services Administration)
Effective Date of Rule: Thirty-one days after filing.
Purpose: The new and amended sections clarify and update policies for dental-related services for clients age twenty-one and older; ensure that department policies are applied correctly and equitably; replace the terms "medical assistance administration" and "MAA" with "the department"; update policy regarding prior authorization requirements; clarify policy on covered versus noncovered benefits; clarify additional benefits and limitations associated with those services for clients age twenty-one and older; and repeal WAC 388-535-1270 and 388-535-1290 and incorporate updated policy into new sections. Clients and dental providers will be able to identify the requirements and criteria that must be met in order to obtain covered dental-related services.
Citation of Existing Rules Affected by this Order: Repealing WAC 388-535-1270 and 388-535-1290; and amending WAC 388-535-1050, 388-535-1065, 388-535-1255, and 388-535-1280.
Statutory Authority for Adoption: RCW 74.08.090, 74.09.500, 74.09.520.
Adopted under notice filed as WSR 07-02-088 (part 1 of 4), 07-02-089 (part 2 of 4), 07-02-090 (part 3 of 4), and 07-02-091 (part 4 of 4) on January 3, 2007.
Changes Other than Editing from Proposed to Adopted Version: Amended Sections:
WAC 388-535-1247 (1) Subject to coverage limitations,
Tthe department pays for ...when the services and procedures:
...(d) Are documented in the client's record in accordance with
chapter 388-502 WAC; (d) (e) Are within prevailing standard of care accepted
dental or medical practice standards; (e) (f) Are consistent...; (f) (g) Are reasonable...; and (g) (h) Are listed...
WAC 388-535-1266 (1)(a) Requires prior authorization...In
addition, the department requires the dental provider to
submit all the following: (i) Submit: (A) Appropriate and
diagnostic radiographs of all remaining teeth; (ii) (B) A
dental record that identifies: (A) (I) All missing teeth for
both arches; (B) (II) Teeth that are to be extracted; and (C)
(III) Dental and periodontal services completed on all
remaining teeth. (iii) (C) A prescription written ...
(ii) Obtain a signed agreement of acceptance from the client at the conclusion of the final denture try-in for a department authorized complete denture or a cast-metal denture described in this section. If the client abandons the complete denture or the cast-metal partial denture after signing the agreement of acceptance, the department will deny subsequent requests for the same type dental prosthesis if the request occurs prior to the dates specified in this section. A copy of the signed agreement that documents the client's acceptance of the dental prosthesis must be submitted to the department's dental prior authorization section before the department pays the claim.
WAC 388-535-1267 (1)(h) Covers alveoloplasty
: (i) Only
only when three or more teeth are extracted per arch. ; and
(ii) That is not performed in conjunction with extractions
only on a case-by-case basis and when prior authorized.
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) 568-1590, e-mail firstname.lastname@example.org.
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 9, Amended 4, Repealed 2.
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 9, Amended 4, Repealed 2.
Date Adopted: February 27, 2007.
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 07-07 issue of the Register.