WSR 20-04-096
PERMANENT RULES
HEALTH CARE AUTHORITY
[Filed February 5, 2020, 10:53 a.m., effective March 7, 2020]
Effective Date of Rule: Thirty-one days after filing.
Purpose: The agency is amending subsection (1)(c) to clarify access to baby and child dentistry (ABCD) program services provided by a dental provider for eligible clients 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 enrolled in an agency-contracted MCO must be billed directly through the client's MCO.
Citation of Rules Affected by this Order: Amending WAC 182-535-1245.
Adopted under notice filed as WSR 20-02-016 on December 19, 2019.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at the Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 1, Repealed 0.
Number of Sections Adopted using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.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: February 5, 2020.
Wendy Barcus
Rules Coordinator
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.