20110323-IR-405100795PRA Amends 405 IAC 5-14-1 to revise the dental covered services included under the dental services limitation and to increase the limitation amount for recipients 21 years of age and over. Effective 30 d...

TITLE 405 OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES

Proposed Rule LSA Document #10-795

DIGEST

Amends 405 IAC 5-14-1 to revise the dental covered services included under the dental services limitation and to increase the limitation amount for recipients 21 years of age and over. Effective 30 days after filing with the Publisher.

405 IAC 5-14-1

SECTION 1. 405 IAC 5-14-1 IS AMENDED TO READ AS FOLLOWS:

405 IAC 5-14-1 Policy

Authority: IC 12-8-6-5; IC 12-15

Affected: IC 12-13-7-3; IC 12-15-13-6

Sec. 1. (a) Medicaid reimbursement is available only for those dental services listed in section 2 of this rule subject to the limitations set out in this rule.

(b) For those recipients twenty-one (21) years of age and over, covered services routinely provided in a dental office will be limited to six hundred one thousand dollars ($600) ($1,000) per recipient, per twelve (12) month period. This limit precedes all other limits within this rule. The All procedure codes that will be included within the limitation.

(1) will be listed and published in a provider bulletin; and

(2) may be updated by the office as needed.

A provider bulletin issued under this subsection shall be effective no earlier than permitted under IC 12-15-13-6.

(c) For those recipients twenty-one (21) years of age and over, all covered services will require prior authorization except the following:

(1) Diagnostic and preventative services.

(2) Direct restorations.

(3) Treatment of lesions.

(4) Periodontal services for the following immuno-compromised individuals:

(A) Transplant patients.

(B) Pregnant women.

(C) Diabetic patients.

(5) Extractions.

(6) Emergency and trauma care.

(Office of the Secretary of Family and Social Services; 405 IAC 5-14-1; filed Jul 25, 1997, 4:00 p.m.: 20 IR 3319; readopted filed Jun 27, 2001, 9:40 a.m.: 24 IR 3822; filed Dec 13, 2002, 4:00 p.m.: 26 IR 1546; filed Aug 17, 2007, 3:23 p.m.: 20070912-IR-405060005FRA; readopted filed Sep 19, 2007, 12:16 p.m.: 20071010-IR-405070311RFA)

Posted: 03/23/2011 by Legislative Services Agency

DIN: 20110323-IR-405100795PRA

Composed: Nov 01,2016 1:07:30AM EDT

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