D.C. Mun. Regs. tit. 29, r. 29-1921

Current through Register 71, No. 45, November 7, 2024

Rule 29-1921 - DENTAL SERVICES

1921.1

The purpose of this section is to establish standards governing Medicaid eligibility for dental services under the Home and Community-Based Services Waiver for Individuals with Intellectual and Developmental Disabilities (Waiver) and to establish conditions of participation for providers of dental services.

1921.2

To be eligible for Medicaid reimbursement, each person shall have a documented need for the service as identified in the Individual Support Plan (ISP) and Plan of Care.

1921.3

Medicaid reimbursable dental services under this Waiver are identical to dental services offered under the District of Columbia's Medicaid State Plan and shall be provided in accordance with the applicable requirements set forth in Section 964 (Dental Services) of Chapter 9 of Title 29 DCMR.

1921.4

Medicaid reimbursable dental services shall be provided by a dentist, or a dental hygienist working directly under the supervision of a dentist, who meets all of the following requirements:

(a) Provides services consistent with the scope of practice authorized pursuant to the District of Columbia Health Occupations Revisions Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code § 3-1201et seq.) or consistent with the applicable professional practices act within the jurisdiction where services are provided;

(b) Is enrolled as a dentist in the District of Columbia Medicaid Program;

(c) Complies with Section 1904 (Provider Qualifications) and Section 1905 (Provider Enrollment Process) of Chapter 19 of Title 29 of the DCMR; and

(d) Provides services consistent with the standards established by the American Dental Association.

1921.5

Each provider of Medicaid reimbursable dental services shall develop a written treatment plan for the person receiving dental services after completion of a comprehensive evaluation. The services provided shall be consistent with the treatment plan.

1921.6

The treatment plan shall be updated annually and shall serve as a guide for treatment to be completed over the course of one (1) year unless special circumstances require a longer treatment plan.

1921.7

Each provider of Medicaid reimbursable dental services shall maintain records in accordance with professional standards, in a manner that protects a person's confidentiality and meets the confidentiality requirements for Protected Health Information under the Health Insurance Portability and Accountability (HIPAA) Act and implementing regulations.

1921.8

If the person enrolled in the Waiver is between the ages of eighteen (18) and twenty-one (21), the Department on Disability Services, Service Coordinator shall ensure that Early and Periodic Screening, Diagnostic and Treatment benefits are fully utilized and there is no duplication of services.

1921.9

In order to be eligible for Medicaid reimbursement, each dental provider shall comply with the following requirements:

(a) Confirm the person's Medicaid eligibility; and

(b) Bill the District of Columbia Medicaid Program using a Waiver provider identification number.

1921.10

Medicaid reimbursement for dental services provided to a person enrolled in the Waiver shall be paid at the reimbursement rate set forth in the District of Columbia Medicaid fee schedule increased by twenty percent (20%). The District of Columbia Medicaid fee schedule is available online at http://www.dc-medicaid.com.

D.C. Mun. Regs. tit. 29, r. 29-1921

Final Rulemaking published at 61 DCR 2602 (March 28, 2014)

Authority: An Act to enable the District of Columbia to receive federal financial assistance under Title XIX of the Social Security Act for a medical assistance program, and for other purposes, approved December 27, 1967 (81 Stat. 774; D.C. Official Code § 1-307.02 (2012 Repl. & 2013 Supp.)) and Section 6(6) of the Department of Health Care Finance Establishment Act of 2007, effective February 27, 2008 (D.C. Law 17-109; D.C. Official Code § 7-771.05(6) (2012 Repl.)).