Or. Admin. Code § 410-123-1510

Current through Register Vol. 63, No. 11, November 1, 2024

Section 410-123-1510 - Additional Dental Care Benefits for Pregnant Members

(1) This rule sets forth the access standards for dental care for pregnant members who receive Oregon Health Plan (OHP) benefits through the fee-for-service (FFS) delivery system.

(2) Pregnant members shall be seen, treated in person or via teledentistry for an OHP-covered service within the following time frames:

(a) For emergency dental care: within 24 hours;

(b) For urgent dental care: within one week.

(c) For routine dental care: within four weeks, unless there is a documented special clinical reason that would make access longer than four weeks appropriate;

(d) For initial dental screening or examination: four weeks.

(3) Additional Dental Services are available to pregnant members if authorized as medically/Dentally Necessary due to the pregnancy. Additional services include:

(a) Additional prophylaxis, fluoride and periodontal services;

(b) Permanent crowns and resin-based composite crowns for anterior teeth;

(c) Prefabricated post and core;

(d) Root canals on first molars;

(e) Apexification/recalcification, pulpal regeneration;

(f) Alveoplasty not in conjunction with extractions.

(4) Nothing in this rule obligates a pregnant member who receives dental care through the FFS delivery system to accept an offered appointment.

(5) Dental care benefits for pregnant members will continue 12 months following the end of the pregnancy.

Or. Admin. Code § 410-123-1510

DMAP 82-2015(Temp), f. 12-23-15, cert. ef. 1-1-16 thru 6-28-16; DMAP 28-2016, f. & cert. ef. 6/28/2016; DMAP 50-2021, amend filed 12/24/2021, effective 1/1/2022; DMAP 13-2022, amend filed 02/09/2022, effective 2/9/2022; DMAP 44-2022, temporary amend filed 03/29/2022, effective 4/1/2022through 9/27/2022; DMAP 74-2022, amend filed 09/23/2022, effective 9/25/2022; DMAP 68-2024, minor correction filed 02/22/2024, effective 2/22/2024

Statutory/Other Authority: ORS 413.042 & ORS 414.065

Statutes/Other Implemented: ORS 414.065