Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Limitations on Non-Emergency Dental Services Provided to Medicaid Clients Twenty-One Years of Age and Older › Section 17b-262-863 - Definitions

Current through July 10, 2024
As used in section 17b-262-862 to 17b-262-866, inclusive, of the Regulations of Connecticut State Agencies:
(1) "Bitewing" means the horizontal or vertical form of the dental radiograph that reveals the coronal halves of the upper and lower teeth showing the interproximal contacts and portions of the interdental alveolar septa on the same film;
(2) "Comprehensive oral examination" means an evaluation by a general dentist consisting of a thorough examination and recording of the extraoral and intraoral hard and soft tissues, evaluation for oral cancer, the evaluation and recording of the patient's medical and dental history and a general health assessment. It also includes the recording of dental caries, previously placed dental restorations, missing or unerupted teeth, existing prosthesis, periodontal conditions, hard and soft tissue anomalies, and occlusal relationships. It may require interpretation of information acquired through additional diagnostic procedures.
(3) "Cosmetic dentistry" means employing a number of different dental procedures singularly or in concert with each other in an effort to enhance the appearance of the teeth or face. Procedures performed for cosmetic reasons include, but are not limited to, crown replacement, veneer placement, bonding techniques for reasons other than the restoration of caries, mechanical reshaping of a tooth or teeth, orthodontic treatment or implant placement and restoration;
(4) "Dental services" means any service provided by or under the direct or indirect supervision of a licensed dentist. The licensed dentist assumes the primary responsibility for all dental procedures performed under his or her direct or indirect supervision;
(5) "Dentist" means an individual who holds a license issued by the Department of Public Health to practice dental medicine in the State of Connecticut pursuant to section 20-106 of the Connecticut General Statutes;
(6) "Dentures" or "denture prosthesis" means artificial structures made by or under the direction of a dentist to replace a full or partial set of teeth;
(7) "Department" or "DSS" means the Department of Social Services or its agent;
(8) "Emergency" means a dental condition manifesting itself in acute symptoms of sufficient severity, including severe pain, such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect that absence of immediate dental attention could result in placing the health of the individual, or with respect to a pregnant woman, her unborn child, in serious jeopardy, cause serious impairment to bodily functions or cause serious dysfunction of any body organ or part;
(9) "Evidence-based practice" means an approach to oral health care that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the patient's oral and medical condition and history, with the dentist's clinical expertise and the patient's treatment needs and preferences;
(10) "Examination" means a comprehensive assessment of the oral condition of an individual performed by a licensed dentist;
(11) "Fixed bridge" means a prosthetic consisting of false teeth, which are anchored onto adjacent teeth in order to replace one or more missing teeth. The false tooth is known as a pontic and is fused in between two crowns that serve as abutments by attaching to the teeth on each side of the false tooth, thereby bridging them together;
(12) "Fluoride treatment" means the application of any professionally prescribed product containing a professional dose of applied fluoride;
(13) "Healthy adult" has the same meaning as provided in section 17b-282d of the Connecticut General Statutes;
(14) "Implant" means the material inserted or grafted endosteally, eposteally or transosseally into the mandible or maxillae as a means of providing for a dental replacement;
(15) "Intraoral" means within the oral cavity;
(16) "Medical necessity" or "medically necessary" has the same meaning as provided in section 17b-259b of the Connecticut General Statutes;
(17) "Medicaid" means the Connecticut Medical Assistance Program operated by the Connecticut Department of Social Services under Title XIX of the federal Social Security Act, and related state and federal rules and regulations;
(18) "Molar" means the three teeth located immediately behind the premolar teeth in the lower and upper arches;
(19) "Oral health" means the well being of the teeth and the gingivae and their supporting connective tissues, ligaments and bone; the hard and soft palate; the mucosal tissue lining of the mouth and throat; the tongue; the lips; the salivary glands; the muscles of mastication and facial expression; the mandible; the maxillae; the temporomandibular joints; the cranial nerves and the vascular systems that support the head and neck;
(20) "Oral examination" means the type of assessment performed by a dentist or a professional who is licensed to perform such examinations to determine the oral health status of a patient. The evaluation is based on the client's history, the interpretation of diagnostic procedures, direct examination and other relevant information;
(21) "Orthodontia" means pertaining to orthodontic treatment, which is the specialty of dental medicine concerned with the growth and development of oro-facial structures, including irregularities of bone and alignment, the non-alignment of teeth within the dental arch, alignment discrepancies between the maxillary and mandibular arches and associated oro-facial anomalies;
(22) "Periapical x-rays" means intraoral films used to reveal the apices of a specified tooth or teeth;
(23) "Periodic oral examination" means an evaluation performed on a patient of record to determine any changes in the patient's dental and medical health status since the previous periodic oral evaluation or comprehensive examination and includes oral cancer evaluation, periodontic screening and may require interpretation of information required through additional diagnostic procedures.
(24) "Prior authorization" means approval from the department for the provision of a service or the delivery of goods before the provider actually provides the service or delivers the goods;
(25) "Prophylaxis" means the complete removal of calculus, soft debris, plaque, stains and the smoothing of unattached tooth surfaces through scaling by rotary, ultrasonic or other mechanical means described as standard procedure by the American Dental Association;
(26) "Resin-based composites" means one of many pliable materials that consists of disparate materials that are cured secondary to a chemical or light stimulated reaction to provide a stable directly placed restoration requiring acid-etching of the tooth surface, liners, bases, a curing process and final finishing, which are part of the placement procedure;
(27) "Restorative procedures" means procedures performed to remove diseased tooth structure or repair broken teeth;
(28) "Teeth" means "teeth" as described using the Universal/National Numbering System:
(A) Anterior teeth are denoted 6 through 11, 22 through 27;
(B) Premolar teeth are denoted 4, 5, 12, 13, 20, 21, 28, 29;
(C) Molar teeth 1 through 3, 14 through 19, 30 through 32;
(D) Posterior teeth are denoted as 1 through 5, 12 - 21, 28 through 32;
(E) Supernumerary primary teeth are denoted as AS through TS;
(F) Supernumerary permanent teeth are denoted as 51 through 83;