Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 420.000 - Dental Services › Section 420.405 - Provider Eligibility: In-state and Out-of-state

Current through Register 1525, July 5, 2024
(A)
In-state
			 Providers
. The following requirements apply when the dental
			 provider's practice is located in Massachusetts.
(1)
Dental
			 Practitioner
. A dentist engaged in private practice is eligible to
			 participate in MassHealth as a dental provider if licensed to practice by
			 BORID. Private practices may include, but are not limited to, solo,
			 partnership, or group practices.
(2)
Community Health
			 Center
. A licensed community health center with a dental clinic is
			 eligible to participate in MassHealth as a provider of dental
			 services.
(3)
Dental
			 School
. A teaching clinic of a dental school accredited by CODA is
			 eligible to participate in MassHealth as a provider of dental
			 services.
(4)
Acute
			 Hospital Outpatient Department, Hospital-licensed Health Center, or Other
			 Satellite Clinic
. An acute hospital's outpatient department,
			 hospital-licensed health center, or other satellite clinic that participates in
			 MassHealth pursuant to the Executive Office of Health and Human Services
			 (EOHHS) Acute Hospital Request for Applications (RFA) and contract is eligible
			 to provide services designated as dental clinic services in Subchapter 6 of the
			 MassHealth
Dental Manual
for providers under
			 130 CMR
			 420.000.
(5)
Dental Clinic
. A
			 dental clinic must be licensed by the Massachusetts Department of Public Health
			 (DPH) to be eligible to participate in MassHealth as a dental provider. A DPH
			 license is not required for a state owned and operated dental clinic. A dental
			 clinic that limits its services to education and diagnostic screening is not
			 eligible to participate in MassHealth as a dental provider.
(6)
Specialist in
			 Orthodontics
. A dentist who is a specialist in orthodontics must
			 have completed a minimum of two years training in a CODA advanced-education
			 program in orthodontics that fulfills all educational requirements for
			 eligibility for the examination by the American Board of
			 Orthodontists.
(7)
Specialist in Oral Surgery
. A dentist who is a
			 specialist in oral surgery must have completed a minimum of four years training
			 in an oral and maxillofacial surgery advanced-education program, fulfilling the
			 requirements for advanced training in oral and maxillofacial surgery as
			 outlined by CODA and leading to a Certificate of Advanced Graduate Studies
			 (CAGS).
(8)
Other
			 Dental Specialists
. A dentist who is a specialist in any other
			 area of dentistry (for example, pedodontics, anesthesiology, endodontics,
			 periodontics, or prosthodontics) must have completed the appropriate
			 CODA-accredited certificate program that satisfies eligibility requirements for
			 the specific specialty board.
(9)
Public Health Dental Hygienist
. A dental hygienist
			 engaged in private practice is eligible to participate in MassHealth as a
			 dental provider and claim payment for certain services without the direct
			 supervision of a dentist if he or she is licensed to practice as a registered
			 dental hygienist by BORID and also meets the board's requirements to practice
			 in a public health setting pursuant to
			 234 CMR
			 2.00:
General Rules and Requirements
.
			 Private practices may include, but are not limited to, solo, partnership, or
			 group practices.
(10)
Mobile Dental Facility (MDF) or Portable Dental Operation
			 (PDO)
. A dentist or public health dental hygienist is eligible to
			 participate in MassHealth as a dental provider and claim payment for certain
			 services provided through a MDF or PDO only if the provider satisfies the
			 requirements of
			 234
			 CMR 7.00:
Mobile and Portable
			 Dentistry
and has obtained a valid permit as a MDF or PDO from
			 BORID.