Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 70 - MO HealthNet Division › Chapter 35 - Dental Program › Section 13 CSR 70-35.010 - Dental Benefits and Limitations, MO HealthNet Program

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This amendment removes restrictions on the
				  MO HealthNet dental coverage benefit, adds the expansion of limited dental
				  services to the MO HealthNet eligible adult population, and changes the date in
				  which the updated online Dental Provider Manual will be published. It also adds
				  the word "Provider" to any instance of "Dental Manual" for the purposes of
				  clarity.
PUBLISHER'S NOTE: The secretary of state has
				  determined that the publication of the entire text of the material which is
				  incorporated by reference as a portion of this rule would be unduly cumbersome
				  or expensive. This material as incorporated by reference in this rule shall be
				  maintained by the agency at its headquarters and shall be made available to the
				  public for inspection and copying at no more than the actual cost of
				  reproduction. This note applies only to the reference material. The entire text
				  of the rule is printed here.
(1) Administration. The MO HealthNet dental
				program shall be administered by the MO HealthNet Division, Department of
				Social Services. The dental services covered and not covered, the limitations
				under which services are covered, and the maximum allowable fees for all
				covered services shall be determined by the MO HealthNet Division and shall be
				included in the MO HealthNet Dental Provider Manual, which is incorporated by
				reference and made part of this rule as published by the Department of Social
				Services, MO HealthNet Division, 615 Howerton Court, Jefferson City, MO 65109,
				at its website at
www.dss.mo.gov/mhd
,
				May 2, 2016. This rule does not incorporate any subsequent amendments or
				additions. Dental services covered by the MO HealthNet program shall include
				only those which are clearly shown to be medically necessary. The division
				reserves the right to effect changes in services, limitations, and fees with
				proper notification to MO HealthNet dental providers.
(2) Provider Participation. A dentist shall
				be licensed by the dental board of the state in which s/he is practicing and
				shall have signed a participation agreement to provide dental services under
				the MO HealthNet program. An oral surgeon or other dentist specialist shall be
				licensed in his/her specialty area by the dental board of the state in which
				s/he is practicing. In those states not having a specialty licensure
				requirement, the dentist specialist shall be a graduate of and hold a
				certificate from a graduate training program in that specialty in an accredited
				dental school. In either case, the dental specialist shall have signed a
				participation agreement to provide dental services under the MO HealthNet
				program. A dental hygienist shall be licensed by the dental board of the state
				for at least three (3) consecutive years and practicing in a public health
				setting to provide fluoride treatments, teeth cleaning, and sealants to MO
				HealthNet/MO HealthNet for Kids eligible children ages zero (0) to twenty
				(20).
(3) Participant Eligibility.
				The MO HealthNet dental provider shall ascertain the patient's MO HealthNet
				status before any service is performed. The participant's MO HealthNet/MO
				HealthNet for Kids eligibility is determined by the Family Support Division.
				The participant's eligibility shall be verified from a current MO HealthNet/MO
				HealthNet for Kids identification card or a letter of new approval in the
				participant's possession. The patient must be a MO HealthNet eligible
				participant under the MO HealthNet/MO HealthNet for Kids program on the date
				the service is performed. The MO HealthNet Division is not allowed to pay for
				any service to a patient who is not eligible under the MO HealthNet/MO
				HealthNet for Kids program.
(A) Coverage of
				dental services for adults is limited to certain categories of service and may
				require prior authorization: trauma of the mouth, jaw, teeth, or other
				contiguous sites as a result of injury; treatment of a disease/medical
				condition without which the health of the individual would be adversely
				affected; preventive services; restorative services; periodontal treatment;
				oral surgery; extractions; radiographs; pain evaluation and relief; infection
				control; and general anesthesia. Further detail on covered adult dental
				services may be referenced at
www.dss.mo.gov/mhd
.