TITLE 405 OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES
Proposed Rule
LSA Document #10-795
DIGEST
Amends
405 IAC 5-14-1 to revise the dental covered services included under the dental services limitation and to increase the limitation amount for recipients 21 years of age and over. Effective 30 days after filing with the Publisher.
Authority:
IC 12-8-6-5;
IC 12-15
Sec. 1. (a) Medicaid reimbursement is available only for those dental services listed in section 2 of this rule subject to the limitations set out in this rule.
(b) For those recipients twenty-one (21) years of age and over, covered services routinely provided in a dental office will be limited to
six hundred one thousand dollars
($600) ($1,000) per recipient, per twelve (12) month period. This limit precedes all other limits within this rule.
The All procedure codes
that will be included within the limitation.
(1) will be listed and published in a provider bulletin; and
(2) may be updated by the office as needed.
A provider bulletin issued under this subsection shall be effective no earlier than permitted under
IC 12-15-13-6.
(c) For those recipients twenty-one (21) years of age and over, all covered services will require prior authorization except the following:
(1) Diagnostic and preventative services.
(2) Direct restorations.
(3) Treatment of lesions.
(4) Periodontal services for the following immuno-compromised individuals:
(A) Transplant patients.
(B) Pregnant women.
(C) Diabetic patients.
(5) Extractions.
(6) Emergency and trauma care.
Posted: 03/23/2011 by Legislative Services Agency
DIN: 20110323-IR-405100795PRA
Composed: May 05,2024 4:12:43PM EDT
A
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