CABINET FOR HEALTH AND
FAMILY SERVICES
Department for Medicaid
Services
Division of Policy and
Operations
(Amended After Comments)
907 KAR 1:026. Dental services’ coverage provisions and
requirements.
RELATES TO: KRS 205.520, 205.8451, 42
U.S.C. 1396a-d
STATUTORY AUTHORITY: KRS 194A.030(2),
194A.050(1), 205.520(3), 42 U.S.C. 1396a-d[, Pub.L. 109-171]
NECESSITY, FUNCTION, AND
CONFORMITY: The Cabinet for Health and Family Services, Department for Medicaid
Services, has the responsibility to administer the Medicaid Program. KRS
205.520(3) authorizes the cabinet, by administrative regulation, to comply with
any requirement that may be imposed or opportunity presented by federal law to
qualify for federal Medicaid funds[for the provision of medical assistance
to Kentucky's indigent citizenry]. This administrative regulation
establishes the Kentucky Medicaid Program provisions and requirements
regarding the coverage of[provisions relating to] dental services.
Section 1. Definitions. (1)
"Comprehensive orthodontic" means a medically necessary dental
service for treatment of a dentofacial malocclusion which requires the application
of braces for correction.
(2) "Current Dental
Terminology" or "CDT" means a publication by the American Dental
Association of codes used to report dental procedures or services.
(3) "Debridement" means a
preliminary procedure that:
(a) Entails the gross removal of
plaque and calculus that interfere with the ability of a dentist to perform a
comprehensive oral evaluation; and
(b) Does not preclude the need for
further procedures[a procedure that is performed:
(a) For removing thick or dense
deposits on the teeth which is required if tooth structures are so deeply
covered with plaque and calculus that a dentist or staff cannot check for decay,
infections, or gum disease]; and
(c) Is separate[(b) Separately]
from a regular cleaning and is usually a preliminary or first treatment when an
individual has developed very heavy plaque or calculus.
(4) "Department" means the
Department for Medicaid Services or its designee.
(5) "Direct practitioner
contact" means the billing dentist or oral surgeon is physically present
with and evaluates, examines, treats, or diagnoses the recipient.
(6) "Disabling malocclusion"
means[that a patient has] a condition that meets the criteria
established in Section 13(7) of this administrative regulation.
(7) "Electronic signature"
is defined by KRS 369.102(8).
(8) "Federal
financial participation" is defined in 42 C.F.R. 400.203.
(9) "Incidental" means that
a medical procedure:
(a) Is performed at the same time
as a primary procedure; and
(b)1.[:
(a)] Requires little additional
practitioner resources; or
2.[(b)] Is clinically
integral to the performance of the primary procedure.
(10)[(8)] "Integral"
means that a medical procedure represents a component of a more complex
procedure performed at the same time.
(11) "Locum tenens dentist"
means a substitute dentist:
(a) Who temporarily assumes
responsibility for the professional practice of a dentist participating in the
Kentucky Medicaid Program; and
(b) Whose services are paid under the
participating dentist’s provider number.
(12) "Managed
care organization" means an entity for which the Department for Medicaid
Services has contracted to serve as a managed care organization as defined in
42 C.F.R. 438.2.
(13)[(9)] "Medically
necessary" or "medical necessity" means that a covered benefit
is determined to be needed in accordance with 907 KAR 3:130.
(14)[(10)] "Mutually
exclusive" means that two (2) procedures:
(a) Are not reasonably performed in
conjunction with one (1) another during the same patient encounter on
the same date of service;
(b) Represent two (2) methods of
performing the same procedure;
(c) Represent medically impossible or
improbable use of CDT codes; or
(d) Are described in CDT as inappropriate
coding of procedure combinations.
(15)[(11)] "Other
licensed medical professional" or "OLMP" means a health
care provider other than a dentist who has been approved to practice a medical specialty
by the appropriate licensure board.
(16)[(12)] "Prepayment
review" or "PPR" means a departmental review of a claim regarding
a recipient who is not enrolled with a managed care organization to
determine if the requirements of this administrative regulation have been met
prior to authorizing payment.
(17)[(13)] "Prior
authorization" or "PA" means approval which a provider shall
obtain from the department before being reimbursed for a covered service.
(18)[(14)] "Provider"
is defined in KRS 205.8451(7).
(19) "Public health hygienist"
means an individual who:
(a) Is a dental hygienist as defined
in KRS 313.010(6);
(b) Meets the public health hygienist
requirements established in KRS 313.040(8);
(c) Meets the requirements for a
public health registered dental hygienist established in 201 KAR 8:562; and
(d) Is employed by or through:
1. The Department for Public Health;
or
2. A governing board of health.
(20)[(15)] "Recipient"
is defined in KRS 205.8451(9).
(21)[(16)] "Resident"
is defined in 42 C.F.R. 415.152.
(22)[(17)] "Timely
filing" means receipt of a claim by Medicaid:
(a) Within twelve (12) months of the date
the service was provided;
(b) Within twelve (12) months of the date
retroactive eligibility was established; or
(c) Within six (6) months of the Medicare
adjudication date if the service was billed to Medicare.
Section 2. Conditions of Participation.
(1) A participating provider shall:
(a) Be licensed as a provider in
the state in which the practice is located;
(b)[. (2) A participating
provider shall] Comply with the terms and conditions established in the
following administrative regulations:
1.[(a)] 907 KAR 1:005;
2.[(b)] 907 KAR 1:671; and
3.[(c)] 907 KAR 1:672;
(c)[.
(3) A participating provider shall]
Comply with the requirements to maintain the confidentiality of personal
medical records pursuant to 42 U.S.C. 1320d and 45 C.F.R. Parts 160 and 164;
and
(d) Comply with all applicable state
and federal laws.
(2)(a)[(4)] A participating
provider shall:
1. Have the freedom to choose
whether to accept an eligible Medicaid recipient; and
2.[shall] Notify the
recipient of the decision prior to the delivery of service.
(b) If the provider accepts the
recipient, the provider:
1.[(a)] Shall bill Medicaid
rather than the recipient for a covered service;
2.[(b)] May bill the
recipient for a service not covered by Kentucky Medicaid, if the provider
informed the recipient of noncoverage prior to providing the service; and
3.[(c)] Shall not bill the
recipient for a service that is denied by the department for:
a.[1.] Being:
(i)[a.] Incidental;
(ii)[b.] Integral; or
(iii)[c.] Mutually
exclusive;
b.[2.] Incorrect billing
procedures, including incorrect bundling of procedures;
c.[3.] Failure to obtain
prior authorization for the service; or
d.[4.] Failure to meet
timely filing requirements.
(3)(a) In accordance with
907 KAR 17:015, Section 3(3), a provider of a service to an enrollee shall not
be required to be currently participating in the fee-for-service Medicaid Program.
(b) A provider
of a service to an enrollee shall be enrolled in the Medicaid Program.
(4)(a) If a provider receives any
duplicate or overpayment from the department or managed care organization,
regardless of reason, the provider shall return the payment to the department
or managed care organization.
(b) Failure to return a payment to the
department in accordance with paragraph (a) of this subsection may be:
1. Interpreted to be fraud or abuse;
and
2. Prosecuted in accordance with
applicable federal or state law.
(c) Nonduplication of payments and
third-party liability shall be in accordance with 907 KAR 1:005.
(d) A provider shall comply with KRS
205.622.
Section 3. Record Maintenance. (1)(a)
A provider shall maintain comprehensive legible medical records which
substantiate the services billed.
(b) A dental record shall be
considered a medical record.
(2) A medical record shall be signed on
the date of service by the:
(a) Provider; or
(b) Other practitioner authorized to
provide the service in accordance with:
1. KRS 313.040; and
2. 201 KAR 8:562[and dated to
reflect the date of service].
(3) An X-ray shall be:
(a) Of diagnostic quality;
and
(b) Maintained in a manner that
identifies[shall include] the:
1.[(a)] Recipient's name;
2.[(b)] Service date; and
3.[(c)] Provider's name.
(4) A treatment regimen shall be
documented to include:
(a) Diagnosis;
(b) Treatment plan;
(c) Treatment and follow-up; and
(d) Medical necessity.
(5) Medical records, including X-rays,
shall be maintained in accordance with 907 KAR 1:672[, Section 4(3) and (4)].
Section 4. General and Certain Service
Coverage Requirements. (1) A covered service shall be:
(a) Medically necessary; and
(b) Except as provided in subsection (3)[(2)]
of this section, furnished to a recipient through direct practitioner contact.
(2) Dental visits shall be limited to
twelve (12) visits per year[; and
(c) Unless a recipient's provider
demonstrates that dental services in excess of the following service
limitations are medically necessary, limited to:
1. Two (2) prophylaxis per twelve (12)
month period for a recipient under age twenty-one (21);
2. One (1) dental visit per month]
per provider for a recipient who is at least[age] twenty-one (21)
years of age[and over; and
3. One (1) prophylaxis per twelve (12)
month period for a recipient age twenty-one (21) years and over].
(3)[(2)] A covered service
provided by an[individual who meets the definition of] other licensed
medical professional shall be covered if the:
(a) OLMP[Individual] is
employed by the supervising oral surgeon, dentist, or dental group;
(b) OLMP[Individual] is
licensed in the state of practice; and
(c) Supervising provider has direct
practitioner contact with the recipient, except for a service provided by a
dental hygienist if the dental hygienist provides the service under general
supervision of a practitioner in accordance with KRS 313.040[313.310].
(4)[(3)](a) A medical
resident may provide and the department shall cover services if provided
under the direction of a program participating teaching physician in accordance
with 42 C.F.R. 415.170, 415.172, and 415.174.
(b) A dental resident, student, or dental
hygiene student may provide and the department shall cover services
under the direction or supervision of a program participating
provider in or affiliated with an American Dental Association accredited institution.
(5) Services provided by a locum
tenens dentist shall be covered:
(a) If the locum tenens dentist:
1. Has a national provider identifier
(NPI) and provides the NPI to the department;
2. Does not have a pending criminal or
civil investigation regarding the provision of services;
3. Is not subject to a formal
disciplinary sanction from the Kentucky Board of Dentistry; and
4. Is not subject to any federal or
state sanction or penalty that would bar the dentist from Medicare or Medicaid
participation; and
(b) For no more than sixty (60)
continuous days.
(6) Preventative services provided by
a public health hygienist shall be covered.
(7) The department shall cover the
oral pathology procedures listed on the DMS Dental Fee Schedule if provided by
an oral pathologist who meets the condition of participation requirements established
in Section 2 of this administrative regulation.
(8)[(4)] Coverage shall be
limited to the procedures or services:
(a) Identified on the DMS
Dental Fee Schedule; or
(b) Established in this administrative
regulation.
(9) The department shall not cover a
service provided by a provider or practitioner that exceeds the scope of
services established for the provider or practitioner in:
(a) Kentucky Revised Statutes; or
(b) Kentucky administrative regulations[in
907 KAR 1:626, Section 3, in the following CDT categories:
(a) Diagnostic;
(b) Preventive;
(c) Restorative;
(d) Endodontics;
(e) Periodontics;
(f) Removable prosthodontics;
(g) Maxillofacial prosthetics;
(h) Oral and maxillofacial surgery;
(i) Orthodontics; or
(j) Adjunctive general services].
Section 5. Diagnostic Service Coverage
Limitations. (1)(a) Except as provided in paragraph (b) of this subsection, coverage
for a comprehensive oral evaluation shall be limited to one (1) per twelve (12)
month period, per recipient, per provider.
(b) The department shall cover a second
comprehensive oral evaluation if the evaluation is provided in conjunction with
a prophylaxis to an individual under twenty-one (21) years of age.
(c) A comprehensive oral evaluation shall
not be covered in conjunction with the following:
1. A limited oral evaluation for trauma
related injuries;
2. A space maintainer[maintainers];
3.[Root canal therapy;
4.] Denture relining;
4. A[5.] transitional appliance[appliances];
5.[6.] A prosthodontic
service;
6.[7.] Temporomandibular
joint therapy;
7.[8.] An orthodontic
service;
8.[9.] Palliative treatment;[or]
9. An extended care facility call;
10. A house[hospital] call;
or
11. A hospital call.
(2)(a) Coverage for a limited oral
evaluation shall:
1. Be limited to a trauma related injury
or acute infection; and
2. Be limited to one (1) per date of
service, per recipient, per provider[; and
3. Require a prepayment review].
(b) A limited oral evaluation shall not
be covered in conjunction with another service except for:
1. A periapical X-ray;
2. A bitewing X-ray[X-rays];
3. A panoramic X-ray;
4. Resin, anterior;
5. A simple or surgical extraction;
6. Surgical removal of a residual tooth
root;
7. Removal of a foreign body;
8. Suture of a recent small wound;
9. Intravenous sedation; or
10. Incision and drainage of infection.
(3)(a) Except as provided in paragraph
(b) of this subsection, the following limitations shall apply to coverage of a
radiograph service:
1. Bitewing X-rays shall be limited to
four (4) per twelve (12) month period, per recipient, per provider;
2. Periapical X-rays shall be limited to
fourteen (14) per twelve (12) month period, per recipient, per provider;
3. An intraoral complete X-ray series
shall be limited to one (1) per twenty-four (24)[twelve (12)]
month period, per recipient, per provider;
4. Periapical and bitewing X-rays shall
not be covered in the same twelve (12) month period as an intraoral complete X-ray
series per recipient, per provider;
5. A panoramic film shall:
a. Be limited to one (1) per twenty-four
(24) month period, per recipient, per provider; and
b. Require prior authorization in
accordance with Section 15(1), (2), and (3) of this
administrative regulation for a recipient under the age of six
(6) years;
6. A cephalometric film shall be limited
to one (1) per twenty-four (24) month period, per recipient, per provider; or
7. A cephalometric and panoramic X-ray[X-rays]
shall not be covered separately in conjunction with a comprehensive
orthodontic consultation.
(b) The limits established in paragraph
(a) of this subsection shall not apply to:
1. An X-ray necessary for a root canal or
oral surgical procedure; or
2. An X-ray that:
a. Exceeds the established service
limitations; and
b. Is determined by the department
to be medically necessary.
Section 6. Preventive Service Coverage
Limitations. (1)(a) Coverage of a prophylaxis shall be limited to:
1. For an individual who is at least
twenty-one (21) years of age[and over], one (1) per twelve (12) month
period, per recipient; and
2. For an individual under twenty-one
(21) years of age, one (1)[two (2)] per six (6)[twelve
(12)] month period, per recipient.
(b) A prophylaxis shall not be covered in
conjunction with periodontal scaling or root planing.
(2)(a) Coverage of a sealant shall be
limited to:
1. A recipient of the age five (5)
through twenty (20) years;
2. Each six (6) and twelve (12) year
molar once every four (4) years with a lifetime limit of three (3) sealants per
tooth, per recipient; and
3. An occlusal surface that is noncavitated[noncarious].
(b) A sealant shall not be covered in
conjunction with a restorative procedure for the same tooth on the same
surface on the same date of service.
(3)(a) Coverage of a space maintainer
shall:
1. Be limited to a recipient under the
age of twenty-one (21) years; and
2. Require the following:
a. Fabrication;
b. Insertion;
c. Follow-up visits;
d. Adjustments; and
e. Documentation in the recipient's
medical record to:
(i) Substantiate the use for maintenance
of existing interdental[intertooth] space; and
(ii) Support the diagnosis and a plan of
treatment that includes follow-up visits.
(b) The date of service for a space
maintainer shall be considered to be the date the appliance is placed on the
recipient.
(c) Coverage of a space maintainer, an
appliance therapy specified in the CDT orthodontic category, or a combination of
the two (2)[thereof] shall not exceed two (2) per twelve (12) month
period, per recipient.
Section 7. Restorative Service Coverage
Limitations. (1) A four (4) or more surface resin-based anterior composite
procedure shall not be covered if performed for the purpose of cosmetic bonding
or veneering.
(2) Coverage of a prefabricated crown
shall[be]:
(a) Be limited to a recipient
under the age of twenty-one (21) years; and
(b) Include[Inclusive of] any
procedure performed for restoration of the same tooth.
(3) Coverage of a pin retention procedure
shall be limited to:
(a) A permanent molar;
(b) One (1) per tooth, per date of
service, per recipient; and
(c) Two (2) per permanent molar, per
recipient.
(4) Coverage of a restorative procedure
performed in conjunction with a pin retention procedure shall be limited to one
(1) of the following:
(a) An amalgam encompassing[,]
three (3) or more surfaces;
(b) A permanent prefabricated resin
crown; or
(c) A prefabricated stainless steel
crown.
Section 8. Endodontic Service Coverage
Limitations. (1) Coverage of the following endodontic procedures shall be
limited to a recipient under the age of twenty-one (21) years:
(a) A pulp cap direct;
(b) Therapeutic pulpotomy; or
(c) Root canal therapy.
(2) A therapeutic pulpotomy shall not be
covered if performed in conjunction with root canal therapy.
(3)(a) Coverage of root canal therapy
shall require:
1. Treatment of the entire tooth;
2. Completion of the therapy; and
3. An x-ray taken before and after
completion of the therapy.
(b) The following root canal therapy
shall not be covered:
1. The Sargenti method of root canal
treatment; or
2. A root canal that does not treat
all root canals on[one (1) root of] a multi-rooted
tooth[molar].
Section 9. Periodontic Service Coverage
Limitations. (1) Coverage of a gingivectomy or gingivoplasty procedure shall
require prepayment review and shall be limited to:
(a) A recipient with gingival[gigival]
overgrowth due to a:
1. Congenital condition;
2. Hereditary condition; or
3. Drug-induced condition; and
(b) One (1) per tooth or per quadrant,
per provider, per recipient per twelve (12) month period.
1. Coverage of a quadrant procedure shall
require a minimum of a four (4)[three (3)] tooth area within the
same quadrant.
2. Coverage of a per-tooth procedure
shall be limited to no more than three (3)[two (2)] teeth within
the same quadrant.
(2) Coverage of a gingivectomy or
gingivoplasty procedure shall require documentation in the recipient's medical
record that includes:
(a) Pocket-depth measurements;
(b) A history of nonsurgical services;
and
(c) A prognosis.
(3) Coverage for a periodontal scaling
and root planing procedure shall:
(a) Not exceed one (1) per quadrant, per
twelve (12) months, per recipient, per provider;
(b) Require prior authorization in
accordance with Section 15(1), (2), and (4) of this administrative
regulation; and
(c) Require documentation to include:
1. A periapical film or bitewing X-ray;[and]
2. Periodontal charting of preoperative
pocket depths; and
3. A photograph if applicable.
(4)(a) Coverage of a quadrant
procedure shall require a minimum of a four (4)[three (3)] tooth
area within the same quadrant.
(b) Coverage of a per-tooth procedure
shall be limited to no more than three (3) teeth.
(5) Periodontal scaling and root planing
shall not be covered if performed in conjunction with dental prophylaxis.
(6)(a) A full mouth debridement shall
only be covered for a pregnant woman.
(b) More than[Only] one (1)
full mouth debridement per pregnancy shall not be covered.
Section 10. Prosthodontic Service
Coverage Limitations. (1) A removable prosthodontic or denture repair shall be
limited to a recipient under the age of twenty-one (21) years.
(2) A denture repair in the following
categories shall not exceed three (3) repairs per twelve (12) month period, per
recipient:
(a) Repair resin denture base; or
(b) Repair cast framework.
(3) Coverage for the following services
shall not exceed one (1) per twelve (12) month period, per recipient:
(a) Replacement of a broken tooth on a
denture;
(b) Laboratory relining of:
1. Maxillary dentures; or
2. Mandibular dentures;
(c) An interim maxillary partial denture;
or
(d) An interim mandibular partial
denture.
(4) An interim maxillary or mandibular
partial denture shall be limited to use:
(a) During a transition period from a
primary dentition to a permanent dentition;
(b) For space maintenance or space
management; or
(c) As interceptive or preventive
orthodontics.
Section 11. Maxillofacial Prosthetic
Service Coverage Limitations. The following services shall be covered if
provided by a board eligible or board certified prosthodontist:
(1) A nasal prosthesis;
(2) An auricular prosthesis;
(3) A facial prosthesis;
(4) A mandibular resection prosthesis;
(5) A pediatric speech aid;
(6) An adult speech aid;
(7) A palatal augmentation prosthesis;
(8) A palatal lift prosthesis;
(9) An oral surgical splint; or
(10) An unspecified maxillofacial
prosthetic.
Section 12. Oral and Maxillofacial
Service Coverage Limitations. (1) The simple use of a dental elevator shall not
constitute a surgical extraction.
(2) Root removal shall not be covered on
the same date of service as the extraction of the same tooth.
(3) Coverage of surgical access of an
unerupted tooth shall:
(a) Be limited to exposure of the tooth
for orthodontic treatment; and
(b) Require prepayment review.
(4) Coverage of alveoplasty shall:
(a) Be limited to one (1) per quadrant,
per lifetime, per recipient; and
(b) Require a minimum of a four (4)[three
(3)] tooth area within the same quadrant.
(5) An occlusal orthotic device shall:
(a) Be covered for tempormandibular joint
therapy;
(b) Require prior authorization in
accordance with Section 15(1), (2), and (5) of this administrative
regulation;
(c) Be limited to a recipient under the
age of twenty-one (21) years; and
(d) Be limited to one (1) per lifetime,
per recipient.
(6) Frenulectomy shall be limited to two
(2)[one (1)] per date of service.
(7) Coverage shall be limited to one (1)
per lifetime, per recipient, for removal of the following:
(a) Torus palatinus (maxillary arch);
(b) Torus mandibularis (lower left
quadrant); or
(c) Torus mandibularis (lower right
quadrant).
(8)(a) A dental service that is
covered by the Kentucky Medicaid Program and provided by an oral surgeon shall
be reimbursed in accordance with 907 KAR 1:626 unless the given service is:
1. Not reimbursed pursuant to 907 KAR 1:626;
and
2. Reimbursed pursuant to 907 KAR 3:010.
(b) A dental service that is covered
by the Kentucky Medicaid Program and provided by an oral surgeon but not
reimbursed pursuant to 907 KAR 1:626 shall be reimbursed in accordance with 907
KAR 3:010[Except as specified in subsection (9) of this section, a
service provided by an oral surgeon shall be covered in accordance with 907 KAR
3:005.
(9) If performed by an oral surgeon,
coverage of a service identified in CDT shall be limited to:
(a) Extractions;
(b) Impactions; and
(c) Surgical access of an unerupted
tooth].
Section 13. Orthodontic Service Coverage
Limitations. (1) Coverage of an orthodontic service shall:
(a) Be limited to a recipient under the
age of twenty-one (21) years; and
(b) Require prior authorization except
as established in Section 15(1)(b) of this administrative regulation.
(2) The combination of space maintainers
and appliance therapy shall be limited to two (2) per twelve (12) month period,
per recipient.
(3) Space maintainers and appliance
therapy shall not be covered in conjunction with comprehensive orthodontics.
(4) The department shall only cover new
orthodontic brackets or appliances.
(5) An appliance for minor tooth guidance
shall not be covered for the control of harmful habits.
(6) In addition to the limitations specified in
subsection (1) of this section, a comprehensive orthodontic service shall:
(a) Require a referral by a dentist; and
(b) Be limited to[: 1.] the
correction of a disabling malocclusion for transitional, full permanent
dentition, or[; or
2. Transitional or full permanent
dentition unless for] treatment of a cleft palate or severe facial anomaly.
(7) A disabling malocclusion shall:
(a) Exist if a patient:
1. Exhibits a severe[(a) Has a
deep impinging] overbite encompassing one (1) or more teeth in[that
shows] palatal impingement diagnosed by a lingual view of orthodontic
models (stone or digital) showing palatal soft tissue contact[the
majority of the lower incisors];
2. Exhibits[(b) Has] a true
anterior open bite:
a.[,] Either skeletal or
habitual in nature[,]
that if
left untreated will result in:
(i)[a.]
The open bite persisting; or
(ii)[b.] A
medically documented speech impediment; and
b. That does not include:
(i) One (1) or two (2) teeth slightly
out of occlusion; or
(ii) Where the incisors have not fully
erupted;
3.[does not include:
1. One (1) or two (2) teeth slightly
out of occlusion; or
2. Where the incisors have not fully
erupted;
(c)] Demonstrates a significant
antero-posterior discrepancy (Class II or III malocclusion that is comparable
to at least one (1) full tooth Class II or III):
a.[,] Dental or skeletal[)];
and
b. If skeletal, requires a traced
cephalometric radiograph supporting significant skeletal malocclusion;
4.[(d)] Has an anterior
crossbite that involves:
a.[1.] More than two (2)
teeth within the same arch[in crossbite]; or
b. A single tooth crossbite if there
is evident detrimental changes in supporting tissues including:
(i)[2.] Obvious gingival
stripping; or
(ii) A functional shift of the
mandible or severe dental attrition for an individual under the age of twelve
(12) years[3. Recession related to the crossbite]; or
c. An edge to edge crossbite if there
is severe dental attrition due to a traumatic occlusion;
5.[(e)] Demonstrates a
handicapping posterior transverse discrepancy that:
a. May include several teeth, one
(1) of which shall be a molar; and
b. Is handicapping in a function
fashion as follows:
(i) Functional shift;
(ii) Facial asymmetry; or[Involving
at least two (2) posterior teeth; and
b. Demonstrating:
(i) An arch collapse;
(ii) A lateral functional shift;]
(iii)[A skeletal
restriction; or
(iv)] A[discrepancies which:
1. May include several teeth, one (1)
of which shall be a molar; and
2. Is handicapping in a function
fashion as follows:
a. Functional shift;
b. Facial asymmetry;
c.] complete buccal or lingual
crossbite;
6. Demonstrates a medically documented
speech pathology resulting from the malocclusion[or
d. Speech concern];
7. Demonstrates[(f) Has] a
significant posterior open bite that does not involve:
a.[1.] Partially erupted
teeth; or
b.[2.] One (1) or two (2)
teeth slightly out of occlusion;
8.[(g)] Except for third
molars, demonstrates an[has] impacted tooth[teeth]
that:
a. Will not erupt into the arch[arches]
without orthodontic or surgical intervention; and
b.(i) Shows a documented pathology; or
(ii) Poses a significant threat to the
integrity of the remaining dentition or to the health of the patient;
9.[(h)] Has an extreme
overjet in excess of eight (8)[to nine (9)] millimeters and one (1) of
the skeletal conditions specified in subparagraphs 1 through 8[paragraphs
(a) through (g)] of this paragraph[subsection];
10.[(i)] Has trauma or
injury resulting in severe misalignment of the teeth or alveolar structures[,]
and does not include simple loss of teeth with no other affects;
11.[(j)] Has a congenital
or developmental disorder giving rise to a handicapping malocclusion; or
12.[(k)] Has a significant
facial discrepancy requiring a combined orthodontic and orthognathic surgery
treatment approach; and
(b) Not include:
1. One (1) or two (2) teeth being
slightly out of occlusion;
2. Incisors not having fully erupted;
or
3. A bimaxillary protrusion; or
(c) Exist if a patient[(l)]
has developmental anodontia in which several congenitally missing teeth result
in a handicapping malocclusion or arch deformation.
(8) Coverage of comprehensive orthodontic
treatment shall not include[be inclusive of] orthognathic
surgery.
(9) If comprehensive orthodontic
treatment is discontinued prior to completion, the provider shall submit to the
department:
(a) Documentation of the[A]
referral referenced in subsection (6) of this section[form, if
applicable]; and
(b) A letter detailing:
1. Treatment provided, including dates of
service;
2. Current treatment status of the
patient; and
3. Charges for the treatment provided.
(10) Remaining portions of comprehensive
orthodontic treatment may be authorized for prorated coverage upon compliance
with[submission of] the prior authorization requirements specified
in Section 15(1), (2), and (7) of this administrative regulation
if treatment:
(a) Is transferred to another provider;
or
(b) Began prior to Medicaid eligibility.
Section 14. Adjunctive General Service
Coverage Limitations. (1)(a) Coverage of palliative treatment for dental pain
shall be limited to one (1) per date of service, per recipient, per provider.
(b) Palliative treatment for dental pain
shall not be covered in conjunction with another service except for a
radiograph[radiographs].
(2)[(a)] Coverage of a hospital or
ambulatory surgical center call or extended care facility call shall
be limited to one (1) per date of service, per recipient, per provider.
(b) A hospital call, ambulatory
surgical center call, or extended care facility call shall not be covered
in conjunction with:
1. Limited oral evaluation;
2. Comprehensive oral evaluation; or
3. Treatment of dental pain.
(3)[(a) Coverage of
intravenous sedation shall be limited to a recipient under the age of
twenty-one (21) years.
(b)] Intravenous sedation
shall not be covered for local anesthesia or nitrous oxide.
Section 15. Prior Authorization. (1)(a)
The prior authorization requirements established in this administrative
regulation shall apply to services for a recipient who is not enrolled with a
managed care organization.
(b) A managed care organization shall
not be required to apply the prior authorization requirements established in
this administrative regulation for a recipient who is enrolled with a managed
care organization.
(c) Prior authorization shall be
required for the following:
1.[(a)] A panoramic film
for a recipient under the age of six (6) years;
2.[(b)] Periodontal scaling
and root planing;
3.[(c)] An occlusal
orthotic device;
4.[(d)] A preorthodontic
treatment visit;
5.[(e)] Removable appliance
therapy;
6.[(f)] Fixed appliance
therapy; or
7.[(g)] A comprehensive
orthodontic service.
(2) A provider shall request prior authorization
by submitting the following information to the department:
(a) A MAP-9, Prior Authorization for
Health Services;
(b) Additional forms or information as
specified in subsections (3) through (7) of this section; and
(c) Additional information required to
establish medical necessity if requested by the department.
(3) A request for prior authorization of
a panoramic film shall include a letter of medical necessity.
(4) A request for prior authorization of
periodontal scaling and root planing shall include periodontal charting of
preoperative pocket depths.
(5) A request for prior authorization of
an occlusal orthotic device shall include a MAP 306, Temporomandibular Joint
(TMJ) Assessment Form.
(6) A request for prior authorization of
removable and fixed appliance therapy shall include:
(a) A MAP 396, Kentucky Medicaid Program
Orthodontic Evaluation Form;
(b) Panoramic film or intraoral complete
series; and
(c) Dental models or the digital equivalent
of dental models.
(7) A request for prior authorization for
comprehensive orthodontic services shall include:
(a) A MAP 396, Kentucky Medicaid Program
Orthodontic Evaluation Form;
(b) A MAP 9A, Kentucky Medicaid Program
Orthodontic Services Agreement;
(c) A cephalometric X-ray[x-rays]
with tracing;
(d) A panoramic X-ray;
(e) Intraoral and extraoral facial
frontal and profile pictures;
(f) An occluded and trimmed dental
model or the digital equivalents of a model[model];
(g) An oral surgeon's pretreatment work
up notes if orthognathic surgery is required;
(h) After six (6) monthly visits are
completed, but not later than twelve (12) months after the banding date of
service:
1. A MAP 559, Six (6) Month Orthodontic
Progress Report; and
2. An additional MAP 9, Prior
Authorization for Health Services; and
(i) Within three (3) months following
completion of the comprehensive orthodontic treatment:
1. Beginning and final records; and
2. A MAP 700, Kentucky Medicaid Program
Orthodontic Final Case Submission.
(8) Upon receipt and review of the materials
required in subsection (7)(a) through (g) of this section, the department may
request a second opinion from another provider regarding the proposed comprehensive
orthodontic treatment.
(9) If a service that requires prior
authorization is provided before the prior authorization is received, the
provider shall assume the financial risk that the prior authorization may not
be subsequently approved.
(10)(a) Prior authorization shall
not be a guarantee of recipient eligibility.
(b) Eligibility verification shall
be the responsibility of the provider.
(11) Upon review and determination by the
department that removing a prior authorization requirement shall
be in the best interest of a Medicaid recipient[recipients],
the prior authorization requirement for a specific covered benefit shall be
discontinued, at which time the covered benefit shall be available to all
recipients without prior authorization.
Section 16. Use
of Electronic Signatures. (1) The creation, transmission, storage, and other
use of electronic signatures and documents shall comply with the requirements established
in KRS 369.101 to 369.120.
(2) A dental
service provider that chooses to use electronic signatures shall:
(a) Develop and
implement a written security policy that shall:
1. Be adhered to
by each of the provider's employees, officers, agents, or contractors;
2. Identify each
electronic signature for which an individual has access; and
3. Ensure that
each electronic signature is created, transmitted, and stored in a secure
fashion;
(b) Develop a
consent form that shall:
1. Be completed
and executed by each individual using an electronic signature;
2. Attest to the
signature's authenticity; and
3. Include a
statement indicating that the individual has been notified of his or her responsibility
in allowing the use of the electronic signature; and
(c) Provide the
department, immediately upon request, with:
1. A copy of the
provider's electronic signature policy;
2. The signed
consent form; and
3. The original
filed signature.
Section 17. Auditing Authority. (1)
The department or the managed care organization in which an enrollee is
enrolled shall have the authority to audit any:
(a) Claim;
(b) Medical record; or
(c) Documentation associated with any
claim or medical record.
(2) A dental record shall be
considered a medical record.
Section 18. Federal
Approval and Federal Financial Participation. The coverage provisions and
requirements established in this administrative regulation shall be contingent
upon:
(1) Receipt of federal
financial participation for the coverage; and
(2) Centers for
Medicare and Medicaid Services’ approval of the coverage.
Section 19. Appeal Rights.[(1)]
An appeal of a department decision regarding a Medicaid recipient who is:
(1) Enrolled with a managed care
organization shall be in accordance with 907 KAR 17:010; or
(2) Not enrolled with a managed care
organization[based upon an application of this administrative regulation]
shall be in accordance with 907 KAR 1:563.
Section 20[(2) An appeal of a
department decision regarding Medicaid eligibility of an individual shall be in
accordance with 907 KAR 1:560.
(3) An appeal of a department decision
regarding a Medicaid provider based upon an application of this administrative
regulation shall be in accordance with 907 KAR 1:671.
Section 17]. Incorporation by
Reference. (1) The following material is incorporated by reference:
(a) "MAP 9, Prior Authorization for
Health Services", December 1995[edition];
(b) "MAP 9A, Kentucky Medicaid Program
Orthodontic Services Agreement", December 1995[edition];
(c) "MAP 306, Temporomandibular
Joint (TMJ) Assessment Form", December 1995[edition];
(d) "MAP 396, Kentucky Medicaid
Program Orthodontic Evaluation Form", March 2001[edition];
(e) "MAP 559, Six (6) Month
Orthodontic Progress Report", December 1995[edition];[and]
(f) "MAP 700, Kentucky Medicaid
Program Orthodontic Final Case Submission", December 1995; and
(g) "DMS
Dental Fee Schedule", September[June]
2015[edition].
(2) This material may be inspected,
copied, or obtained, subject to applicable copyright law:
(a)[,] At the Department
for Medicaid Services, 275 East Main Street, Frankfort, Kentucky 40621, Monday
through Friday, 8 a.m. to 4:30 p.m.; or
(b) Online at the department’s Web site
located at http://www.chfs.ky.gov/dms/incorporated.htm.
LISA LEE, Commissioner
AUDREY TAYSE HAYNES, Secretary
APPROVED BY AGENCY: September 9, 2015
FILED WITH LRC: September 11, 2015 at 3 p.m.
CONTACT PERSON: Tricia Orme, tricia.orme@ky.gov, Office of Legal Services, 275 East Main
Street 5 W-B, Frankfort, Kentucky 40601, phone (502) 564-7905, fax (502)
564-7573.
REGULATORY IMPACT
ANALYSIS And Tiering Statement
Contact person: Stuart Owen
(1) Provide a brief summary of:
(a) What this administrative regulation
does: This administrative regulation establishes the Kentucky Medicaid Program provisions
and requirements regarding the coverage of dental services.
(b) The necessity of this administrative regulation:
This administrative regulation is necessary to establish the Kentucky Medicaid
Program provisions and requirements regarding the coverage of dental services.
(c) How this administrative regulation
conforms to the content of the authorizing statutes: This administrative
regulation conforms to the content of the authorizing statutes by establishing
the Kentucky Medicaid Program provisions and requirements regarding the coverage
of dental services.
(d) How this administrative regulation
currently assists or will assist in the effective administration of the
statutes: This administrative regulation will assist in the effective
administration of the authorizing statutes by establishing the Kentucky
Medicaid Program provisions and requirements regarding the coverage of dental
services.
(2) If this is an amendment to an
existing administrative regulation, provide a brief summary of:
(a) How the amendment will change this
existing administrative regulation: Amendments include altering the definition
of debridement; inserting a definition of electronic signature and inserting
electronic signature usage requirements; inserting a definition of locum tenens
dentist and establishing Medicaid coverage of dental services provided by locum
tenens dentists; inserting a definition of public health hygienist and
establishing Medicaid coverage of dental services provided by public health
hygienists; inserting general program integrity and records maintenance requirements;
replacing the limit of one (1) dental visit per month to twelve (12) per year; incorporating
by reference a dental fee schedule which lists covered procedures; allowing
root canal therapy to be provided in conjunction with a comprehensive oral examination;
establishing that a comprehensive oral evaluation shall not be covered in
conjunction with an extended care facility; establishing that an intraoral
complete x-ray series shall be limited to one (1) per twenty-four (24) months
rather than per twelve (12) months; not covering a root canal on just one (1)
root of a multi-rooted tooth; requiring a quadrant procedure to span at least
four (4) teeth rather than three (3); requiring a per-tooth procedure to be
limited to no more than three (3) teeth within the same quadrant rather than
two (2);eliminating the requirement for prepayment review for a limited oral
evaluation; instead of only covering maxillofacial prosthetic services provided
by a board certified prosthodontist paying for such procedures if performed by
a board eligible prosthodontist (as well as board-certified prosthodontist); clarifying
that a medical record shall be signed on the date of service and that another
licensed medical professional can sign a medical record; clarifying that the
Kentucky Medicaid Program will cover a second periodic examination per twelve
(12) months [for those under twenty-one (21)] if the examination is provided in
conjunction with a prophylaxis; clarifying that a cephalometric and panoramic
x-ray shall not be covered separately in conjunction with a complete
orthodontic consultation; establishing that required documentation shall
include a photograph if applicable; clarifying policy regarding a disabling
malocclusion; allowing for the digital equivalent of dental models to be used
for prior authorization purposes; establishing that a dental service provided
by an oral surgeon shall be reimbursed per the Medicaid dental reimbursement
administrative regulation (907 KAR 1:626) unless there is no reimbursement for
the service per that administrative regulation - in which case it will be
reimbursed per the Medicaid physician’s reimbursement regulation (907 KAR
3:010); and additional clarifications. The amendment after comments revises the
DMS Dental Fee Schedule incorporated by reference into the administrative
regulation by adding a current dental terminology (CDT) code - D0145 - for oral
evaluation of a child under three (3) years of age along with counseling of the
primary caregiver; adds a CDT code for house/extended care facility calls
(D9410); adds a CDT code (D7471) for a procedure related to bony ridges; increases
reimbursement for a procedure [(D5620 – repair cast framework) related to
preparing for dentures] from $97.50 to $210.00; expands coverage of intravenous
sedation (on the DMS Dental Fee Schedule) to be covered for adults; revises the
prophylaxis coverage limit for individuals under twenty-one (21) two (2)
prophylaxis per recipient per twelve (12) months to one (1) per recipient per
six (6) months; revises the coverage criteria for a sealant and simultaneous
restorative procedure to allow for a sealant and simultaneous restorative
procedure on the same tooth as long as it is not on the same surface of the
tooth; revises the root canal criteria; deletes the age limit - twenty-one (21)
– for intravenous sedation; and re-inserts prior criteria regarding a disabling
malocclusion (criteria related to orthodontic procedures.)
(b) The necessity of the amendment to
this administrative regulation: The amendment that establishes that paying for
dental services provided by oral surgeons per the dental reimbursement
regulation if the dental reimbursement regulation contains a rate for the service
(rather than the physicians’ reimbursement regulation) is necessary to ensure
consistency of payment among provider types; altering the definition of debridement
is necessary to comport with the current dental terminology (CDT) description
of debridement; authorizing the use of electronic signatures is necessary to
modernize requirements; requiring a medical record to be signed on the date of
service is necessary to strengthen program integrity; clarifying that a
licensed medical professional other than the provider may sign the medical
record is necessary to comport with Kentucky law and the Board of Dentistry
regulation establishing dental hygienist requirements (201 KAR 8:562); covering
an extra periodic examination within twelve (12) months if provided in
conjunction with a prophylaxis [for individuals under twenty-one (21)] is necessary
to conform with American Association of Pediatric Dentistry guidelines; establishing
that a comprehensive oral evaluation shall not be covered as part of an extended
care facility call is necessary as such an evaluation is appropriately performed
in a dental office with all necessary equipment available; changing the limit
of limited oral x-rays from one (1) per twelve (12) months to one (1) per
twenty-four (24) months is necessary as more frequent of such x-rays is
inappropriate and unnecessary; clarifying that a cephalometric and panoramic x-ray shall
not be covered separately in conjunction with a complete orthodontic
consultation is necessary as such a x-ray is appropriately encompassed in the
complete consultation rather than unbundled as a separate service; establishing
that required documentation shall include a photograph if applicable is necessary
for program integrity and enhancing the recipient’s medical record; the revision regarding a
disabling malocclusion is necessary to clarify policy/language; allowing for a
digital equivalent of dental models is necessary to modernize in accord with
new technology; establishing that DMS won’t cover a root canal on just one (1)
root of a multi-rooted tooth is necessary to prevent inappropriate utilization;
requiring a
quadrant procedure to span at least four (4) teeth rather than three (3) is
necessary to comport with the relevant current dental terminology (CDT) code requirements
for the procedure; requiring a per-tooth procedure to be limited to no more
than three (3) teeth within the same quadrant rather than two (2) is necessary
to comport with the relevant current dental terminology (CDT) code requirements
for the procedure; creating a locum tenens option for dentists and covering preventive
services by public health hygienists is necessary to expand/enhance the
Medicaid provide base; allowing root canal therapy to be provided in
conjunction with a comprehensive oral examination is necessary as it is appropriate
for an individual to receive the therapy at the same time as an examination and
would increase the likelihood of the recipient receiving the service rather
than asking the recipient to return on another day for the therapy; eliminating
the prepayment review requirement for a limited oral examination is necessary
as the exams are necessary in the circumstance and prepayment review would be
an unnecessary burden; and
other amendments or clarifications are necessary to reflect current practice.
Adding the CDT code for oral evaluation of a child under the age of three (3)
years along with counseling of the primary caregiver is necessary to enhance
oral health care for children. Adding the CDT code for house/extended care
facility calls to the fee schedule is necessary as the administrative regulation
establishes that DMS covers the services but the corresponding CDT code was not
included on the fee schedule. Adding the CDT code related to bony ridges dental
work is necessary as the procedure is an appropriate medically necessary
procedure. Increasing the rate for repair cast framework is necessary as the
prior rate was less than half of the costs experienced by dentists in performing
the service. Expanding intravenous sedation to be covered for adults is appropriate
and fiscally responsible as DMS currently covers a much more expensive option –
general anesthesia for dental procedures in a hospital. Expanding intravenous
sedation to be covered for adults will enable adults to be sedated in dental
offices and receive dental treatment rather than have such treatment performed
in a hospital. Revising the prophylaxis limit for individuals under twenty-one
(21) from two (2) per twelve (12) months to one (1) per six (6) months is
necessary to address a problem of mobile dental vans performing such services
at schools within six (6) months which also precludes the child’s primary
dentist from providing such care to the child at least once a year. Revising
the coverage restriction for a sealant and simultaneous restorative procedure
is necessary as it would be appropriate to have a simultaneous restorative
procedure on the same tooth but not on the same surface of the tooth. Revising
the root canal criteria is necessary to ensure that the entire tooth is treated
as a result of the procedure. Deleting the age limit for intravenous sedation
is necessary as this is an appropriate covered service for adults and DMS
currently covers a more expensive option – general anesthesia provided in a
hospital for dental work. Re-inserting prior criteria regarding a disabling
malocclusion is being done in response to public comments for clarity.
(c) How the amendment conforms to the
content of the authorizing statutes: The amendments conform to the content of
the authorizing statutes by clarifying policies, accommodating the use of new
technology, enhancing program integrity, adopting policies consistent with the
industry standards, and by adopting policies appropriate for eliminating
unnecessary utilization of services.
(d) How the amendment will assist in the
effective administration of the statutes: The amendments will assist in the
effective administration of the authorizing statutes by clarifying policies,
accommodating the use of new technology, enhancing program integrity, adopting
policies consistent with the industry standards, and by adopting policies appropriate
for eliminating unnecessary utilization of services.
(3) List the type and number of
individuals, businesses, organizations, or state and local government affected
by this administrative regulation: Medicaid-participating dental service
providers will be affected by the amendments. Currently, there are 1,078 individual
dentists, 158 group dental practices, sixty-nine (69) individual physicians who
perform oral surgery, and nine (9) group physician practices that perform oral
surgery enrolled in Kentucky’s Medicaid program.
(4) Provide an analysis of how the
entities identified in question (3) will be impacted by either the
implementation of this administrative regulation, if new, or by the change, if
it is an amendment, including:
(a) List the actions that each of the
regulated entities identified in question (3) will have to take to comply with
this administrative regulation or amendment. Dental providers will need to
ensure that they provide services within the limits established in the
administrative regulation if they wish to be reimbursed for services.
(b) In complying with this administrative
regulation or amendment, how much will it cost each of the entities identified
in question (3). The amendment imposes no cost on the regulated entities.
(c) As a result of compliance, what
benefits will accrue to the entities identified in question (3). Dental providers will
benefit from the Medicaid provisions comporting with current dental terminology
(CDT) guidelines and from modernizing coverage to include coverage of the
digital equivalent of dental models. Oral pathologists will benefit from DMS
expanding coverage to include oral pathology services/procedures. Recipients
will benefit from root canal therapy being covered in conjunction with an oral
examination rather than the recipient having to reappear at the dental office
on another day to receive the therapy.
(5) Provide an estimate of how much it
will cost to implement this administrative regulation:
(a) Initially: The Department for
Medicaid Services (DMS) anticipates no additional costs as a result of the
amendments.
(b) On a continuing basis: DMS
anticipates no additional costs as a result of the amendments.
(6) What is the source of the funding to
be used for the implementation and enforcement of this administrative
regulation: The sources of revenue to be used for implementation and
enforcement of this administrative regulation are federal funds authorized
under the Social Security Act, Title XIX and matching funds of general fund
appropriations.
(7) Provide an assessment of whether an
increase in fees or funding will be necessary to implement this administrative
regulation, if new, or by the change if it is an amendment. Neither an increase
in fees nor funding is necessary to implement the amendment to this administrative
regulation.
(8) State whether or not this
administrative regulation establishes any fees or directly or indirectly
increases any fees: This administrative regulation neither establishes nor increases
any fees.
(9) Tiering: Is tiering applied? Tiering
is not applied as the provisions apply equally to the regulated entities.
FEDERAL MANDATE ANALYSIS
COMPARISON
1. Federal statute or regulation
constituting the federal mandate. 42 U.S.C. 1396d(r)(3)
2. State compliance standards. KRS
194A.050(1) states, "The secretary shall promulgate, administer, and
enforce those administrative regulations necessary to implement programs
mandated by federal law, or to qualify for the receipt of federal funds and
necessary to cooperate with other state and federal agencies for the proper
administration of the cabinet and its programs." KRS 205.520(3) states: "...
it is the policy of the Commonwealth to take advantage of all federal funds
that may be available for medical assistance. To qualify for federal funds the
secretary for health and family services may by regulation comply with any
requirement that may be imposed or opportunity that may be presented by federal
law. Nothing in KRS 205.510 to 205.630 is intended to limit the secretary's
power in this respect."
3. Minimum or uniform standards contained
in the federal mandate. Coverage of dental services is not mandated on Medicaid
programs except through the early and periodic screening, diagnosis and treatment
(EPSDT) program for individuals under age twenty-one (21.)
4. Will this administrative regulation
impose stricter requirements, or additional or different responsibilities or
requirements, than those required by the federal mandate? The administrative
regulation does not impose stricter than federal requirements.
5. Justification for the imposition of
the stricter standard, or additional or different responsibilities or
requirements. The administrative regulation does not impose stricter than
federal requirements.
FISCAL NOTE ON STATE OR
LOCAL GOVERNMENT
1. What units, parts or divisions of
state or local government (including cities, counties, fire departments, or
school districts) will be impacted by this administrative regulation? The
Department for Medicaid Services will be affected by the amendment to this
administrative regulation.
2. Identify each state or federal statute
or federal regulation that requires or authorizes the action taken by the
administrative regulation. KRS 194A.050(1), 205.520(3), 42 U.S.C. 1396d(r)(3).
3. Estimate the effect of this
administrative regulation on the expenditures and revenues of a state or local
government agency (including cities, counties, fire departments, or school
districts) for the first full year the administrative regulation is to be in
effect.
(a) How much revenue will this
administrative regulation generate for the state or local government (including
cities, counties, fire departments, or school districts) for the first year? The
amendment is not expected to generate revenue for state or local government.
(b) How much revenue will this
administrative regulation generate for the state or local government (including
cities, counties, fire departments, or school districts) for subsequent years?
The amendment is not expected to generate revenue for state or local government.
(c) How much will it cost to administer
this program for the first year? The Department for Medicaid Services
anticipates no additional costs as a result of the amendments.
(d) How much will it cost to administer
this program for subsequent years? The Department for Medicaid Services
anticipates no additional costs as a result of the amendments.
Note: If specific dollar estimates cannot
be determined, provide a brief narrative to explain the fiscal impact of the
administrative regulation.
Revenues (+/-):
Expenditures (+/-):
Other Explanation:
