Regulation (2008:193) On State Dental Care

Original Language Title: Förordning (2008:193) om statligt tandvårdsstöd

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Read the untranslated law here: http://rkrattsbaser.gov.se/sfst?bet=2008:193

Introductory provision



paragraph 1 of this regulation are given supplementary regulations to the

Act (2008:145) on State dental care.



The words and terms used in the regulation has the same

meaning as in the Act.



Eligible dental measures and reference rates



section 2 of the dental and pharmaceutical benefits agency must notify

regulations on



1. What are the dental measures that may be eligible for reimbursement

under the Act (2008:145) on State dental care and under

what conditions may be reimbursed for these measures

(eligible dental care measures), as well as



2. the reference prices for the eligible

Dental operations. Regulation (2008:844).



paragraph 3 of the Dental procedures in which amalgams have been used as the material is

not reimbursable.



General dental premiums



paragraph 4 of the General dental contribution left with 150 kronor a year.



Of the patients who fill the lowest in 20 years and no more than 29 years or

not less than 75 years in the year in which the earliest dental

used, provided grant with 300 dollars a year.



Especially dental premiums



4 a of the Particular Dental grants may be used for payment

by reimbursable preventive dental measures

If the patient



1. is dry mouth due to prolonged drug therapy,



2. is dry mouth due to radiotherapy in ear, nose,

mouth or throat region,



3. have Sjogren's syndrome,



4. have chronic obstructive pulmonary disease and have been prescribed

oxygen therapy or nutritional drink,



5. has cystic fibrosis,



6. have ulcerative colitis,



7. have Crohn's disease,



8. have intestinal weight,



9. have burns on the teeth and anorexia nervosa,

bulimia nervosa or gastroesophageal reflux disease,



10. have svårinställd diabetes,



11. is undergoing dialysis treatment,



12. is immunosupprimerad due to drug therapy,

or



13. have undergone an organ transplant.



Unless there are special reasons, the patient should be accompanied by a certificate

or other evidence that he or she has such

illness or disabilities referred to in the first

paragraph. Regulation (2011:1184).



4 b of the Special dental contribution is left with a maximum of 600 USD per

half of the year. Regulation (2011:1184).



4 c § the National Board may announce further provisions

If



1. the diseases and disabilities that are specified in section 4 (a)

first subparagraph, and



2. the supporting documents referred to in paragraph 4 (a).

Regulation (2011:1184).



Subscription dentistry



4 d section a contract for the subscription dentistry pursuant to Chapter 2. section 2 of the Act

(2008:145) on State dental care need not include

dental care as a result of occupational injury or accident.

Regulation (2012:784).



Dental health care



paragraph 5 of the dental and pharmaceutical benefits agency must notify

regulations on



1. the amount of the patient's total dental care costs

under a compensation period shall exceed to

dental health care to be provided, as well as



2. what proportion of the total costs

excess of the amount provided for in paragraph 1 that dental reimbursement shall

left. Regulation (2008:844).



section 6, if the prosthetic treatment needs to be done and the new

treatment



1. in accordance with the regulations adopted pursuant to section 2 of 1 is not

eligible, and



2. performed by another health care provider than the one that carried out the

treatment needs to be done if,



get insurance agency pay compensation to caregivers who

Repeat the treatment with an amount equal to the amount

may be demanded back or deducted from a different claim under

Chapter 4. the second subparagraph of paragraph 3 of law (2008:145) on State

dental care.



The remuneration referred to in the first subparagraph may not, however, exceed the

the lowest of the following amounts:



-healthcare provider's price for making the treatment for it

current patient, and



-the reference price to do the treatment.



If the new treatment is more extensive or otherwise

consists of other eligible dental measures than

the treatment needs to be done about, the dental health care

be provided for the costs of these measures as referred

in Chapter 2. paragraph 4 of the law on State dental care. Costs may

not, however, be estimated higher than an amount equal to the difference

between the cost of the new treatment and the cost of

the treatment needs to be done. The calculation of the

the costs of the measures included in the treatments should be performed

on the basis of the reference prices for these actions, however,

maximum caregiver Award for the current patient.

Regulation (2011:83).



section 7 compensation is not payable for a dental operation that has

carried out without a prior examination has been made where such

required. However, this does not apply if the action has been of such

character to that of dental or medical reasons been

necessary to implement without waiting for a

prior authorisation or if there existed special reasons

to begin operation prior to a preliminary examination has been made.



Healthcare provider's responsibility to the patient



section 8 of the health care provider must provide price lists with information on



1. the healthcare provider's prices and reference prices for the

eligible dental care provider actions

perform,



2. what guarantees that the caregiver is leaving for their jobs,

as well as the



3. the patient's right to request written information on

the materials used in prosthetic work and other

treatments aimed at permanently replace lost

tissue.



section 9 If the healthcare provider suggests a dental operation that is not

eligible health care provider shall inform the patient

whether there are any other measure that may be eligible for

State dental care.



section 10 if a patient needs to be treated on more than one occasion,

the caregiver should give the patient a preliminary written

price quote over the total cost of treatment.



If the patient needs a more extensive processing, shall

the caregiver also give the patient a written treatment plan.

The treatment plan shall include information on



1. the diagnosis has been made,



2. the proposed treatment and the reasons for this,



3. possible alternative treatment suggestions,



4. whether dental measures are eligible,

as well as the



5. the healthcare provider's rates, reference rates and resolution codes

Dental operations.



section 11 On the receipt that the patient receives over payment, the

the health care provider type



1. its price for each performed dental operation for the current

the patient,



2. reference price and resolution code for each executed

Dental action, as well as



3. where applicable, the compensation granted under the Act

(2008:145) on State dental care.



If dental work has been included in the treatment, to

the receipt shall be attached a copy of the dossier that the dental

laboratory left over the cost of the dental

the work.



12 § After each survey that is not solely intended

single teeth or a single problem, the caregiver

establish a research protocol. The Protocol must be submitted

to the patient immediately after the survey.



paragraph 13 of the health care provider shall, unless there are special reasons, after

survey and treatment offer the patient to get

a notice to a new investigation in the appropriate time.



section 14 of the health insurance fund shall, at the request of a health care provider

provide data pursuant to Chapter 4. section 1 of the Act

(2008:145) on State dental care if



1. whether the patient is covered by the right to State

dental care,



2. patient's utilization of dental benefits,



3. the patient's total costs for

eligible dental measures

completed during the replacement period,



4. what date ongoing replacement period started to run,



5. the date the last completed

eligible dental operation completed successfully,



6. presence of subscription agreement pursuant to Chapter 2, dental care

section 2 of the Act on State dental care and any

case, the subscription period for the agreement, and the dental

covered by it, and



7. decisions in cases where prior authorisation according to Chapter 4.

5 a of the Act on State dental care.



The data may relate only to patients that the caregiver is

in terms of treating or has treated.

Regulation (2011:1184).



Healthcare provider's obligation to



section 15 of the health care provider should establish a basis for follow-up and

statistics as well as for calculation of State dental care for

all eligible dental measures

the health care provider has performed on a patient. The dossier shall be submitted

to the social insurance office within two weeks of the respective

Dental operation has completed.



The dossier shall contain the



1. the treating dentist or tandhygienists name and

social security number,



2. the patient's name and social security number,



3. the date when the operation was completed,



4. authorisation and resolution code for the action

reimbursable in each case,



5. authorisation and resolution code for the actually performed

the measure, if this is not allowable in the

individual case,



6. tooth number and tooth position,



7. the caregiver Award for action taken for the current

the patient, and



8. the basis for the request for compensation in the form of special

dental benefits.



In connection with the request for compensation in the form of General

dental care provider shall also provide information to

The National Board if the patient's number of remaining respective

intact teeth.



The obligation also applies to such dental care covered


of a current subscription agreement. Regulation (2012:785).



section 16 When a subscription agreement pursuant to Chapter 2, dental care section 2 of the

Act (2008:145) on State dental care has been concluded, or

expired prematurely, do the caregiver within two weeks

from the time the contract was concluded or expired leave

statement to the insurance fund.



When a contract has been concluded shall be provided



1. subscription period,



2. the dental services covered by the agreement, and



3. the fee for the subscription.



Submission of information



section 17 of the Dossier in accordance with paragraph 15, first and second subparagraphs, information

According to the third paragraph of section 15 and section 16 as well as the application for

prior authorisation and application for compensation under the Act

(2008:145) on State dental care must be provided by electronic

Road.



Social insurance may provide for the cases in which

information may be provided by other means.



The connection to the Swedish social insurance agency's electronic system for

State dental care



section 18 application for connection to the Swedish social insurance agency

electronic systems for State dental care should be made by

the health care provider. The application must be in writing and submitted to the

The social insurance agency.



To get connected to the electronic system,

the caregiver must be a licensed dentist or dental hygienist

or, through employment or otherwise, recourse to such

staff. Health care providers in particular undertaken activities to further

be approved for F-tax to be attached to the system.

Regulation (2011:1469).



section 19 of the insurance fund may decide that accession to the

electronic system for State dental care shall cease where

the health care provider



1. request in writing to the Association shall cease,



2. has ceased to pursue dentistry,



3. no longer meets the requirements set out in section 18 of the other

subparagraph, or



4. has not started operations within six months of the

the Swedish social insurance agency announced the decision on accession.



Insurance obligation



19 a of to dental and pharmaceutical benefits the work should

able to carry out their activities in the areas of the State

Dental assistance, social insurance to leave

data on:



1. serial number of patient's number and,

case coordination number,



2. the patient's sex and age, condition and action code

for the action, the tooth number and tooth position, date

When the operation was completed and, where appropriate, if the patient

been referred for action to the dentist with proof of

specialist expertise,



3. the patient's replacement time, start and finish dates, and

use of dental benefits,



4. the caregiver Award for action taken for the current

the patient and if the treating dentist has evidence about

specialist expertise,



5. where appropriate, in accordance with the subscription agreement dentistry 2

Cape. section 2 of the Act (2008:145) on State dental care,

subscription period and if performed dental services covered by

such an agreement as well as the fee for the subscription,



6. reference price per action taken, the amount the patient

has a State dental care, patient's price per visit,

allowable amount per visit, provider's price for

visit, accumulated allowable amount under

benefit period and correction amount, if appropriate,



7. dental reception geographical location relating to the County and

kind of care provider: public, private or other, or in

where applicable, if the operation was carried out in another EU/EEA

country,



8. serial number of the provider's registration number, and

dental clinic,



9. date when the provider's claim against the State arises, date

When the provider's claim against the State is regulated, the date when the case

registered or changed in the database in the insurance fund, and



10. serial number of administrative tasks that case number,

line numbers from the database of the Swedish social insurance agency, case type and

case status.



Each social security number, coordination number, routing number and

Dental reception number, before the data referred to in the first

the paragraph is left out to be encrypted in such a way that

identification is not possible.



The data may be disclosed to the media for automated

treatment. Regulation (2012:784).



Other appropriations



section 20 of the health insurance fund may provide for



1. application for and the calculation and payment of compensation

under the Act (2008:145) on State dental care,



2. subscription dentistry,



3. notification of new replacement period under Chapter 2. paragraph 4 of the law on

State dental care and if after such period shall begin

run,



4. connection to the Swedish social insurance agency's electronic system for

State dental care,



5. the healthcare provider's obligation under Chapter 3. paragraph 3 of the first

law on State dental care,



6. the application for prior authorisation,



7. price lists pursuant to section 8,



8. treatment plans according to section 10, as well as



9. the Protocol according to section 12.



Insurance agency may announce further provisions concerning

the enforcement of the law on State dental care and of

This regulation.



section 21 of the National Board may provide for the caregiver

obligation under Chapter 3. the second subparagraph of paragraph 3 of the law

(2008:145) on State dental care.



section 22 of the dental and pharmaceutical benefits agency must notify

regulations about when prior examination shall be carried out in other cases

than those referred to in Chapter 4. 5-6 of the Act (2008:145) on State

dental care. Regulation (2011:1184).



Transitional provisions



2008:193



1. This Regulation shall enter into force on 1 July 2008, when

Ordinance (1998:1337) if dental tariff shall cease to

apply.



2. For dental measures that have been initiated before the entry into force

for older replacement provisions.



2008:844



This Regulation shall enter into force on 1 december 2008. The

repealed annexes and paragraph 5 of its older version, however,

still for those dental measures have commenced before

end of december 2008.



Annex I repealed Regulation (2008:844).



Annex 2 is repealed by Regulation (2008:844).