WAC 388-535-1065   Coverage limits for dental-related services provided under the GA-U and ADATSA programs.  (1) Clients who receive medical care services under the following programs may receive the dental-related services described in this section:

     (a) General assistance unemployable (GA-U); and

     (b) Alcohol and drug abuse treatment and support act (ADATSA).

     (2) The department covers the following dental-related services for a client eligible under the GA-U or ADATSA program:

     (a) Services provided only as part of dental treatment for:

     (i) Limited oral evaluation;

     (ii) Periapical or bite-wing radiographs that are medically necessary to diagnose only the client's chief complaint;

     (iii) Palliative treatment to relieve dental pain;

     (iv) Pulpal debridement to relieve dental pain; or

     (v) Endodontic (root canal only) treatment for maxillary and mandibular anterior teeth (cuspids and incisors) when prior authorized).

     (b) Tooth extraction when at least one of the following apply:

     (i) The tooth has a radiograph apical lesion;

     (ii) The tooth is endodontically involved, infected, or abscessed;

     (iii) The tooth is not restorable; or

     (iv) The tooth is not periodontally stable.

     (3) Tooth extractions require prior authorization when:

     (i) The extraction of a tooth or teeth results in the client becoming edentulous in the maxillary arch or mandibular arch; and

     (ii) A full mouth extraction is necessary because of radiation therapy for cancer of the head and neck.

     (4) Each dental-related procedure described under this section is subject to the coverage limitations listed in chapter 388-535 WAC.

     (5) The department does not cover any dental-related services not listed in this section for clients eligible under the GA-U or ADATSA program, including any type of removable prosthesis (denture).



[Statutory Authority: RCW 74.04.050, 74.08.090. 07-17-107, § 388-535-1065, filed 8/17/07, effective 9/17/07. Statutory Authority: RCW 74.08.090, 74.09.500, 74.09.520. 07-06-041, § 388-535-1065, filed 3/1/07, effective 4/1/07. Statutory Authority: RCW 74.04.050, 74.04.057, and 74.09.530. 04-14-100, § 388-535-1065, filed 7/6/04, effective 8/6/04. Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.530, 2003 1st sp.s. c 25, P.L. 104-191. 03-19-077, § 388-535-1065, filed 9/12/03, effective 10/13/03.]