WAC 388-535-1079   Dental-related services for clients through age twenty -- General.  (1) Subject to coverage limitations, the department pays for dental-related services and procedures provided to clients through age twenty when the services and procedures:

     (a) Are within the scope of an eligible client's medical care program;

     (b) Are medically necessary;

     (c) Meet the department's prior authorization requirements, if any;

     (d) Are documented in the client's record in accordance with chapter 388-502 WAC;

     (e) Are within accepted dental or medical practice standards;

     (f) Are consistent with a diagnosis of dental disease or condition;

     (g) Are reasonable in amount and duration of care, treatment, or service; and

     (h) Are listed as covered in the department's published rules, billing instructions and fee schedules.

     (2) Under the early periodic screening and diagnostic treatment (EPSDT) program, clients ages twenty and younger may be eligible for dental-related services listed as noncovered.

     (3) Clients who are eligible for services through the division of developmental disabilities may receive dental-related services according to WAC 388-535-1099.

     (4) The department evaluates a request for dental-related services:

     (a) That are in excess of the dental program's limitations or restrictions, according to WAC 388-501-0169; and

     (b) That are listed as noncovered according to WAC 388-501-0160.



[Statutory Authority: RCW 74.08.090, 74.09.500, 74.09.520. 07-06-042, § 388-535-1079, filed 3/1/07, effective 4/1/07.]