WAC 388-535-1247   Dental-related services for clients age twenty-one and older -- General.  (1) Subject to coverage limitations, the department pays for dental-related services and procedures provided to clients age twenty-one and older when the services and procedures:

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

     (b) Are medically necessary as defined in WAC 388-500-0005;

     (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 prevailing standard of care 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) Clients who are eligible for services through the division of developmental disabilities may receive dental-related services under the provisions of WAC 388-535-1099.

     (3) 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 under the provisions in WAC 388-501-0160.



[Statutory Authority: RCW 74.08.090, 74.09.500, 74.09.520. 07-06-041, § 388-535-1247, filed 3/1/07, effective 4/1/07.]