Library: Policy

317:40-5-112. Dental services

Revised 9-1-17

(a) Applicability.Coverage applies to members:

(1) receiving dental services through the Homeward Bound Waiver; and

(2) 21 years of age and older receiving dental services through the Community Waiver or In-Home Supports Waiver for adults.

(b) Description of services.Dental services include services per OAC 317:30-5-482. Preventative, restorative, replacement, and repair services to achieve or restore functionality are provided after appropriate review, when required per OAC 317:40-5-112(e).

(c) Standard of care.Comprehensive diagnostic and treatment services are authorized for each member eligible to receive such services from qualified personnel including licensed dentists and dental hygienists per applicable Home and Community-Based Services (HCBS) Waiver limits. Part 79 of OAC 317:30-5 and dental guidelines published by the Oklahoma Health Care Authority (OHCA) must be followed.

(d) Providers.Providers of dental services must have a non-restrictive license to practice dentistry in Oklahoma or the state where treatment is rendered.

(e) Treatment plan.A proposed dental treatment plan must be submitted to the member and Personal Support Team (Team) for review.

(1) All arrangements for services must be made with the Developmental Disabilities Services (DDS) case manager and be specified in the member's Individual Plan (IP).

(2) Requests for pre-authorization must propose services that are the most cost effective to restore dental health per OHCA published dental guidelines.

(f) Frequency of examination.The dentist and Team determine frequency of examinations on an individual basis.

(g) Documentation of dental services. The dental provider summarizes dental services on the Oklahoma Department of Human Services (DHS) Form 06HM005E, Referral Form for Examination or Treatment, or comparable form for members who receive residential services.

(h) Prevention.The member's IP must address the prevention of dental disease and promotion of dental health.Independence in oral hygiene care is promoted. When the member is unable to maintain adequate oral hygiene as determined by the dentist and Team, direct assistance and responsibility must be assigned to appropriate Team members in the IP.