Or. Admin. Code § 410-123-0010

Current through Register Vol. 63, No. 12, December 1, 2024

Section 410-123-0010 - Foreword

(1) The Oregon Health Plan (OHP) offers Medicaid dental/denturist benefits on a fee-for-service (FFS) basis and through Managed Care Entities (MCE). These rules are Division rules to give FFS providers direction in the delivery of dental services and in the preparation of dental care claims.

(2) MCE provide dental/denturist services under an approved contract with the Authority. In accordance with 42 CFR 438.210, MCEs are required to provide medical and dental services in an amount, duration and scope. In accordance with 42 CFR 438.210, MCEs are required to provide medical and dental services in an amount, duration and scope that meets the minimum requirements for amount, duration and scope for the same services provided under FFS Medicaid., duration and scope for the same services provided under FFS Medicaid.

(a) MCEs must adhere to the FFS Dental/Denturist Services rules in providing the minimum standard of care required per federal regulations and within the MCE's contract. MCEs may provide services above and beyond these rules, according to each contract agreement, State Plan, and 1115 Waiver.

(b) For members enrolled in an MCE, refer to the MCE rules and contracts for services rendered above and beyond the minimum standard found within the FFS Dental/Denturist Services rules or guides. The MCE has the authority to provide more services than those found in these rules, as long as the amount, duration and scope is no less than the amount, duration and scope for the same services provided in these rules.

(c) The FFS Dental/Denturist rules do not list every policy, procedure, and criteria for services. All Division rules shall be used in conjunction with the General Rules for Oregon Medical Assistance Programs (OAR chapter 410, division 120), and the Oregon Health Plan (OHP) Administrative Rules for Managed Care Entities (OAR chapter 410, division 141).

Or. Admin. Code § 410-123-0010

DMAP 50-2021, adopt filed 12/24/2021, effective 1/1/2022; DMAP 89-2022, amend filed 12/16/2022, effective 1/1/2023; DMAP 56-2024, minor correction filed 02/21/2024, effective 2/21/2024

Statutory/Other Authority: ORS 413.042 & ORS 414.065

Statutes/Other Implemented: ORS 414.065