S.D. Admin. R. 67:16:11:03.06

Current through Register Vol. 51, page 67, December 16, 2024

Section 67:16:11:03.06 - Orthodontic treatment

Orthodontic treatment is subject to prior authorization. The authorization is based on the results of an orthodontic evaluation and assessment completed by the treating dentist or orthodontist. In addition, the following requirements must be met:

(1) The treatment is medically necessary to correct a handicapping malocclusion;

(2) There are reasonable assurances that the teeth are in good condition and will remain in good condition for a considerable length of time; and

(3) There is reason to anticipate that the recipient will be compliant with scheduled appointments and the treating dentist's or orthodontist's treatment plan.

S.D. Admin. R. 67:16:11:03.06

17 SDR 37, effective 9/11/1990; 17 SDR 184, effective 6/6/1991; 19 SDR 56, effective 10/19/1992; 19 SDR 202, effective 7/5/1993; 23 SDR 197, effective 5/26/1997; 35 SDR 88, effective 10/23/2008.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.

Covered services must be medically necessary, § 67:16:01:06.02;