Pediatric Dental Fee and Adult Dental Services

The Division of Medicaid and Health Financing (DMHF) will submit a change to the Medicaid State Plan through SPA 16-0024-UT, Pediatric Dental Fee and Adult Dental Services. The purpose of this amendment is to provide dental services to blind or disabled individuals in accordance with S.B. 39 passed during the 2016 General Session, and to provide a fee-for-service supplemental payment to pediatric dental providers in accordance with legislative appropriations for pediatric dental services.

This amendment, therefore, makes dental services available to blind or disabled individuals, and specifies the annual time period that Medicaid will reimburse pediatric dental providers with a supplemental payment based on paid claims from the previous period of interest. This amendment also specifies limited emergency dental services available to all other eligible individuals, updates the effective date of rates for dental and denture services to July 1, 2016, and makes other clarifications.

DMHF estimates total annual expenditures to be about $2,750,000 to make dental services available to blind or disabled individuals, and estimates a total annual cost of about $684,900 to implement the supplemental payment for pediatric dental providers.

The proposed effective date to implement the supplemental payment to pediatric dental providers is July 1, 2016, and the proposed effective date to implement dental services for blind or disabled individuals is May 1, 2017.

This amendment is pending approval from the Centers for Medicare and Medicaid Services.

A copy of the change may be obtained from Craig Devashrayee (801-538-6641), or by writing the Technical Writing Unit, Utah Department of Health, PO Box 143102, Salt Lake City, UT 84114-3102. Comments are welcome at the same address. Copies of the change are also available at local county health department offices.