10A NCAC 25H .0204       AMOUNT: DURATION: AND SCOPE OF SERVICES

(a)  Necessary and essential dental services, subject to the criteria and restrictions in the North Carolina Dental Manual are covered for all eligible Medicaid recipients.  Only the procedures listed in the North Carolina Dental Manual are generally covered under the North Carolina Dental Program.

(b)  Exceptions may be made when recommended by the Dental Consultant and approved by the agency head when:

(1)           An emergency condition causing pain or suffering needs immediate attention; or

(2)           An alternative dental treatment plan is safe, medically acceptable and less expensive but is not on the procedure list; or

(3)           The procedure is medically necessary and is of such complexity and the circumstances are so unusual that a coverage decision requires individual consideration based on the medical condition of the client, diagnosis, prognosis, and the unavailability of other alternative treatment options.

 

History Note:        Authority G.S. 108A‑25(b); S.L. 1985, c. 479, s. 86;

Eff. February 1, 1976;

Readopted Eff. October 31, 1977;

Amended Eff. May 1, 1990; February 29, 1980;

Transferred from 10A NCAC 22O .0204 Eff. May 1, 2012;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. July 23, 2016.