TO: INTERMEDIATE CARE FACILITIES FOR THE MENTALLY RETARDED (ICF/MR)
FROM: PAUL SWATSENBARG, Deputy Administrator
Division of Medicaid
Effective April 1, 2002, Legislative intent limited Medicaid dental coverage for adults to emergency services. However, ICF/MR facilities are required by federal law to provide preventive and routine dental services to all residents. Federal ICF/MR regulations at 42 CFR §483.460(e) through (h) require both diagnostic and treatment dental services by facilities, including "restoration of teeth and maintenance of dental health." Therefore, despite the Legislative intent, comprehensive dental services are still a necessary cost of ICF/MR services.
Additionally, Legislative intent requires a freeze on daily and special ICF/MR rates through June 2002. Although Medicaid’s automated claims system is unable to directly reimburse dentists who provide non-emergency adult dental services to ICF/MR residents between April and June 2002, these costs will be recognized through the current prospective payment system to ICF/MR facilities.
The following process will enable dentists to bill for covered services while recognizing costs federally required to be incurred by ICFs/MR:
· Dentists who provide services to ICF/MR residents will continue to bill Medicaid using the existing claims processing system.
· Medicaid’s claims processing system will process payment for emergency adult dental services and dental services to children. The system will deny payment for non-emergency adult dental care.
· ICF/MR facilities will need to notify the dentists who see their residents to bill the ICF/MR after Medicaid has denied or paid the claim. Dentists will bill the denied services for non-emergency dental care, using the existing billing requirements, to the appropriate ICF/MR facility.
· ICF/MR facilities will pay dentists for the non-emergency adult dental services according to the existing Medicaid fee schedule (see attached and for future reference, consult the on-line pricing file at www2.state.id.us/dhw/medicaid/fee_schedule.htm).
· ICF/MR dental costs will roll into each facility’s cost report which will be used to calculate daily rates through the prospective payment system.
Medicaid will work with ICF/MR facilities and its existing dental providers to make this process as efficient as possible. Dentists who provide services to ICF/MR residents will be notified by Medicaid of this change in billing procedure. Should you have questions or would like clarification regarding this information release, please contact Colleen Osborn at 208-334-5795, ext. 16.
Attachment not available electronically.