Chapter 4: Department of Social Services Medical Services Policy Overview
Chapter 4 outlines current regulations, and how to access the most current policy. It also reviews the policy sections, The Medical Necessity: Section 22 of Public Act 10-03 (Deficit Mitigation Act) and Commonly Asked Questions – regarding missed appointments and financial arrangements.
Chapter Contents:
- Current Regulations
- How to Access the Most Current Policy
- Department of Social Services Medical Services Policy
- Medical Necessity: Section 22 of Public Act 10-03 (Deficit Mitigation Act)
- Services Which Cannot be Charged to an Eligible HUSKY Client
Current Regulations
Chapter Seven of the Connecticut Medical Assistance Program contains the current dental regulations that CTDHP/BeneCare will use to determine whether or not a service meets qualifying standards under the program as related to the client’s medical necessity.
CTDHP/BeneCare dental consultants may request additional prior authorization documentation to better evaluate whether a service is appropriate or not. Any updates to state policy will be communicated to providers in the form of a Policy Transmittal or bulletin distributed by Gainwell. You should maintain copies of them as they are received.
How to Access the Most Current Policy
- To access Chapter Seven, go to www.ctdssmap.com
- On the left-hand menu bar, locate the “Information” box
- Select “Publications” from this box
- Locate Chapter 7
- Select “Dental” from the drop-down box that states “Select a Provider Type”
- Click “View Chapter 7”
New regulations are expected to be released in the future. You will be given a thirty (30) day notice by the Department before any new regulations become effective.
Department of Social Services Medical Policy
This section outlines the medical services policy and regulations of the Connecticut State Agencies as they relate to dental services, dental practices, dental hygienists and clinics. Topics in each section below include:
- Scope
- Definitions
- Provider participation
- Eligibility
- Services covered and limitations
- Services not covered
- Billing procedures
- Documentation of services provided
- Summary of Benefits Grid
Dental Services
Chapter 7 Pgs 1-19
For the purposes of this section, dental services are diagnostic, preventive, or restorative procedures, performed by a licensed dentist in a private or group practice or in a clinic; a dental hygienist, trained dental assistant or, or other dental professionals employed by the dentist, group practice or clinic, providing such services are performed within the scope of their profession in accordance with State law.
These services relate to:
I. The teeth and other structures of the oral cavity; and
II. Disease, injury, or impairment of general health only as it relates to the oral health of the recipient.
Clinics
Chapter 7 Pgs 20-23
For the purposes of this Section, clinics are facilities not associated with a hospital. They provide medical or medically-related services for diagnosis, treatment and care of persons with chronic or acute conditions.
Dental Clinics
Chapter 7 Pgs 24-36
A dental clinic provides diagnostic, preventive, or restorative procedures to outpatients in a clinic staffed by dentists, dental hygienists, dental assistants and other dental professionals performing within the scope of their profession in accordance with State law.
Services performed relate to:
I. The teeth and other structures of the oral cavity; and
II. Disease, Injury, or impairment of general health only as it relates to the oral health of the recipient.
Requirements for Payment of Public Health Dental Hygienist Services (Regulations of Connecticut State Agencies)
Chapter 7 Last 7 pages
Sections 17b-262-693 to 17b-262-700, inclusive, set forth the requirements for payment of public health dental hygienist services for persons determined eligible for Connecticut’s Medicaid Program pursuant to Section 17b-262 of the Connecticut General Statutes.
Summary of Benefits Grid
The summary of dental benefits grid for providers is located in the dropdown menu for Dental Providers on ctdhp.org.
It is also easily accessible from the Welcome page:
https://ctdhp.org/dental-providers/welcome/
Dental Coverage List as of 1/10/24
