Appendix IV, Dental Treatment

Body

Revision 11-1; Effective June 13, 2011

 

Dental treatment consists of dental services and dental sedation.

Dental services within the Community Living Assistance and Support Services (CLASS) program include the following.

  • Emergency Dental Treatment — Includes procedures necessary to control bleeding, relieve pain and eliminate acute infection; operative procedures that are required to prevent the imminent loss of teeth; and treatment of injuries to the teeth or supporting structures.
  • Routine Preventative Dental Treatment — includes examinations, X-rays, cleanings, sealants, oral prophylaxes and topical fluoride applications.
  • Therapeutic Dental Treatment — Includes fillings; scaling; extractions; crowns; pulp therapy for permanent and primary teeth; restoration of carious permanent and primary teeth; maintenance of space; and limited provision of removable prostheses when masticatory function is impaired, when an existing prosthesis is unserviceable, or when aesthetic considerations interfere with employment or social development.
  • Orthodontic Dental Treatment — Includes treatment of retained deciduous teeth; cross-bite therapy; facial accidents involving severe traumatic deviations; cleft palates with gross malocclusion that will benefit from early treatment; and severe, handicapping malocclusions affecting permanent dentition with a minimum score of 26 as measured on the Handicapping Labio-lingual Deviation Index.

Note: Dental treatment in CLASS does not include cosmetic orthodontia.

Dental sedation in CLASS includes sedation that is necessary to perform dental treatment, including non-routine anesthesia, (for example, intravenous sedation, general anesthesia or sedative therapy prior to routine procedures).

Note: Dental sedation does not include administration of routine local anesthesia.

The maximum amount the Department of Aging and Disability Services (DADS) authorizes as payment for all adaptive aids and dental treatment combined is $10,000 per Individual Plan of Care (IPC) year.

Individuals must exhaust all non-CLASS resources before requesting dental treatment through CLASS.

Note: Individuals under age 21 have access to Texas Health Steps for their dental treatment and as such do not qualify to receive dental treatment in CLASS.

Procurement Process for Dental Services/Dental Sedation

The case management agency (CMA) must:

  • provide general information about the availability of dental services/dental sedation to the individual or legally authorized representative (LAR) during service planning and at any other time upon request by the individual or LAR.
  • inform the individual or LAR about the limitations of dental services/dental sedation as it applies in CLASS.
  • aid the individual or LAR to access non-CLASS resources for needed dental care.
  • complete, with input from the individual or LAR, Part A of Form 3660, CLASS – Request for Adaptive Aids, Medical Supplies, Minor Home Modifications or Dental Services/Sedation.
  • complete Part B of Form 3660.
  • submit Form 3660 to the direct service agency (DSA) selected by the individual or LAR no later than 14 business days from completion of Form 3660, Part A. Note: This form must be signed by the individual or LAR.
  • receive and review the dental treatment plan for the individual.
  • initiate an IPC revision within five business days of receipt of Form 3660 and the treatment plan.
  • transmit an IPC revision signed by all applicable service planning team (SPT) members to DADS at least 30 calendar days before the effective date proposed by the SPT.
  • provide a record of the DADS-approved IPC to all SPT members.
  • monitor service delivery in accordance with the IPC and Individual Program Plan (IPP) and applicable CLASS standards.

The DSA must:

  • complete Form 3660, Part C, within five business days of receipt from the CMA.
  • obtain a written treatment plan from a qualified service provider for dental treatment (a person licensed to practice dentistry, dental surgery or dental hygiene in accordance with Texas Occupations Code, Chapter 256) within 14 business days of receipt of the request (Form 3660). The individuals' preferences in the selection of the service provider for dental treatment should be considered when obtaining the treatment plan.
  • ensure the treatment plan includes a complete description of the proposed dental services, dental sedation service and a breakdown of the cost for each element of the proposed service.
  • provide a copy of the proposed treatment plan to the CMA.

Once the DSA has determined the cost of the requested dental treatment and/or dental sedation, the DSA must request in writing that the case manager initiate an IPC revision. The DSA must inform the individual's case manager of the cost of the requested dental treatment and/or dental sedation.

After reviewing submitted documentation, if DADS determines the requested dental treatment and/or dental sedation meets the standards outlined in this appendix, DADS authorizes the IPC.

The DSA must initiate delivery of the requested dental treatment and/or dental sedation within14 calendar days after the date DADS authorizes the proposed IPC or the effective date of the individual's IPC, as determined by the SPT (whichever is later).

If the DSA cannot provide the dental treatment and/or dental sedation within the time frame described, the DSA must:

  • notify the individual and the individual's case manager, orally or in writing before the 14-day time frame expires, that the dental treatment and/or dental sedation will not be provided within the 14-day time frame; and
  • notify the individual and the individual's case manager of a new proposed date for provision of the dental treatment and/or dental sedation.

Immediate Jeopardy

When an individual requires emergency dental treatment and/or dental sedation, the DSA will provide the services in accordance with Section 3330, Revision, and Section 3510, Immediate Jeopardy. Following provision of emergency dental treatment, the CMA must complete an IPC revision in accordance with Section 2331, Immediate Jeopardy.