405 IAC 5-14-20 Dental services provided in a state owned ICF/IID

Sec. 20. Dental services that can be provided in a state owned ICF/IID shall be included in the per diem rate and do not require prior authorization. Necessary dental services that cannot be provided on-site by the dental staff require prior authorization according to the following: (1) Dental services prior authorized by the contractor must be billed to Medicaid directly by the outside dental provider. (2) Prior authorization shall not be given for dental services provided off-site that are included within the per diem rate. (3) Documentation on the Medicaid dental prior authorization request must substantiate: (A) the dental service is medically necessary; and (B) an explanation of why the service cannot be rendered at the facility. (4) The office will review criteria for prior authorization set forth in this rule for the specific dental service requested.