| (a) The facility must assist a resident in obtaining
routine and 24-hour emergency dental care.
(1) At the time of admission, the facility must obtain
the name of the resident's preferred dentist and record the name in
the clinical record.
(2) At least annually, the facility must ask each resident
and resident representative if the resident desires a dental examination
at the resident's expense.
(3) The facility must make all reasonable efforts to
arrange for a dental examination for each resident who desires one.
(4) The facility is not liable for the cost of the
resident's dental care.
(5) Licensed-only facilities must maintain a list of
local dentists for a resident who requires a dentist.
(b) Medicaid-certified facilities also must provide
or obtain from an outside resource, in accordance with §19.1906
of this chapter (relating to Use of Outside Resources), the following
dental services to meet the needs of each resident:
(1) Emergency dental services, which are limited to
procedures necessary to control bleeding, relieve pain, and eliminate
acute infection; operative procedures which are required to prevent
the imminent loss of teeth; treatment of injuries to the teeth or
supporting structures.
(A) Covered emergency dental procedures include:
(i) alleviation of extreme pain in oral cavity associated
with serious infection or swelling;
(ii) repair of damage from loss of tooth due to trauma
(acute care only, no restoration);
(iii) open or closed reduction of fracture of the maxilla
or mandible;
(iv) repair of laceration in or around oral cavity;
(v) excision of neoplasms, including benign, malignant
and premalignant lesions, tumors and cysts;
(vi) incision and drainage of cellulitis;
(vii) root canal therapy, for which payment is subject
to dental necessity review and pre- and post-operative x-rays are
required; and
(viii) extractions: single tooth, permanent; single
tooth, primary; supernumerary teeth; soft tissue impaction; partial
bony impaction; complete bony impaction; surgical extraction of erupted
tooth or residual root tip.
(B) Routine restorative procedures are not considered
emergency procedures. Dental services not covered include:
(i) cleaning;
(ii) filling teeth with amalgam composite, glass ionomer,
or any other restorative material;
(iii) cast or preformed crowns (capping);
(iv) restoration of carious or noncarious permanent
or primary teeth, including those requiring root canal therapy;
(v) replacement or repositioning of teeth;
(vi) services to the alveolar ridges or periodontium
of the maxilla and the mandible, except for procedures covered under
subparagraph (A) of this paragraph; and
(vii) complete or partial dentures.
(2) Assistance to the resident, if necessary:
(A) in making appointments; and
(B) by arranging for transportation to and from the
dentist's office.
(3) Prompt referral, within three days, of a resident
with lost or damaged dentures for dental services. If a referral does
not occur within three days, the facility must provide documentation
of what they did to ensure the resident could still eat and drink
adequately while awaiting dental services and the extenuating circumstances
that led to the delay.
(4) Coordination of dental services for pediatric residents
age 12 months to 21 years, in accordance with Texas Health Steps (THSteps)
guidelines.
(c) The facility must have a written policy identifying
those circumstances when the loss or damage of dentures is the facility's
responsibility and may not charge a resident for the loss or damage
of dentures determined in accordance with facility policy to be the
facility's responsibility.
(d) Medicaid-certified facilities are not required
to provide routine dental services.
(e) Payment for services provided on the teeth, gums,
alveolar ridges, and supporting structures are not a benefit of the
Texas Medicaid Program; however, recipients with applied income may
use incurred medical expenses to pay for routine dental services and
appliances.
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| Source Note: The provisions of this §554.1401 adopted to be effective May 1, 1995, 20 TexReg 2393; amended to be effective March 24, 2020, 45 TexReg 2025; transferred effective January 15, 2021, as published in the Texas Register December 11, 2020, 45 TexReg 8871 |
