TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER d: MEDICAL PROGRAMS
PART 140 MEDICAL PAYMENT
SECTION 140.420 DENTAL SERVICES


 

Section 140.420  Dental Services

 

Effective for dates of service on or after July 1, 2014, except as otherwise specified in this Section:

 

a)         Except as outlined in subsection (b), payment for dental services shall be made only to enrolled licensed dentists.

 

b)         Payment for oral health screening and fluoride varnish services shall be made to enrolled licensed dentists, and physicians or advance practice nurses (APNs) who are trained and approved to provide oral health screening and fluoride varnish services.

 

c)         Payment for comprehensive orthodontic care shall be made only to a dentist licensed for provision of those services.

 

d)         Except as specified in subsections (e) and (f), payment shall be made for allowable dental services specified in Table D that are:

 

1)         Necessary to relieve pain or infection, preserve teeth, or restore adequate dental function;

 

2)         Diagnostic, preventive, or restorative services, endodontics, prosthodontics, orthodontics or oral surgery included in the Department's Schedule of Dental Procedures (see Table D); and

 

3)         Performed by the dentist or under the direct supervision of the dentist, or for oral health screening and fluoride varnish services, performed by or under the direct supervision of an enrolled licensed dentist, physician or APN.

 

e)         Payment shall not be made for experimental dental care and procedures performed only for cosmetic reasons.

 

f)         Effective for dates of service July 1, 2012 through June 30, 2014, notwithstanding other provisions of this Section or Section 140.421, dental services rendered to recipients age 21 years and older shall be limited to those dental services that are medically necessary to treat pain, infection, swelling, uncontrolled bleeding, or traumatic injury that can be treated by extraction and dental services that are medically necessary as a prerequisite for necessary medical care.

 

(Source:  Amended at 38 Ill. Reg. 23623, effective December 2, 2014)