Adopted and Filed

Dental program—payment for emergency services, annual benefit maximum, amendments to ch 78

Untitled document

ARC 6389C

HUMAN SERVICES DEPARTMENT[441]

Adopted and Filed

Rule making related to emergency dental services

The Human Services Department hereby amends Chapter 78, "Amount, Duration and Scope of Medical and Remedial Services," Iowa Administrative Code.

Legal Authority for Rule Making

This rule making is adopted under the authority provided in Iowa Code section 249A.4.

State or Federal Law Implemented

This rule making implements, in whole or in part, Iowa Code section 249A.4.

Purpose and Summary

The Department is adopting this rule making for the dental program to clarify that payment will be made for emergency services as defined in the federal regulations set forth in 42 CFR 438.114 as amended to April 7, 2022. This rule making also sets an annual benefit maximum for members 21 years of age or older of $1,000 per fiscal year for coverage of dental services as set forth in rule 441—78.4(249A). Preventive services, diagnostic services, emergency services, anesthesia, and fabrication of removable dentures and related services do not count toward the annual benefit amount.

Public Comment and Changes to Rule Making

Notice of Intended Action for this rule making was published in the Iowa Administrative Bulletin on May 4, 2022, as ARC 6313C. No public comments were received. No changes from the Notice have been made.

Adoption of Rule Making

This rule making was adopted by the Council on Human Services on June 9, 2022.

Fiscal Impact

This rule making aligns rules with waiver and State Plan Amendment policies. Based on analysis by the Iowa Medicaid actuary and incorporated within current capitation rates, it is anticipated this rule making will result in a cost savings to the State. This change is already in effect, and savings have been incorporated into the Medicaid budget.

Jobs Impact

After analysis and review of this rule making, no impact on jobs has been found.

Waivers

Any person who believes that the application of the discretionary provisions of this rule making would result in hardship or injustice to that person may petition the Department for a waiver of the discretionary provisions, if any, pursuant to rule 441—1.8(17A,217).

Review by Administrative Rules Review Committee

The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee's meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).

Effective Date

This rule making will become effective on September 1, 2022.

The following rule-making actions are adopted:

Item 1. Adopt the following new subrules 78.4(11) and 78.4(12):

78.4(11) Emergency services. Payment shall be made for emergency services, as defined in and pursuant to the requirements set forth in 42 CFR 438.114, as amended to April 7, 2022.

78.4(12) Annual benefit maximum.

a. Members 21 years of age or older have an annual benefit maximum of $1,000 per state fiscal year for coverage of dental services set forth in this rule. Payment for services exceeding the $1,000 annual benefit maximum is the responsibility of the member.

b. The following services do not count toward the annual benefit maximum:

(1)Preventive services as set forth in subrule 78.4(1);

(2)Diagnostic services as set forth in subrule 78.4(2);

(3)Fabrication of removable dentures and related services as set forth in paragraphs 78.4(7)"a" to "c" and 78.4(7)"f" to "l";

(4)Anesthesia as set forth in paragraph 78.4(9)"f," when provided in conjunction with oral surgery codes approved for payment; or

(5)Emergency services as set forth in subrule 78.4(11).

Item 2. Adopt the following new implementation sentence in 441—Chapter 78:

These rules are intended to implement Iowa Code chapter 249A.

[Filed 6/10/22, effective 9/1/22]

[Published 6/29/22]

Editor's Note: For replacement pages for IAC, see IAC Supplement 6/29/22.

Human Services Department

Official Document

  • Dental program—payment for emergency services, annual benefit maximum, amendments to ch 78
  • Published on 6/29/2022
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  • Adopted and Filed

The official published PDF of this document is available from the Iowa General Assembly’s Administrative Rules page.

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View the Iowa Administrative Bulletin for 6/29/2022.

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Related Notices

Administrative Rule References

The following administrative rule references were added to this document. You may click a reference to view related notices.

Rule 441-78.4(1) Rule 441-78.4(11) Rule 441-78.4(12) Rule 441-78.4(2) Rule 441-78.4(7) Rule 441-78.4(9)

Iowa Code References

The following Iowa code references were added to this document. You may click a reference to view related notices.

Iowa Code 249A

Keywords

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Annual benefit maximum Emergency services
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