(1) Clients who receive medical care services under the following programs may receive the dental-related services described in this section:
(a) General assistance unemployable (GA-U); and
(b) Alcohol and drug abuse treatment and support act (ADATSA).
(2) The department covers the following dental-related services for a client eligible under the GA-U or ADATSA program:
(a) Services provided only as part of dental treatment for:
(i) Limited oral evaluation;
(ii) Periapical or bite-wing radiographs that are medically necessary to diagnose only the client's chief complaint;
(iii) Palliative treatment to relieve dental pain;
(iv) Pulpal debridement to relieve dental pain; or
(v) Endodontic (root canal only) treatment for maxillary and mandibular anterior teeth (cuspids and incisors) when prior authorized).
(b) Tooth extraction when at least one of the following apply:
(i) The tooth has a radiograph apical lesion;
(ii) The tooth is endodontically involved, infected, or abscessed;
(iii) The tooth is not restorable; or
(iv) The tooth is not periodontally stable.
(3) Tooth extractions require prior authorization when:
(i) The extraction of a tooth or teeth results in the client becoming edentulous in the maxillary arch or mandibular arch; and
(ii) A full mouth extraction is necessary because of radiation therapy for cancer of the head and neck.
(4) Each dental-related procedure described under this section is subject to the coverage limitations listed in chapter
388-535 WAC.
(5) The department does not cover any dental-related services not listed in this section for clients eligible under the GA-U or ADATSA program, including any type of removable prosthesis (denture).
[Statutory Authority: RCW 74.04.050, 74.08.090. 07-17-107, § 388-535-1065, filed 8/17/07, effective 9/17/07. Statutory Authority: RCW 74.08.090, 74.09.500, 74.09.520. 07-06-041, § 388-535-1065, filed 3/1/07, effective 4/1/07. Statutory Authority: RCW 74.04.050, 74.04.057, and 74.09.530. 04-14-100, § 388-535-1065, filed 7/6/04, effective 8/6/04. Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.530, 2003 1st sp.s. c 25, P.L. 104-191. 03-19-077, § 388-535-1065, filed 9/12/03, effective 10/13/03.]