Date: January 15, 2019
To: Participating Dentists and Orthodontists
Re: Revised Orthodontia Scoring Tool
This notice informs providers that effective with dates of service on or after January 1, 2019, the Department is implementing an additional automatic qualifier to the orthodontia scoring tool, Handicapping Labio-Lingual Deviation Index (HLD).
Participants are required to either score a minimum of 28 points on the HLD or automatically qualify to be eligible to receive medically necessary orthodontia services. The automatic qualifiers now include:
· Cleft palate.
· Deep impinging bite with signs of tissue damage, not just touching palate.
· Anterior cross bite with gingival recession.
· Severe traumatic deviation – attach description (i.e., accidents, tumors, etc.).
· Impacted maxillary central incisor.
Additional Orthodontia Services Information
· A patient’s eligibility may change during the course of treatment, therefore, it is imperative that providers check MEDI on the date of each service to determine if the individual is 1) eligible for services and 2) participating in fee-for-service or enrolled in an MCO health plan.
· Broken brackets are not reimbursable and are considered part of the Medicaid payment. Eligible participants should not be charged for broken brackets.
· Authorizations are valid for three years. If additional time is needed to complete an orthodontic case, an extension must be requested.
· Participants should not be charged for the continuation of services as long as the patient remains eligible.
For questions regarding this notice, please contact your provider representative or the Department’s Bureau of Professional and Ancillary Services at 877-782-5565.
Interim Medicaid Director