Section 482-5-004 - SERVICES IN THE DENTAL BENEFITS PACKAGEThe Dental Benefits Manager must provide the services listed in the Nebraska Medicaid Dental Fee Schedule in amount, duration and scope defined by Medicaid in 471 NAC 6.
004.01DENTAL BENEFITS MANAGER AND ACCESS STANDARDS. The Dental Benefits Manager is responsible for ensuring the eligible member has access to all services when medically necessary.004.01(A)ACCESSIBILITY. The Dental Benefits Manager must ensure services provided to the member are accessible, in terms of timeliness, amount, duration, and scope, as those services provided to the non-managed care member.004.01(B)LIMITATIONS. The Dental Benefits Manager may place appropriate limits on services based on medical necessity or utilization control.004.01(C)ADDITIONAL AND SUBSTITUTE SERVICES. The Dental Benefits Manager is allowed to provide additional medically necessary services than those covered by Medicaid. The Dental Benefits Manager is also allowed to provide substitute dental services when the Dental Benefits Manager determines the service is more cost effective than the covered service and the health status of the member is expected to improve or stabilize. (i) If the Dental Benefits Manager provides additional or substitute dental services, the Department will not adjust the rate or total payment to the Dental Benefits Manager as the contract between the two parties dictate. The rate will remain within the rate range that the Centers for Medicare and Medicaid Services approved and certified.482 Neb. Admin. Code, ch. 5, § 004
Amended effective 7/29/2020Amended effective 9/27/2021