Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid 600 Washington Street Boston, MA 02111 www.mass.gov/masshealth Eligibility Operations Memo 09-17 September 15, 2009 TO: MassHealth Eligibility Operations Staff FROM: Russ Kulp, Director, MassHealth Operations RE: Dental Coverage for Certain Family Assistance Premium Assistance Members Introduction Effective October 1, 2009, MassHealth will provide dental benefits to Family Assistance members under age 19 who are receiving Family Assistance premium assistance payments. This change is being made to comply with the Children’s Health Insurance Program Reauthorization Act (CHIPRA). Benefits The dental coverage provided will be the same benefit that is provided to all MassHealth members under age 21, excluding those members who have coverage under MassHealth Limited. The coverage includes, but is not limited to, the following services: * emergency care visits; * diagnostic services, including oral evaluation (comprehensive and periodic); * radiographs (X rays); * preventive services, including prophylaxis (cleanings), periodontal scaling and root planing, and gingivectomy or gingivoplasty; * restorative services, including amalgam restorations (fillings), composite resin restorations (fillings), reinforcing pins, and crowns for anterior teeth; * endodontic services, including root canals for anterior teeth; * prosthodontic services, including full and partial dentures; * exodontic services (extractions); and * oral surgery. Dental benefits are fully described at 130 CMR 420.000. (continued on next page) Other Insurance If the member has other insurance that pays for any of these services, MassHealth will pay only for services and charges that are not paid by other insurance. The other insurer must be billed first. MassHealth Card These members will now receive a MassHealth card to be used for dental services. Advance Notice In September, MassHealth will send these members an advance notice (attached to this memo) to inform them of the change in benefits. This notice is in English and Spanish and will be sent with the UNIV-5C sheet. Questions If you have any questions about this memo, please have your MEC designee contact the Policy Hotline. EOM 09-17 September 15, 2009 Attachment Commonwealth of Massachusetts Executive Office of Health and Human Services www.mass.gov/masshealth September 2009 Dear Family Assistance Premium Assistance Member, Federal law now requires MassHealth to provide dental coverage to your family members who are under age 19. This benefit is in addition to your premium assistance payment. These new services include ? emergency care visits; ? diagnostic services, including oral evaluation (comprehensive and periodic); ? radiographs (X rays); ? preventive services, including prophylaxis (cleanings), periodontal scaling and root planing, and gingivectomy or gingivoplasty; ? restorative services, including amalgam restorations (fillings), composite resin restorations (fillings), reinforcing pins, and crowns for anterior teeth; ? endodontic services, including root canals for anterior teeth; ? prosthodontic services, including full and partial dentures; ? exodontic services (extractions); and ? oral surgery. Some of these services have limitations or require prior authorization. The benefits that you or your family members are now eligible for are more fully described in MassHealth regulations at 130 CMR 420.000. To view these regulations, go to www.gov/masshealth/pubs. Click on Provider Library. Click on MassHealth Provider Regulations. Click on Dental. If you have other insurance that pays for any of these services, MassHealth will pay only for services and charges that are not paid by your other insurance. Your other insurer must be billed first. All Family Assistance premium assistance members who are under age 19 will soon get a MassHealth card for dental services. You should show this card along with your private insurance card when you get dental services. Members who are under age 19 will be able to get dental services from providers who accept MassHealth. When you call to schedule an appointment, please ask if the provider accepts MassHealth. If you have any questions about these new benefits or to find a MassHealth dental provider, please call 1-800-207-5019, e-mail member@masshealth- dental.net, or visit the dental Web site at www.masshealth-dental.net.