Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid 600 Washington Street Boston, MA 02111 www.mass.gov/masshealth MassHealth Dental Bulletin 39 July 2008 TO: Dental Providers Participating in MassHealth FROM: Tom Dehner, Medicaid Director RE: MassHealth-Contracted Managed Care Organizations (MCOs) Covered Dental Services Background This bulletin does not describe benefits available to members enrolled in MassHealth Senior Care Organizations (SCOs). Questions about dental benefits for SCO enrollees should be directed to the member’s Senior Care Organization. This bulletin clarifies those dental services covered by MassHealth- contracted managed-care organizations (MCOs), and those dental services that are not, and that may be covered by the MassHealth Dental Program. This bulletin supersedes the information transmitted in Dental Bulletin 23 dated June 1999. MCO Covered MassHealth-contracted MCOs cover the following dental services: Dental Services • Emergency-related dental services that are furnished to an enrollee by a provider that is qualified to furnish such services under Title XIX of the Social Security Act, and needed to evaluate or stabilize an enrollee’s emergency medical condition; and • oral surgery performed in an outpatient hospital setting or ambulatory surgery setting when it is medically necessary to treat an underlying medical condition. Examples of an underlying medical condition could include situations where the individual has a heart condition that requires close monitoring in an outpatient hospital setting, or situations where the individual has an underlying behavioral health issue serious mental illness that requires the procedure to be performed in an outpatient hospital setting. When these services are furnished, providers should bill the appropriate MassHealth-contracted MCO as listed below. (continued on next page) MassHealth Covered Oral surgery and dental benefits not covered by an MCO as listed Dental Services above may be covered by the MassHealth Dental Program if the services were performed by a MassHealth dental provider in accordance with all MassHealth regulations, including those at 130 CMR 420.000 and 450.000. This includes preventive and basic services for the prevention and control of dental diseases and the maintenance of oral health. When these dental services are furnished, MassHealth dental providers should bill the MassHealth. Questions If you have any questions about the MassHealth-contracted MCOs covered dental services information in this bulletin, providers must contact the appropriate MCO Customer Service Center listed below. • Boston Medical Center HealthNet Plan: 1-888-566-0008 or 1-800-900-1451 • Fallon Community Health Plan: 1-866-275-3247 • Network Health: 1-888-257-1985 • Neighborhood Health Plan: 1-800-462-5449. If you have any questions about the MassHealth covered dental services information in this bulletin, please contact MassHealth Dental Customer Service at 1-800-207-5019 or e-mail your inquiry to inquiries@masshealth-dental.net. .