Medicaid Direct Reimbursement of Dental Hygienists
The following 16 practice acts contain statutory or regulatory language allowing
the state Medicaid department to directly reimburse dental hygienists for services rendered..
AHCCS Medical Policy Manual 610‐1
Dental Hygienists in affiliated practice with a dentist who is also a Medicaid provider may be reimbursed for certain services included in the practice agreement with the dentist.
The State Medicaid rules provide for registered dental hygienists in alternative practice (RDHAP’s) to be directly reimbursed. All dental hygiene services provided by an RDHAP pursuant to the practice act may be covered as long as they are within the scope of Denti‐Cal benefits and they are necessary services provided by an RDHAP.
25.5‐4‐411 (Formerly 26‐4‐414.3)
Authorizes reimbursement of unsupervised dental hygienists for services to children. Dental hygienists employed by a dentist, institution or clinic cannot submit claims individually. Dental hygienists who are directly reimbursed must identify Medicaid‐participating dentists or any other licensed dentist for each child the dental hygienists serves.
Unsupervised dental hygienists may provide and bill for preventive services: oral prophylaxis, fluoride, sealants and oral hygiene instructions.
Medicaid Regulations, Sec. 17b‐262‐695
All dental hygienists who participate in Medicaid shall be public health dental hygienists.
The regulations cite what services will be reimbursed to dental hygienists and in which settings they can practice. Settings include a nursing home, a group home, a school without a dental clinic, a hospital without a dental clinic and a community health center without a dental clinic.
Bureau of Medical Services Regulations
MaineCare Benefits Manual 10‐144, 25.07‐5
Maine is somewhat unique in that entities are reimbursed but every dental hygienist who works for an enrolled entity must also enroll as a Medicaid provider.
Dental hygiene services shall be reimbursed to entities enrolled as MaineCare providers employing or sponsoring licensed hygienist services allowed under public health supervision. Entities wishing to enroll as MaineCare providers must submit documentation showing they meet the requirements for public health supervision status and must enroll all hygienists as MaineCare servicing providers with proof of licensure. Hygienists must meet the requirements of public health supervision status to enroll.
Chapter 112 Section 51
The Massachusetts Dental Practice Act authorizes public health dental hygienists to be directly reimbursed by Medicaid. A rule change to enact the statute is pending.
Michigan Department of Community Health
Medicaid policy allows any dental hygienist including dental hygienists working within PA 161 Programs, to enroll as providers in the Michigan Medicaid Program. The enrollment process is through the Community Health Automated Medicaid Processing System (CHAMPS) system. This is a Medicaid Program decision and does not require state legislation. An RDH is required to have a Type 1 (Individual) NPI number to enroll. The RDH is considered a rendering/servicing-only provider.*
*Rendering/Servicing-Only Provider is a Type 1 (Individual) NPI who renders services strictly on behalf of an organization, clinic or group practice. They are required to affiliate themselves with a Type 2 (Group) NPI such as a Federally Qualified Health Center (FQHC), Local Health Department, clinic, sole dentist or dental group in CHAMPS.
Minnesota Department of Human Services
A policy change by the state department of human services was made in fall of 2002 allowing dental hygienists to apply for Medicaid provider numbers. This policy change was made in conjunction with collaborative practice. To obtain a provider number, a dental hygienist must complete the application form provided by the Minnesota Department of Human services. The provider must comply with rules relating to the delivery of services to individuals and to the submission of claims for such services.
Dental hygienists with three years' experience and practicing in a public health setting may provide fluoride treatments, oral prophylaxis and sealants, if appropriate, to children who are eligible for medical assistance without the supervision of a dentist. Hygienists are reimbursed for fluoride treatments, oral prophylaxis and sealants.
Dental hygienists practicing under public health supervision may provide preventive dental hygiene services.
Lists dental hygienists as Medicaid dental providers.
New Mexico 2002
NMAC 8.310.7.10 New Mexico Medical Assistance Division Regulations
Dental hygienists who are certified for collaborative practice may provide dental hygiene services to Medicaid recipients as allowed by their scope of practice. The services that will be reimbursed are listed specifically in the section: oral prophylaxis, sealants, fluoride treatments, etc.
1003.20 (Dental Manual) Department of Human Resources
Although the Nevada Medicaid laws remain non‐specific concerning providers, in 2003 the department began to issue provider numbers to dental hygienists practicing without supervision in public settings. The dental manual notes dental hygienists as providers.
Medicaid Regulations, Office of Medical Assistance OAR 410‐.23‐1040(a); OAR 410‐123‐1060(8)
Medicaid will reimburse dental hygienists and denturists as well as dentists. It will also pay for services provided by a person under the supervision of a limited access permit dental hygienist.
Dental hygienists are listed as providers eligible to enroll with the state medical assistance administration (MAA) to furnish and bill for dental‐related services to eligible clients.
HFS 105.01 and 105.06
Dental hygienists certified as Medicaid providers by the Wisconsin Department of Health and Family Services may be directly reimbursed for a specific set of preventive services, including: prophylaxis, fluoride treatments, sealants and oral health evaluations.