37.79.326    DENTAL BENEFITS

(1) The maximum dental benefits paid under the basic dental plan will be 85% of the billed services received. Up to $1,615 in basic dental care will be paid per benefit year for each enrollee. For example, $1,900 in services received results in $1,615 paid.

(a) Providers may not balance bill the enrollee, parent, or guardian for the remaining 15% of the billed charges.

(b) Providers may bill the enrollee, parent, or guardian for services received in excess of $1,900 per benefit year.

(2) Providers must bill for services using the procedure codes and modifiers set forth, and according to the definitions contained in the American Dental Association Manual of Current Dental Terminology (CDT 2023).

(3) Effective July 1, 2023, only the dental procedures listed at http://dphhs.mt.gov/hmk are benefits of the HMK coverage group Dental Program.

(4) Providers must comply with all applicable state and federal statutes, rules and regulations, including the United States Code governing the HMK Plan and all applicable Montana statutes and rules governing licensure and certification.

(5) Providers must also comply with the requirements of ARM Title 37, chapter 85, subchapters 4 and 5 to the extent those provisions are not inconsistent with this subchapter.

(6) For purposes of applying the provisions of any Medicaid rule as required by this subchapter, references in the Medicaid rule to "Medicaid" or the "Montana Medicaid program" or similar references shall be deemed to apply to the HMK coverage group or the HMK Plus coverage group as the context permits.

 

History: 53-4-1004, 53-4-1005, 53-4-1009, 53-4-1105, MCA; IMP, 53-4-1003, 53-4-1004, 53-4-1005, 53-4-1009, 53-4-1104, 53-4-1105, MCA; NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 330, Eff. 2/13/04; AMD, 2008 MAR p. 49, Eff. 1/18/08; AMD, 2009 MAR p. 1673, Eff. 10/1/09; AMD, 2010 MAR p. 2217, Eff. 10/1/10; AMD, 2011 MAR p. 70, Eff. 1/1/11; AMD, 2014 MAR p. 1405, Eff. 7/1/14; AMD, 2015 MAR p. 2292, Eff. 1/1/16; AMD, 2017 MAR p. 1521, Eff. 9/9/17; AMD, 2018 MAR p. 1168, Eff. 7/1/18; AMD, 2019 MAR p. 546, Eff. 7/1/19; AMD, 2020 MAR p. 1531, Eff. 8/8/20; AMD, 2022 MAR p. 1077, Eff. 7/1/22; AMD, 2023 MAR p. 1025, Eff. 9/9/23.