DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT Prevention Services Division – Rules promulgated by the Colorado Board of Health SERVICE GRANTS FOR THE DENTAL ASSISTANCE PROGRAM 6 CCR 1015-8 [Editor’s Notes follow the text of the rules at the end of this CCR Document.] _________________________________________________________________________

1.1 Definitions

1) "Advisory Committee" means the Dental Advisory Committee created in Section 25-21-107.5, C.R.S.

2) "Department" means the Department of Public Health and Environment 3) "Eligible Senior" means an adult who is eligible for old age pension dental assistance Program as defined in section 25-21-103, C.R.S.

4) "Qualified Grantee" means an entity that either provides comprehensive dental and oral health services or that can administer funds for such services through sub-grants, awards, or reimbursement processes that comply with the federal "Health Insurance Portability and Accountability Act of 1996", 42 U.S.C. sec. 1320d to 1320d-8.

5) "Service grant" means a grant awarded by the Department to a qualified grantee pursuant to this article.

1.2 Application requirements

1) At a minimum, all applications for service grants submitted to the Department shall contain the following information:

1. A) Compliance with the definition of "qualified grantee" as defined in Section 1.1(4).
2. B) Demonstrates an established relationship with or willingness to coordinate with local community organizations serving eligible seniors. Evidence of this relationship may be demonstrated by, but is not limited to, a Memorandum of Agreement with local community organizations serving eligible seniors or, minutes for regular meetings with local community organizations serving eligible seniors that will be submitted to the Department on a semi-annual basis.
3. C) Defined service area.
4. D) A plan for outreach to include:
   1. i. A plan for marketing the available services to eligible seniors within the defined service area; and ii. A plan for meeting needs of eligible seniors in contiguous service areas should they not be served by another qualified grantee.
5. E) A description of plan for verifying eligibility of seniors.
6. F) An operating budget that designates a procedure for prioritization of funds to meet the needs of those eligible seniors most in need.
7. G) A description of the applicant's ability to comply with and monitor the implementation of the grant requirements, which includes a statement whether the applicant will charge a copayment to eligible seniors and certifying that the copayment shall not exceed twenty percent of the cost of the services provided.
8. H) Demonstration of capacity to implement and administer the program specified in Section 2(1).

2) A successful applicant for participation in the program shall sign a contract with the Department or a Purchase Order with a scope of work that complies with the State's Procurement Rules in 24-101- 101 to 24-112-101, C.R.S.. The terms of the service grant contract/purchase order shall be determined by the Department and shall include, but need not be limited to, the following:

1. A) The total amount of grant to qualified grantee;
2. B) The qualified grantee's agreement to provide care to eligible seniors for the length of the grant;
3. C) The qualified grantee's agreement to provide the Department with semi-annual reports. At a minimum, the reports shall include:
   1. i. The number of eligible seniors served;
   2. ii. The types of dental and oral health services provided; and iii. The amount of co-payments charged and received.
4. D) Reasonable penalties and other enforcement remedies available to the Department in the event the qualified grantee breaches contract or purchase order;
5. E) The qualified grantee's agreement to notify the department if there is a decrease in eligible seniors served; and F) The time period of the grant.

1.3 Review of Application

1) The initial review will be done by the Department to determine whether the application is complete and to ensure the grantee meets the requirements of the definition previously stated in 1.1(4).

2) After initial review of applications, the dental advisory committee will review applications, and then submit their recommendations to the Department.

3) The Department will consider the recommendations made by the dental advisory committee, but is not bound by them. In the event the Department disagrees with the committee's findings, it will provide a written statement of its rationale to both the applicant and the committee for their reference.

Allowable Procedures and Fees for Dental Services 2.1 Effective January 16, 2013 through May 15, 2013 or such time that the Board of Health approves a new effective provider procedures and fee schedule, a qualified grantee, as defined in Section 1.1 of these regulations, may charge fees, not to exceed the maximum allowable fee, and perform the procedures for an eligible senior as set forth in Section 2.3.

2.2 Nothing in this part shall prohibit a qualified grantee from charging less than the allowable fee or reducing the amount of the patient co-payment set forth in Section 2.3. Any reduction in the amount of the patient co-payment shall be at the discretion of the qualified grantee.

2.3 TABLE OF ALLOWABLE PROCEDURES AND FEES

CDT 2013 Procedure Description Maximum Allowable Program Payment Fee Diagnostic 0120 Periodic Oral Evaluation $ 46 $ 46 – Est. Pt.

0140 Limited Oral Evaluation $ 62 $ 52 0150 Comprehensive Oral $ 81 $ 81 Exam 0180 Comprehensive $ 88 $ 88 periodontal evaluation – new or est. pt.

0210 Intraoral– Complete $ 125 $ 125 series of radiographic images 0220 Periapical – 1st $ 25 $ 25 radiographic image 0230 Periapical – each $ 23 $ 23 additional radiographic image 0270 Bitewing – single film $ 26 $ 26 0272 Bitewings – two films $ 42 $ 42 0273 Bitewings – three films $ 52 $ 52 0274 Bitewings – four films $ 60 $ 60 0330 Panoramic radiographic $ 63 $ 63 image Preventive 1110 Prophylaxis (Adult) $ 88 $ 88 1206 Topical Fluoride Varnish $ 52 $ 52 1208 Topical Fluoride $ 52 $ 52 Restorative 2140 Amalgam – one surface $ 107 $ 97 2150 Amalgam – two surfaces $ 138 $ 128 2160 Amalgam – three surfaces $ 167 $ 157 2161 Amalgam – four + $ 203 $ 193 surfaces 2330 Resin – one surface, $ 115 $ 105 anterior 2331 Resin – two surface, $ 146 $ 136 anterior 2332 Resin – three surface, $ 179 $ 169 anterior 2335 Resin – four surface, $ 212 $ 202 incisal angle 2391 Resin – one surface, $ 134 $ 124 posterior 2392 Resin – two surface, $ 176 $ 166 posterior 2393 Resin – three surface, $ 218 $ 208 posterior 2394 Resin – four surface, $ 268 $ 258 posterior 2951 Pin retention per tooth $ 50 $ 40 Periodontics 4341 Scaling and Root Planing $ 177 $ 167 ≥ 4 teeth/quad 4342 Scaling and Root Planing $ 128 $ 128 ≤ 3 teeth/quad 4910 Periodontal Maintenance $ 136 $ 136 Prosthetics (Patient co-pay for these services are not to exceed 10%) 5110 Complete denture - $ 793 $ 713 maxillary 5120 Complete denture, $ 793 $ 713 mandibular 5211 Partial denture, maxillary $ 700 $ 640 – resin, inc. clasps, rests, teeth 5212 Partial denture, $ 778 $ 718 mandibular – resin, inc.

1. clasps, rests, teeth 5510 Repair broken complete $ 87 $ 77 denture 5520 Replace missing or $ 73 $ 63 broken teeth – Complete denture/tooth 5610 Repair broken partial $ 95 $ 85 base 5630 Replace or repair broken $ 123 $ 113 clasp 5640 Replace missing or $ 80 $ 70 broken teeth – partial denture/tooth 5650 Add tooth to existing $ 109 $ 99 partial 5660 Add clasp to existing $ 131 $ 121 partial 5710 Rebase complete denture $ 322 $ 297 - maxillary 5711 Rebase complete denture $ 308 $ 283 – mandibular 5720 Rebase partial denture – $ 304 $ 279 maxillary 5721 Rebase partial denture – $ 304 $ 279 mandibular 5730 Reline denture – $ 182 $ 172 maxillary - chair-side 5731 Reline denture – $ 182 $ 172 mandibular – chairside 5740 Reline partial – maxillary $ 167 $ 157 - chair-side 5741 Reline partial – $ 167 $ 157 mandibular – chairside 5750 Reline denture – $ 243 $ 218 maxillary - laboratory 5751 Reline denture – $ 243 $ 218 mandibular – laboratory 5760 Reline partial – maxillary $ 239 $ 214 - laboratory 5761 Reline partial – $ 239 $ 214 mandibular – laboratory Oral Surgery 7140 Extraction erupted tooth $ 82 $ 72 or exposed root 7210 Surgical removal of $ 135 $ 125 erupted tooth 7250 Surgical removal of $ 143 $ 133 residual tooth roots 7286 Biopsy, soft tissue $ 381 $ 381 7310 Alveoloplasty $ 150 $ 140 (w/extractions) (Four or more teeth)

7311 Alveoloplasty $ 138 $ 128 (w/extractions) (Three teeth or less)

7320 Alveoloplasty (w/out $ 150 $ 140 extractions)(Four or more teeth)

7321 Alveoloplasty (w/out $ 138 $ 128 extractions) (Three teeth or less)

7510 Incision and drainage of $ 193 $ 183 abscess – intraoral soft tissue 9110 Palliative treatment – ER $ 61 $ 36 treatment of dental pain - minor procedure (limited to one exam per year)

_________________________________________________________________________ Editor’s Notes History Sections 2.1 – 2.3 eff. 12/30/2008.

Entire rule eff. 10/30/2012.

Sections 2.1 – 2.3 emer. rules eff. 01/16/2013.