Wash. Admin. Code § 182-535-1245 – Access to baby and child dentistry (ABCD) program

The access to baby and child dentistry (ABCD) program increases access to dental services for certain medicaid-eligible clients.

(1) A client is eligible for the ABCD program if the client is:
1. (a) Eligible for one of the following medical assistance programs:
  1. (i) Categorically needy program (CNP);
  2. (ii) Limited casualty program-medically needy program (LCP-MNP);
  3. (iii) Children's health program; or
  4. (iv) State children's health insurance program (SCHIP); and
2. (b) Follow the age requirements:
  1. (i) Under age six; or
  2. (ii) Under age 13 and has one or more disabilities as defined by RCW 74.09.390.
(2) If the eligible client is enrolled in an agency-contracted managed care organization (MCO):
1. (a) Dental providers must bill the agency's fee-for-service payment system for ABCD program services.
2. (b) Medical providers must bill the MCO for ABCD program services.
(3) If the eligible client is not enrolled in an agency-contracted managed care organization (MCO):
1. (a) Dental providers must bill the agency's fee-for-service payment system for ABCD program services.
2. (b) Medical providers must bill the agency's fee-for-service payment system for ABCD program services.
(4) Health care providers and community service programs identify and refer eligible clients to the ABCD program. If the eligible client is treated by an ABCD certified provider, the client and an adult family member may receive:
1. (a) Oral health education;
2. (b) "Anticipatory guidance" (expectations of the client and the client's family members, including the importance of keeping appointments); and
3. (c) Assistance with transportation, interpreter services, and other issues related to dental services.
(5) Only ABCD-certified dental providers and primary care providers certified in ABCD are paid an enhanced fee for furnishing ABCD program services. ABCD program services include, when appropriate:
1. (a) Family oral health education. An oral health education visit:
  1. (i) Is limited to one visit per day per family, up to two visits per client in a 12-month period, per provider or clinic; and
  2. (ii) Must include all of the following services, provision of which must be documented in the client's record:
    1. (A) "Lift the lip" training;
    2. (B) Oral hygiene training;
    3. (C) Risk assessment for early childhood caries;
    4. (D) Dietary counseling; and
    5. (E) Benefits of fluoride.
2. (b) Comprehensive oral evaluations as defined in WAC 182-535-1050, once per client, per provider or clinic, as an initial examination. The agency covers an additional comprehensive oral evaluation if the client has not been treated by the same provider or clinic within the past five years;
3. (c) Periodic oral evaluations as defined in WAC 182-535-1050, once every six months. Six months must elapse between the comprehensive oral evaluation and the first periodic oral evaluation;
4. (d) Topical application of fluoride varnish;
5. (e) Amalgam, resin, and glass ionomer restorations on primary teeth, as specified in the agency's current published documents;
6. (f) Interim therapeutic restorations (ITRs) for primary teeth. The agency pays an enhanced rate for these restorations to ABCD-certified, ITR-trained dentists as follows:
  1. (i) A one-surface, resin-based composite, or glass ionomer restoration with a maximum of five teeth per visit; and
  2. (ii) Restorations on a tooth can be done every 12 months or until the client can be definitively treated for a restoration.
7. (g) Therapeutic pulpotomy;
8. (h) Prefabricated stainless steel crowns on primary teeth, as specified in the agency's current published documents;
9. (i) Resin-based composite crowns on anterior primary teeth; and
10. (j) Other dental-related services, as specified in the agency's current published documents.

[Statutory Authority: RCW 41.05.021, 41.05.160 and 2020 c 242. WSR 21-22-051, § 182-535-1245, filed 10/28/21, effective 11/28/21. Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 21-14-055, § 182-535-1245, filed 7/1/21, effective 8/1/21; WSR 20-04-096, § 182-535-1245, filed 2/5/20, effective 3/7/20. Statutory Authority: RCW 41.05.021, 41.05.160 and 2019 c 415 §§ 211 (1)(c) and 1111 (1)(c). WSR 19-20-047, § 182-535-1245, filed 9/25/19, effective 10/26/19. Statutory Authority: RCW 41.05.021, 41.05.160 and 2017 3rd sp.s. c 1 § 213 (1)(c). WSR 19-09-058, § 182-535-1245, filed 4/15/19, effective 7/1/19. Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 17-20-097, § 182-535-1245, filed 10/3/17, effective 11/3/17; WSR 16-13-110, § 182-535-1245, filed 6/20/16, effective 8/1/16. Statutory Authority: RCW 41.05.021 and 2013 2nd sp.s. c 4 § 213. WSR 14-08-032, § 182-535-1245, filed 3/25/14, effective 4/30/14. WSR 11-14-075, recodified as § 182-535-1245, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.04.050, 74.08.090. WSR 08-16-009, § 388-535-1245, filed 7/24/08, effective 8/24/08. Statutory Authority: RCW 74.08.090, 74.09.500, 74.09.520. WSR 07-06-042, § 388-535-1245, filed 3/1/07, effective 4/1/07. Statutory Authority: RCW 74.08.090, 74.09.035, 74.09.500, 42 U.S.C. 1396d(a), 42 C.F.R. 440.100 and .225. WSR 02-11-136, § 388-535-1245, filed 5/21/02, effective 6/21/02.]