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Ohio Laws and Rules
(A) Eligible providers of dental services.
(1) All individuals currently licensed under state of Ohio law to practice dentistry are eligible to participate in the Ohio medicaid program as a dental provider upon execution of the “Medicaid Provider Agreement” according to rule 5101:3-1-17.2 of the Administrative Code.
(2) A professional dental group (group dental practice) is also considered eligible as a group dental practice if organized in accordance with rule 5101:3-1-17 of the Administrative Code, for the sole purpose of providing professional dental services.
(3) Dentists practicing and serving Ohio medicaid consumers outside of Ohio must be licensed by the dental examining board in their own state and must complete the “Medicaid Provider Agreement.”
(4) Other eligible providers of dental services include, but are not limited to, the following medicaid providers if the providers employ or have under contractual arrangement individuals licensed to practice dentistry:
(a) Fee-for-service ambulatory health care clinics as defined in Chapter 5101:3-13 of the Administrative Code.
(b) Outpatient health facilities as defined in Chapter 5101:3-29 of the Administrative Code.
(c) Federally qualified health centers as defined in Chapter 5101:3-28 of the Administrative Code.
(B) General anesthesia.
(1) General anesthesia is reimbursable only when performed by a dentist who has an “Ohio state dental board permit.”
(2) Dentists practicing and serving Ohio medicaid consumers outside the state of Ohio must meet the requirements of the dental examining board in their own state for administering general anesthesia.
(C) Drugs.
(1) Drugs are provided under the medicaid program only upon written prescription of a physician, physician assistant, advanced practice nurse, or dentist.
(2) Providers are required to print or stamp their ten digit national provider identifier (NPI) number on the prescription blank or give their provider numbers to the pharmacist on prescriptions telephoned directly to the pharmacy.
(D) Co-payments (except for medicaid consumers enrolled in the medicaid managed health care program). For dates of service on or after January 1, 2006, the department has adopted a medicaid co-payment of three dollars per date of service per provider in accordance with rules 5101:3-1-09 and 5101:3-1-60 of the Administrative Code. Services provided to a consumer on the same date of service by the same provider are subject only to one co-payment.
(E) Unless otherwise specified, reimbursement for covered dental services provided by eligible providers to eligible consumers is contained in appendix DD of rule 5101:3-1-60 of the Administrative Code.
(F) Reimbursement for some services covered under the medicaid program is available only upon obtaining prior authorization from the Ohio department of job and family services (ODJFS) as specified in accordance with rule 5101:3-1-31 of the Administrative Code. Dental services which require prior authorization are identified in Chapter 5101:3-5 of the Administrative Code. A completed prior authorization request for such dental services is required for reimbursement consideration.
(1) All prior authorization requests must be submitted through the ODJFS web portal. Paper prior authorization requests will be returned to the provider unprocessed.
(2) Documentation necessary to complete the prior authorization request that cannot be uploaded and submitted through the ODJFS web portal, such as x-rays and dental molds, must be submitted separately.
Effective: 08/02/2011
R.C. 119.032 review dates: 09/20/2010 and 08/01/2016
Promulgated Under: 119.03
Statutory Authority: 5111.02, 5111.0112
Rule Amplifies: 5111.01, 5111.0112, 5111.02, 5111.021
Prior Effective Dates: 4/7/77, 9/2/85, 2/1/88, 11/15/93, 12/29/95 (Emer.), 3/21/96, 1/1/00, 10/1/03, 1/1/06, 7/1/08