Vermont § 1992 - Medicaid coverage for adult dental services

§ 1992. Medicaid coverage for adult dental services

• (a) Vermont Medicaid shall provide coverage for medically necessary dental services provided
  by a dentist, dental therapist, or dental hygienist working within the scope of the
  provider’s license as follows: (1) Preventive services, including prophylaxis and fluoride treatment, with no co-payment.
  These services shall not be counted toward the annual maximum benefit amount set forth
  in subdivision (2) of this subsection. (2)(A) Diagnostic, restorative, and endodontic procedures, to a maximum of $1,500.00 per
  calendar year, provided that the Department of Vermont Health Access may adjust the
  maximum pursuant to the process outlined in subdivision (B) of this subdivision (2)
  and may approve expenditures in excess of that amount when exceptional medical circumstances
  so require. Exceptional medical circumstances include emergency dental services, as
  defined by the Department by rule. (B) The Department may set the maximum for coverage of diagnostic, restorative, and endodontic
  procedures in excess of the amount set forth in subdivision (A) of this subdivision
  (2) for a calendar year based on the Department’s annual assessment of available funds,
  provided that the Department submit a report to the House Committee on Health Care,
  the Senate Committee on Health and Welfare, and the House and Senate Committees on
  Appropriations, or to the Joint Fiscal Committee if the General Assembly is not in
  session, each time the Department adjusts the maximum. (C) The following individuals shall not be subject to the annual maximum benefit amount
  set forth in this subdivision (2): (i) individuals served through the Community Rehabilitation and Treatment and Developmental
  Disability Services programs pursuant to Vermont’s Global Commitment to Health Section
  1115 demonstration; and (ii) Medicaid beneficiaries who are pregnant or in the postpartum eligibility period, as
  defined by the Department by rule. (3) Other dental services as determined by the Department by rule. (b) The Department of Vermont Health Access shall develop a reimbursement structure for
  dental services in the Vermont Medicaid program that encourages dentists, dental therapists,
  and dental hygienists to provide preventive care. (Added 2019, No. 72, § E.306.1; amended 2021, No. 130 (Adj. Sess.), § 1, eff. May 24, 2022; 2023, No. 51, § 1, eff. July 1, 2023; 2023, No. 78, § E.307.1, eff. July 1, 2023.)