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Title: Section 506.5 - Utilization threshold.

506.5 Utilization threshold. (a) This section describes the utilization threshold that the department has established for dental services and supplies. Part 503 of this Title authorizes the department to establish a utilization threshold for specific provider types, including dental services and supplies. Part 503 also describes the application of utilization thresholds, services and procedures excluded from the utilization threshold for all provider service types subject to a threshold, the method for obtaining an exemption from or increase in the utilization threshold, notices, and the right to a fair hearing in certain situations.

(b) General rule. The department will pay for up to three dental service encounters in a benefit year. For purposes of this section, each discrete visit to a dentist or to a dental clinic is one encounter, regardless of the number of services provided or procedures performed during the visit.


VOLUME C (Title 18)