AHCCS Medical Policy Manual 610-1

Dental hygienists in affiliated practice with a dentist who is also a Medicaid provider may be reimbursed for certain services included in the practice agreement with the dentist.

Statute‐1413

The State Medicaid rules provide for registered dental hygienists in alternative practice (RDHAP’s) to be directly reimbursed. All dental hygiene services provided by an RDHAP pursuant to the practice act may be covered as long as they are within the scope of Denti‐Cal benefits and they are necessary services provided by an RDHAP.

8.200.5.C

Dental hygienists may be directly reimbursed for unsupervised dental hygiene services. 

• Hygienists employed by a dentist, clinic, or institution shall submit claims under the employer’s provider identification number.
• Unsupervised dental hygienists may provide and bill for specific dental hygiene services. A full list of reimbursable procedures is included in the “RDH Table” of the Health First Colorado (Medicaid) Dental Plan Program’s Office Reference Manual, available here.

Unsupervised dental hygiene may be performed by licensed dental hygienists without the supervision of a licensed dentist. Unsupervised dental hygienists practice within the scope of their education, training, and experience.

Medicaid Regulations, Sec. 17b‐262‐695

All dental hygienists who participate in Medicaid shall be public health dental hygienists. 

The regulations cite what services will be reimbursed to dental hygienists and in which settings they can practice. Settings include a nursing home, a group home, a school without a dental clinic, a hospital without a dental clinic and a community health center without a dental clinic.

Bureau of Medical Services Regulations

MaineCare Benefits Manual 10‐144, 25.07‐5

Maine is somewhat unique in that entities are reimbursed but every dental hygienist who works for an enrolled entity must also enroll as a Medicaid provider. 

Dental hygiene services shall be reimbursed to entities enrolled as MaineCare providers employing or sponsoring licensed dental hygienist services allowed under public health supervision. Entities wishing to enroll as MaineCare providers must submit documentation showing they meet the requirements for public health supervision status and must enroll all dental hygienists as MaineCare servicing providers with proof of licensure. Dental hygienists must meet the requirements of public health supervision status to enroll.

Chapter 112 Section 51

The Massachusetts Dental Practice Act authorizes public health dental hygienists to be directly reimbursed by Medicaid.

Michigan Department of Community Health

Medicaid policy allows any dental hygienist including dental hygienists working within PA 161 Programs, to enroll as providers in the Michigan Medicaid Program. The enrollment process is through the Community Health Automated Medicaid Processing System (CHAMPS) system. This is a Medicaid Program decision and does not require state legislation. An RDH is required to have a Type 1 (Individual) NPI number to enroll. The RDH is considered a rendering/servicing-only provider.*

*Rendering/Servicing-Only Provider is a Type 1 (Individual) NPI who renders services strictly on behalf of an organization, clinic or group practice. They are required to affiliate themselves with a Type 2 (Group) NPI such as a Federally Qualified Health Center (FQHC), Local Health Department, clinic, sole dentist or dental group in CHAMPS.

Minnesota Department of Human Services Revised: February 18, 2020

Collaborative practice dental hygienists (CPDH) must be employed or retained by one of the following Minnesota Health Care Programs (MHCP)-enrolled groups: health care facility, program (such as Head Start) or nonprofit organization. Individual CPDH are not eligible for direct MHCP reimbursement and must enroll with a group affiliation to receive reimbursement at the group level for all dental hygiene services rendered to MHCP enrollees. As part of this process, MHCP requires individual National Provider Identifiers (NPIs) and affiliation with one or more of these enrolled group providers. Additional information is available here.

Statute‐332.311.1‐2

Dental hygienists with three years’ experience and practicing in a public health setting may provide fluoride treatments, oral prophylaxis and sealants, if appropriate, to children who are eligible for medical assistance without the supervision of a dentist. Dental hygienists are reimbursed for fluoride treatments, oral prophylaxis and sealants.

Rule 37.86.1001

Dental hygienists practicing under public health supervision may provide preventive dental hygiene services.

Rule 6.007

Lists dental hygienists as Medicaid dental providers.

NMAC 8.310.7.10 New Mexico Medical Assistance Division Regulations

Dental hygienists who are certified for collaborative practice may provide dental hygiene services to Medicaid recipients as allowed by their scope of practice. The services that will be reimbursed are listed specifically in the section: oral prophylaxis, sealants, fluoride treatments, etc.

1003.20 (Dental Manual) Department of Human Resources

Although the Nevada Medicaid laws remain non‐specific concerning providers, in 2003 the department began to issue provider numbers to dental hygienists practicing without supervision in public settings. The dental manual notes dental hygienists as providers. 

Medicaid Regulations, Office of Medical Assistance OAR 410‐.23‐1040(a); OAR 410‐123‐1060(8)

Medicaid will reimburse dental hygienists and denturists as well as dentists. It will also pay for services provided by a person under the supervision of a limited access permit dental hygienist.

Medicaid Regulations, Office of Medical Assistance OAR 410‐.23‐1040(a); OAR 410‐123‐1060(8)

A public health dental hygienist shall be directly reimbursed for services administered in a public health setting by Medicaid or the state health care insurance program except as required by federal Medicaid law. Public health settings includes, but are not limited to, residences of the homebound, schools, nursing home and long-term care facilities, clinics, hospitals, medical facilities or community health centers.

Utah Code Subsection 26-18-2.6(9)

Dental hygienists providing dental services in a public health setting may be reimbursed by Medicaid. The department shall reimburse dental hygienists beginning the earlier of January 1, 2023 or 30 days after the date on which the replacement of the department’s Medicaid 79 Management Information System software is complete.

Vermont Medicaid State Plan, 42 CFR 435.10 and Subpart J

The Department of Vermont Health Access (DVHA) recognizes licensed dental hygienists as Medicaid providers and are able bill Medicaid directly. DVHA is now implementing an approved state plan amendment (SPA), which allows dental hygienists to practice in public health settings to increase access to dental services for beneficiaries who may not be able to access conventional settings (e.g. nursing homes). Dental hygienists will have to have a collaborative agreement with a Vermont licensed dentist.

Chapter 5-31.1-39

Dental hygienists are listed as providers eligible to enroll with the state medical assistance administration (MAA) to furnish and bill for dental‐related services to eligible clients.

HFS 105.01 and 105.06

Dental hygienists certified as Medicaid providers by the Wisconsin Department of Health and Family Services may be directly reimbursed for a specific set of preventive services, including: prophylaxis, fluoride treatments, sealants and oral health evaluations.