Sec. 10.09.05.03. Provider Qualifications and Conditions for Participation

A. General requirements for participation in the Program are that a provider shall meet all conditions for participation as set forth in COMAR 10.09.36.03.

B. Specific requirements for participation in the Program as a dental provider requires that the provider:

(1) Meets the licensure requirements as provided in Regulation .02 of this chapter; and

(2) Not knowingly employ another person to provide services to Medical Assistance patients after that person has been disqualified from the Program unless prior approval has been received from the Department.

C. To participate in the Program as an EPSDT certified provider of fluoride varnish services, the provider shall:

(1) Have MDH Certification for the Application of Fluoride Varnish; and

(2) Meet the following requirements:

(a) Be board-certified in one of the following:

(i) Pediatrics;

(ii) Family practice; or

(iii) Internal medicine;

(b) Be a licensed physician, physician assistant, or licensed and certified nurse practitioner, delivering primary health care to children and adolescents; or

(c) Be a local health department or a federally qualified health center.

D. The provider shall:

(1) Complete the Dental Provider Application; and

(2) Submit verification of the National Provider Identifier (NPI) Number.

E. Mobile Dental Unit.

(1) The mobile dental unit shall provide or arrange for comprehensive dental services with a participating Maryland Healthy Smiles Dental Program provider.

(2) The mobile dental unit shall be linked through either ownership or a legally binding contract to a primary dental office that has a permanent and fixed location.

(3) The primary dental office shall participate in the Maryland Healthy Smiles Dental Program.

(4) The mobile dental unit shall have and utilize the electronic technology that enables the same day exchange of patient records with:

(a) The primary dental office; and

(b) If requested, the dental office of the parent or legal guardian’s choice.

(5) The mobile dental unit’s service area shall be limited to 30 miles in a rural setting and 10 miles in an urban setting from the primary dental office that the mobile dental unit is either owned by or with which the dental office holds a legally binding contract.

(6) A mobile dental unit shall:

(a) Maintain dental records for the patient;

(b) Observe all patient rights;

(c) Obtain written, informed consent from a parent or legal guardian, which shall:

(i) Be renewed each school year before treating a minor; and

(ii) Allow the parent or legal guardian to request that the dental records be sent to a provider of their choice;

(d) Comply with all applicable federal, State, and local laws, regulations, and ordinances regulating:

(i) Equipment;

(ii) Flammability;

(iii) Construction;

(iv) Infection control;

(v) Sanitation procedures; and

(vi) Zoning;

(e) Comply with the statutes and regulations of the Maryland Department of the Environment for all dental radiographic and imaging equipment;

(f) Obtain, keep current, and make readily available all applicable county and city licenses or permits necessary to operate the mobile dental unit which would include the active dentist, hygienist and dental assistant licenses and the dental radiographic and imaging equipment permits;

(g) Provide an update to the Department regarding any mobile dental unit provider changes within 72 hours;

(h) Provide access to a ramp or a lift if services are provided to disabled individuals;

(i) Have ready access to a properly functioning sterilization system;

(j) Have ready access to an adequate supply of potable water, including hot water;

(k) Have immediate access to toilet facilities;

(l) Have an appropriately covered noncorrosive metal container for refuse and waste materials;

(m) Have a carbon monoxide detection device or system installed and in proper working condition;

(n) Have a chair designed and purposed exclusively for the provision of dental services;

(o) Have a dental treatment light;

(p) Have a radiograph unit with appropriate processing equipment;

(q) Have an evacuation unit suitable for dental surgical use;

(r) Have written procedures for medical emergencies;

(s) Have appropriate equipment to treat medical emergencies;

(t) Have appropriate and sufficient dental instruments and infection control supplies; and

(u) Have any other equipment or system that is necessary to provide the services being rendered by the mobile dental unit.

(7) Dental hygienists or dental assistants may not solely operate a mobile dental unit.

(8) The owner or owners of a mobile dental unit shall submit a business plan to the Dental Administrative Services Organization (ASO) for the mobile unit that includes:

(a) The mission of the mobile dental unit;

(b) Verification of ownership of the mobile dental unit;

(c) A list of the clinical practitioners that will render services in the mobile dental unit; and

(d) The targeted population.

F. For services provided pursuant to Regulation .04C of this chapter, the dental provider shall:

(1) Inform the participant in writing of the $800 annual cap on Medicaid coverage; and

(2) Obtain the participant’s written approval prior to beginning any services that cannot be completed within the cap amount.