This week, we’re looking at two Ftags with similar content, F790 Routine/Emergency Dental Services in SNFs (Medicare) and F791 Routine/Emergency Dental Services in NFs (Medicaid). These are the only tags that comprise the 483.55 Dental Services regulatory group.
What’s Required for Both SNFs and NFs
Facilities must:
- Assist residents in obtaining both routine and 24-hour emergency dental care, either through services provided in the facility or by an outside resource
- Have a policy in place that identifies circumstances when the loss/ damage of dentures is the facility’s responsibility and when a resident may not be charged for replacement. The Interpretive Guidance (IG) clearly states that blanket facility policies of non-responsibility do not meet this requirement, nor would policies that state that the facility is only responsible when the dentures are in actual physical possession of facility staff. Facilities are also not allowed to ask residents to waive facility liability for potential losses.
- Must promptly – within 3 days – refer a resident who has lost or damaged dentures for dental services. This referral does not require that the resident actually see a dentist within 3 days but requires the facility to ensure the resident has the earliest available appointment or is actively working to assist with fixing/replacing dentures, including contacting the dentist timely.
- Ensure that the resident could still eat and drink adequately if the referral does not occur within 3 days. Documentation needs to be provided related to the steps taken for the resident as well as the extenuating circumstances that led to the delay in the referral.
- Assist with making arrangements for appointments and arranging for transportation to/from an outside location if necessary.
F790 – Other SNF Responsibilities
Skilled nursing facilities are allowed to charge Medicare residents for an additional amount for these routine and emergency dental services.
F791 – Other NF Responsibilities
The regulatory guidance at F791 clarifies that nursing facilities need to provide routine dental services to the extent that they are covered under the State plan. The facilities also need to assist residents who are eligible and wish to apply for reimbursement of dental services as an incurred medical expense under the State plan.
Just a reminder – lack of dentures, poorly fitting dentures, teeth that are broken and decaying or a resident who is in need of mouth care are very “visual” observations that can easily be made by a surveyor. You need to ensure that you have a sound system for annual dental exams as well as routine monitoring to identify changes in a resident’s dental care needs.