Request By:
Hon. John R. Cox
Attorney
Office of the City Attorney
City of Morehead
Morehead, Kentucky 40351
Opinion
Opinion By: David L. Armstrong, Attorney General; Greg Holmes, Assistant Attorney General
This is in response to your letter to the Attorney General in which you seek an opinion concerning the status of oral surgeons with respect to the Kentucky Medical Assistance Program (Medicaid). Specifically, you ask whether the Kentucky Medical Assistance Program may refuse to reimburse oral surgeons for procedures performed by them while paying physicians for the same procedures. Initially we direct your attention to KRS 205.560 which governs the scope of payments to be made under the Kentucky Medical Assistance Program. This statute provides in pertinent part:
(1) The scope of medical care for which the department for human resources undertakes to pay shall be designated and limited by regulations promulgated by said department, pursuant to the provisions hereof. . . . The selection of another class or other classes of medical care shall be recommended by the council to the secretary for human resources after taking into consideration, among other things, the amount of federal and state funds available, the most essential needs of recipients, and the meeting of such need on a basis insuring the greatest amount of medical care as defined in KRS 205.510 consonant with the funds available including but not limited to the following categories: . . . (d) Physician, podiatric, dental and optometric services; . . . .
Pursuant to the authority delegated to it by KRS 205.560, supra, the Kentucky Department for Human Resources (now Cabinet for Human Resources) has promulgated, inter alia, 904 KAR 1.026.
904 KAR 1.026. Dental Services. . . .
Section 3. Inpatient Hospital Services.
(1) Payment shall be made for all hospital inpatient services rendered by oral surgeons. . . .
Section 4. Coverage of Dental Benefits for Adults. The following named dental benefits only shall be covered for adults (eligible individuals aged twenty-one (21) or over), effective January 1, 1982:
(1) Oral surgery, as follows:
(a) Extraction, uncomplicated, single tooth, with local anesthetic and including routine post-operative care; and
(b) Extraction, uncomplicated, each additional tooth, with local anesthetic and including routine post-operative care. . . .
It is important to stress that KRS 205.560 vests the Cabinet for Human Resources with the exclusive authority to designate the parameters within which Kentucky Medical Assistance Program payments may be made. Other statutes which purport to specify uniform payments for various categories of health professionals outside the Kentucky Medical Assistance Program (such as KRS 304.18-097, 304.17-315 and 304.32-159) are not applicable to the question posed in your letter. It is therefore the opinion of this office that the Kentucky Cabinet for Human Resources is authorized to designate the types of dental and medical services which are payable under the Kentucky Medical Assistance Program and that these services need not be identical for oral surgeons and physicians.