The Contractor must provide essential Dental services to inmates, as requested by the Chief Health Services, in accordance with the National Essential Health Services Framework, including any amendment to this Framework issued by CSC during the contract period and any optional period if and when exercised by CSC.
With the exception of dental emergency care, the Contractor must submit a Standard Dental Claim Form detailing the proposed dental services being requested for the inmate before the Contractor provides any services along with other submission requirements, consistent with the CSC Dental Predetermination/Adjudication Guide – Community and in accordance with the Essential Health Services Framework. A dentist will make the predetermination on behalf of Health Services, National Headquarters. In such instances, CSC will pay initial consultation fees and emergency dental services the Contractor provides without predetermination. However, CSC may not pay for services the Contractor provides beyond those required to address the immediate emergency may not be covered. Upon receipt of the dental predetermination, the Contractor must provide only those dental services approved in the dental predetermination of the inmate.
The Contractor, in their role as dentist, must manage all aspects of dental care services including coordination of care provided by dental specialists to inmates to ensure continuity and integration of care. This includes, but is not limited to, approval of all recommendations made by dental care providers outside of CSC.
