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Elizabeth M. Whitehorn, Director

Provider Notice Issued 03/21/2025

 

To: Enrolled Dentists
​Date March 21, 2025
​Re:
 Orthodontic Handicapping Labio-Lingual Deviation (HLD) Tool Changes per Public Act 103-0593

The Department of Healthcare and Family Services (HFS) would like to inform enrolled dental providers of recent administrative rule changes to 89 Ill. Admin. Code Section 140.421 regarding the Handicapping Labio-Lingual Deviation (HLD) orthodontic scoring tool. These changes are required for the Medicaid fee-for-service program and the managed care organizations (MCOs).

Pursuant to the FY25 Medicaid Omnibus bill, later signed as PA 103-0593, HFS has expanded the HLD to include additional automatic qualifiers and added a dental vendor reporting requirement on denials.

Effective January 1, 2025, the automatic qualifiers are:   

·         Cleft palate or other craniofacial anomalies

·         Deep impinging bite with signs of tissue damage, not just touching palate

·         Anterior crossbite with gingival recession

·         Severe traumatic deviation (i.e., accidents, tumors, etc.)

·         Overjet of 9mm or greater

·         Impacted teeth where eruption is impeded but extraction is not indicated

Also, effective January 1, 2025, if a prior authorization request for orthodontic treatment is denied, the dental vendor will supply to the provider who submitted the request the HLD scoring tool and the HLD score that prompted denial of the request.

If any orthodontic cases were denied after January 1, 2025, that would have qualified under the new HLD scoring tool, please contact the appropriate dental vendor for possible approval.

Questions regarding these changes for the FFS program should be sent to HFS.Dental@Illinois.gov or the Bureau of Professional and Ancillary Services at 877-782-5565. Providers should check with the respective Medicaid MCOs for details on changes for the managed care population.

 

 

Kelly Cunningham, Administrator

Division of Medical Programs