Reserved Functions - Prescribed Dental Services Clause Samples

The 'Reserved Functions - Prescribed Dental Services' clause defines which dental services are specifically reserved for performance by qualified dental professionals as prescribed by law or regulation. In practice, this clause outlines the types of dental procedures—such as extractions, fillings, or anesthesia—that only licensed dentists or dental specialists are permitted to perform, ensuring compliance with professional standards. Its core function is to protect patient safety and maintain regulatory compliance by clearly delineating the scope of practice within dental services.
Reserved Functions - Prescribed Dental Services. 12.1 The following functions and related activities shall continue to be exercised by NHS England (the “Reserved Prescribed Dental Services Functions”): 12.1.1 determining the outcomes expected from Prescribed Dental Services and the main characteristics of high quality services, taking into account national priorities for improving NHS outcomes; designing and delivering national transformation programmes in line with any applicable commissioning policies and guidance; 12.1.2 in respect of any Prescribed Dental Services contracted pursuant to NHS England’s functions under Part 5 of the NHS Act the negotiation and agreement of matters concerning those contracts with national stakeholders including, without limitation, the Department of Health and Social Care and bodies representing providers of primary dental services nationally; 12.1.3 in respect of any Prescribed Dental Services contracted pursuant to NHS England’s functions under Part 5 of the NHS Act, the development of standard contracts and national contract variations and guidance; 12.1.4 the provision of all dental commissioning and contracting policy and guidance to support ICBs to meet their delegated duties; 12.1.5 in respect of any Prescribed Dental Services contracted pursuant to NHS England’s functions under Part 5 of the NHS Act, the provision of nationally contracted services delivering digital, logistical and support services in England (including but not limited to): 12.1.5.1 Payments 12.1.5.2 Pensions 12.1.5.3 Performer List

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  • Outpatient Dental Anesthesia Services This plan covers anesthesia services received in connection with a dental service when provided in a hospital or freestanding ambulatory surgical center and: • the use of this is medically necessary; and • the setting in which the service is received is determined to be appropriate. This plan also covers facility fees associated with these services. This plan covers dental care for members until the last day of the month in which they turn nineteen (19). This plan covers services only if they meet all of the following requirements: • listed as a covered dental care service in this section. The fact that a provider has prescribed or recommended a service, or that it is the only available treatment for an illness or injury does not mean it is a covered dental care service under this plan. • dentally necessary, consistent with our dental policies and related guidelines at the time the services are provided. • not listed in Exclusions section. • received while a member is enrolled in the plan. • consistent with applicable state or federal law. • services are provided by a network provider.

  • Surgery Services This plan covers surgery services to treat a disease or injury when: • the operation is not experimental or investigational, or cosmetic in nature; • the operation is being performed at the appropriate place of service; and • the physician is licensed to perform the surgery. This plan covers reconstructive surgery and procedures when the services are performed to relieve pain, or to correct or improve bodily function that is impaired as a result of: • a birth defect; • an accidental injury; • a disease; or • a previous covered surgical procedure. Functional indications for surgical correction do not include psychological, psychiatric or emotional reasons. This plan covers the procedures listed below to treat functional impairments. • abdominal wall surgery including panniculectomy (other than an abdominoplasty); • blepharoplasty and ptosis repair; • gastric bypass or gastric banding; • nasal reconstruction and septorhinoplasty; • orthognathic surgery including mandibular and maxillary osteotomy; • reduction mammoplasty; • removal of breast implants; • removal or treatment of proliferative vascular lesions and hemangiomas; • treatment of varicose veins; or • gynecomastia.