10.20.220 Orthodontia.
(1) The Samish Indian Nation manages a program for funding of orthodontia that has been established by the Tribal Council. Samish PRC has the responsibility to review each request for services and to authorize purchase orders for orthodontic services for Samish citizens, where appropriate, and if funds for the program are adequate.
(2) Orthodontia coverage is determined on an annual basis.
(3) Attempts will be made to accommodate as many participants as possible, recognizing that the budget is limited. Some requests for funding may be denied or deferred. Funding of services will be prioritized if needed to conserve resources for those with the greatest need. If 50 percent of the funding is used by the midpoint of the fiscal year, lower priority cases may be deferred until the following year. Three general levels of priority have been established, Level I being the highest and Level III being considered last.
(a) Priority Level I. Cases in this group are those which could have medical or dental consequences if early orthodontic intervention is not performed. Examples of this type of priority include, but are not limited to, skeletal jaw inequities (retrognathic and prognathic cases), abnormalities related to cleft palate, open bite (where upper and lower teeth do not contact), tongue thrusting, or severe crowding (generally due to inherited combinations of small jaws/large teeth).
(b) Priority Level II. Youth under the age of 19.
(c) Priority Level III. Any age.
(4) Samish PRC will cover orthodontic treatments, records fees, and aftercare equipment (primarily retainers). Extractions for preparation to receive orthodontic care are not covered by the orthodontia program. Creation of a false tooth is a general dentistry procedure and, although an orthodontist may recommend this, the orthodontic funding will not generally be used to cover this, even if it is recommended to maintain alignment and spacing. Exceptions will be considered if, by judgment of the orthodontist, failure of alignment could occur if creation of a false tooth is deferred until the patient receives the next calendar year of dental benefits.
(5) Orthodontic therapy requires a high level of cooperation from patients to successfully complete treatment. This includes possibly wearing head gear, wearing elastics (rubber bands), brushing extra thoroughly, keeping monthly appointments over a two-and-one-half-year period, and altering one’s diet so as not to fracture off braces, etc. In addition, patient must maintain regular dental check-ups (every six to 12 months) while they have their braces on. Patient motivation is critical to reach a successful result. For this reason, the following “cooperation factors” must be present before beginning this program:
(a) Patients must strongly desire orthodontic treatment.
(b) Patients must have a history of seeking annual routine dental care.
(c) Parent(s) or guardians must be interested and supportive.
(d) Patients must have a history of keeping their appointments for regular dental care. Those with a history of broken or cancelled appointments are not eligible for orthodontic treatment.
(e) Patients must have good oral hygiene with no active gum disease or cavities.
(f) Dental sealants must be placed on all necessary teeth.
(g) Patient should have plans to remain in an area where they are able to maintain orthodontic care for at least two and one-half years.
(6) Candidates for the orthodontia program must have a signed orthodontia contract on file. Parent(s)/guardian(s) must sign for minors. Selection of the orthodontist will be guided by the dentist with secondary approval by Samish PRC.
(7) Patients are expected to keep their orthodontia appointments. Samish PRC will pay for treatment as funding allows and the treatment plan has been followed. Treatment absences may lead to discontinuation of payment by Samish PRC. [Res. 2020-10-013 § 2, 2020.]