{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T01:09:57Z","timestamp":1789780197301,"version":"4.0.1"},"reference-count":17,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2017,12,14]],"date-time":"2017-12-14T00:00:00Z","timestamp":1513209600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The Cleft Palate Craniofacial Journal"],"published-print":{"date-parts":[[2018,3]]},"abstract":"<jats:p>Provision and timing of orthodontic treatment is a crucial part of comprehensive cleft palate and craniofacial care. Some states statutorily mandate orthodontic coverage for the medically necessary care of cleft palate and craniofacial anomalies. However, application of the medically necessary standard varies broadly. Disputes over medical necessity lead to orthodontic coverage denials and surgical intervention delays. Provider-friendly statutory definitions of medical necessity enable patients and providers to avoid such hurdles. The objective of this study is to evaluate state mandates and highlight language favorable to patients and providers.<\/jats:p>","DOI":"10.1177\/1055665617736765","type":"journal-article","created":{"date-parts":[[2018,2,13]],"date-time":"2018-02-13T13:03:16Z","timestamp":1518526996000},"page":"466-469","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":21,"title":["Primer on State Statutory Mandates of Third-Party Orthodontic Coverage for Cleft Palate and Craniofacial Care in the United States"],"prefix":"10.1177","volume":"55","author":[{"given":"Kristin D.","family":"Pfeifauf","sequence":"first","affiliation":[{"name":"Department of Surgery, Division of Plastic and Reconstructive Surgery, Cleft Palate-Craniofacial Institute, Washington University School of Medicine, Saint Louis, MO, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison","family":"Snyder-Warwick","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Plastic and Reconstructive Surgery, Cleft Palate-Craniofacial Institute, Washington University School of Medicine, Saint Louis, MO, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary B.","family":"Skolnick","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Plastic and Reconstructive Surgery, Cleft Palate-Craniofacial Institute, Washington University School of Medicine, Saint Louis, MO, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sybill D.","family":"Naidoo","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Plastic and Reconstructive Surgery, Cleft Palate-Craniofacial Institute, Washington University School of Medicine, Saint Louis, MO, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard J.","family":"Nissen","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Plastic and Reconstructive Surgery, Cleft Palate-Craniofacial Institute, Washington University School of Medicine, Saint Louis, MO, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamlesh B.","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Plastic and Reconstructive Surgery, Cleft Palate-Craniofacial Institute, Washington University School of Medicine, Saint Louis, MO, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2017,12,14]]},"reference":[{"key":"bibr1-1055665617736765","unstructured":"American Association of Oral and Maxillofacial Surgeons. AAOMS white paper: craniofacial anomalies. Available at: http:\/\/www.aaoms.org\/docs\/govt_affairs\/advocacy_white_papers\/craniofacial_anomalies.pdf. Accessed September 27, 2016."},{"key":"bibr2-1055665617736765","unstructured":"American Association of Orthodontics. AAO leads effort to establish consistency on medically necessary orthodontic care. Available at: www.aaoinfo.org\/news\/2015\/07\/aao-leads-effort-establish-consistency-medically-necessary-orthodontic-care. Accessed September 27, 2016."},{"key":"bibr3-1055665617736765","unstructured":"American Cleft Palate-Craniofacial Association. Standards for approval of cleft palate and craniofacial teams. Available at: http:\/\/www.acpa-cpf.org\/team_care\/standards. Accessed September 27, 2016."},{"key":"bibr16-1055665617736765","unstructured":"Children\u2019s Access to Reconstructive Evaluation & Surgery (CARES) Act, S. 1588, 110th Cong. (2007a)."},{"key":"bibr17-1055665617736765","unstructured":"Children\u2019s Access to Reconstructive Evaluation & Surgery (CARES) Act, H.R. 1655, 110th Cong. (2007b)."},{"key":"bibr4-1055665617736765","unstructured":"Children\u2019s Access to Reconstructive Evaluation & Surgery (CARES) Act, S. 1235, 111th Cong. (2009a)."},{"key":"bibr5-1055665617736765","unstructured":"Children\u2019s Access to Reconstructive Evaluation & Surgery (CARES) Act, H.R. 1339, 111th Cong. (2009b)."},{"key":"bibr6-1055665617736765","unstructured":"Children\u2019s Access to Reconstructive Evaluation & Surgery (CARES) Act, S. 1045, 112th Cong. (2011a)."},{"key":"bibr7-1055665617736765","unstructured":"Children\u2019s Access to Reconstructive Evaluation & Surgery (CARES) Act, H.R. 1955, 112th Cong. (2011b)."},{"key":"bibr8-1055665617736765","unstructured":"Department of Health and Human Services. Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation Final Rule, 45 C.F.R. \u00a7\u00a7 147, 155\u2013156 (2013)."},{"key":"bibr9-1055665617736765","first-page":"52","volume":"4","author":"Long RE","year":"2009","journal-title":"J Lancaster Gen Hosp"},{"key":"bibr10-1055665617736765","doi-asserted-by":"crossref","unstructured":"Okla. Admin. Code \u00a7 365:40-5-20(12) (2016).","DOI":"10.13186\/group.40.4.0365"},{"key":"bibr11-1055665617736765","unstructured":"Okla. Stat. tit. 36, \u00a7 36-6058A (2015)."},{"key":"bibr12-1055665617736765","unstructured":"Patient Protection and Affordable Care Act, 42 USC \u00a7 18001 et seq. (2010)."},{"key":"bibr13-1055665617736765","unstructured":"Reconstructive Surgery Act, H.R. 2820, 110th Cong. (2007)."},{"key":"bibr14-1055665617736765","unstructured":"State of Hawai\u2019i Auditor. Study of proposed mandatory health insurance for treatment of orofacial anomalies: a report to the Governor and the Legislature of the State of Hawai\u2019i, Rep. No. 14\u201308 (2014). Available at: http:\/\/files.hawaii.gov\/auditor\/Reports\/2014\/14-08.pdf. 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