Dental Checkup, Summer 2016

OHCA budget wrap-up, rule changes, Caries Risk Assessment update, and more!

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Oklahoma Health Care Authority Dental Checkup

Summer 2016

2016 Session in Review

Oklahoma flag

The Second Session of the 55th Oklahoma Legislature adjourned on May 27, 2016.

With a $1.3 billion budget hole in an election year, the Legislature had their work cut out for them before they arrived on day 1. The state experienced not just one but two revenue failures during state fiscal year (SFY) 2016 (July 1, 2015 – June 30, 2016). These mid-fiscal year cuts impacted agencies differently and set up the legislature with more work than anticipated. The Oklahoma Health Care Authority (OHCA) lost approximately $63 million in state appropriations due to the revenue failures.

From a legislative standpoint, OHCA was involved with the requests for two high-profile measures – the “Medicaid Rebalancing Act of 2020” and the $1.50 cigarette tax increase. Throughout the first few weeks of the legislative session, budget cuts to most agencies were projected to be between 10 to 15 percent of the previous year’s appropriation. For OHCA, a cut of this magnitude equated to a large provider rate cut - up to 25 percent. State legislators heard directly from SoonerCare providers, members and the business community on their shared concerns of how a 25 percent provider rate cut would impact patients, facilities and communities as a whole. While our request bills did not receive final passage from the legislature, health care was prioritized in the state’s upcoming budget. 

Senate Bill (SB) 1616, the SFY 2017 general appropriations bill, was introduced on May 17, 10 days before the state constitutionally required adjournment (also known as sine die). SB 1616 appropriated $6.8 billion out to agencies for SFY 2017. With an appropriation of $991 million, OHCA was one of only a handful of agencies that received an increase in appropriations and/or a flat appropriation. There are no provider rates cuts scheduled due to the approved budget agreement.

Click here for an issue statement on the budget agreement from OHCA CEO Nico Gomez.


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Dental Checkup Doctor's Note

Oklahoma Oral Health Coalition

Dr. Leon Bragg, OHCA chief dental officer

In this newsletter, I wish to make you aware of the Oklahoma Oral Health Coalition (OOHC). Maybe you have heard of this organization. If not, perhaps this will give you a reason to check them out and join! 

This group was formally established in early 2003. Led by Sally Selvidge, family outreach coordinator, Sooner SUCCESS, and Kay Floyd, director of the Head Start State Collaboration Office, the group chose to initially operate under the name Children's Oral Health Coalition with its attention and intentions focused on the dental health of children. 

Over the years, the coalition has worked to bring together representatives from various state and local organizations that address children's oral health. However, the group is now known as the all-encompassing Oklahoma Oral Health Coalition.

The Coalition's mission is to impact the oral health of all Oklahomans by facilitating collaboration and encouraging improved oral health education. OOHC is managed by a volunteer executive committee, comprised of the following:

Marsha Wilkes Beatty, B.S., M.PH
Assistant Professor of Research, Community Dentistry Division
Oklahoma University College of Dentistry

Melissa Reese
Manager, MobileSmiles Oklahoma
Oklahoma Dental Foundation

Brandon Oshel
Foundation Specialist
Delta Dental of Oklahoma Oral Health Foundation

Immediate past chair
Patricia Christensen
Program Development Specialist
Oklahoma Primary Care Association

The Coalition meets quarterly, and their website provides members with opportunities to coordinate their efforts and maximize their outcomes. The website also provides reliable, accessible dental health information and resources for obtaining dental care and education.


Click the links below to learn more about:

Dr. Leon Bragg
Chief Dental Officer

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Dental Checkup For the record

Rule changes effective September 1

Adult patient at the dentst

Gov. Mary Fallin signed and certified the OHCA’s 2016 permanent rule changes on June 9, 2016. All policy changes are effective Sept. 1, 2016, and will post to the policy webpage on that date. 

2016 changes to the OHCA’s permanent rules were available for review and input in two rounds - Dec. 16, 2015, - Jan. 15, 2016, or January 15 - Feb. 16, 2016. The rules include new regulations requested by the public, members, providers, other state agencies and OHCA staff and leadership. (Visit our Proposed Policy Changes Archive for rule impact summaries.)

Simultaneously, we considered rules previously promulgated on an emergency basis.

The OHCA Board considered and voted on the rules at the Feb. 11, 2016, and March 24, 2016 meetings. Afterward, the rules were forwarded to the Legislature and governor for action. 

There is a total of 43 permanent rule changes for 2016. Those specific to dental providers are as follows: 

Dental policy at OAC 317:30-5-696 is amended to add limited dental services for adult SoonerCare members who meet all medical criteria, but need dental clearance to obtain organ transplant approval. The rule states that services must be prior authorized and are limited to: Comprehensive oral evaluation, two radiographic bitewings, prophylaxis, fluoride application, limited restorative procedures, and periodontal scaling/root planing. Policy is further revised to mirror new terminology from the Code on Dental Procedures and Nomenclature (CDT) and to clean up outdated language. In addition, a change includes removing language which restricts emergency examination/limited oral evaluation from being performed within two months, the new language will allow dentists to perform emergency evaluations as medically necessary. Revisions also clarify the separate note requirement for 5As counseling. Although separate office notes must be provided for 5As counseling, only one office signature is needed at the end of the office visit (not separate signatures for the office visit and the 5As counseling).

(Reference APA WF #15-01)

Dental policy at OAC 317:30-5-695, 317:30-5-696.1, 317:30-5-698 through 317:30-5-700.1, 317:30-5-704, and 317:30-5-705 is revised to mirror new terminology from the Code on Dental Procedures and Nomenclature (CDT), to clean-up outdated terms, and to add oversight requirements for dentists who supervise certified registered nurse anesthetists during the administration of anesthesia to members. The oversight requirement would align OHCA policy with requirements set forth by the Oklahoma Board of Dentistry. In addition, revisions include updating policy to reflect that diagnosis codes must appear on the dental form when requesting a prior authorization and the removal of language for the recoupment of restoration services. The removal of recoupment language will mirror other policy sections concerning dental services that are silent to the recoupment process. Recoupment for inappropriate restorations will still occur as deemed appropriate by the agency's Program Integrity Division.


(Reference APA WF #15-28) 

There are also many OHCA program and policy updates, including rules related to Program Integrity audits.

OHCA will send you complete details on all 2016 permanent rule changes in the next few weeks.

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Revised Caries Risk Assessment form

OHCA has revised our Caries Risk Assessment (CRA) form for SoonerCare dental partners, to make it more user friendly. The tool is a modified version of one originated by the American Dental Association (ADA) for its members. It is our hope that the CRA opens a dialogue between the parent/member and the dentist. The CRA form and instructions are on our website

Please note that the assessment cannot address every aspect of a patient’s health. It isn’t a replacement for the dentist’s inquiry and judgment. Additional or more focused assessment may be appropriate for patients with specific health concerns. As with other forms, this assessment may only be a starting point for evaluating the patient’s health status.

OHCA partner dentists are encouraged to complete and upload this information yearly through the secure Provider Portal.

Scroll down to our FAQs section ("At the root") for more information.

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Medicaid documentation training online

In spring 2016, the Oklahoma Health Care Authority (OHCA) presented a special Medicaid dental documentation seminar around the state. Now, a PDF of that popular provider training is available for download from our website. 

Developed specifically for SoonerCare dentists by an expert in the field, “Documentation of Medical Necessity in Your Dental Records” provides a framework for better understanding Medicaid requirements and concerns related to records and billing reviews.

Click here to view the training now.

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Help your patients quit tobacco

As health care professionals, many dentists encourage their patients to quit tobacco. The American Dental Association (ADA), the nation's largest dental organization, has long upheld policies and recommendations to reduce the prevalence of tobacco use and increase the number of people living healthier lives.* The OHCA is also a strong anti-tobacco advocate. That is why SoonerCare offers coverage for tobacco cessation counseling and tobacco cessation products, through our SoonerQuit program.

SoonerCare offers reimbursement to providers who use the “5As” approach to tobacco cessation, developed by the Agency for Healthcare Research and Quality and endorsed by the U.S. Public Health Service. Dentists are one provider type approved to perform the 5As and be reimbursed for those services. Practice facilitation is also available from SoonerCare.

Most SoonerCare members who use tobacco and are age 12 and older are qualified to participate in SoonerQuit. 

For more information about the SoonerQuit benefit, practice facilitation and additional tobacco cessation resources, please visit


*American Dental Association. Summary of Policy and Recommendations Regarding Tobacco, 1964 – Present. American Dental Association. Revised 2014. Available at Accessed March 15, 2016. 

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Meet your new MAC representative

Dr. Ashley Orynich

The OHCA would like to welcome Dr. Ashley Orynich as the new dental representative on the Medical Advisory Committee (MAC).

The MAC offers recommendations to the OHCA about health and medical care services. They also help to advise the agency on issues of policy, finance and administration. The ultimate goal of the MAC is to assist the agency and its providers to achieve quality standards of the Medicaid program.

Members of the MAC are appointed on a rotating basis.

Dr. Orynich graduated from the University of Florida with a bachelor’s in nutrition, completed her doctorate in dental medicine (DMD) from the Harvard School of Dental Medicine and her Master of Public Administration from the Harvard Kennedy School of Government. She is a board-certified pediatric dentist, having completed her Master of Oral Science from the Texas A&M Baylor College of Dentistry Pediatric Department. Dr. Orynich currently works in private practice at On the Cusp Pediatric Dentistry in Tulsa, Okla., while continuing health policy research as part-time faculty with Baylor.


The MAC meets bi-monthly (starting in January of each year), at 1 p.m., on the third Thursday of the month. Meetings are typically in the OHCA boardroom. Click here for meeting dates and agendas.

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Dental Checkup Crowning achievements

Dr. Leon Bragg recognized for leadership of national organization

Chief Dental Officer Dr. Leon Bragg

The OHCA congratulates Chief Dental Officer Leon Bragg, D.D.S., on his recent recognition by Delta Dental of Oklahoma for his service as president of the Medicaid Medicare CHIP (Children's Health Insurance Program) Services Dental Association (MSDA).

The award, presented during a luncheon at the annual MSDA Symposium in Washington, D.C., included a $10,000 sponsorship from Delta Dental of Oklahoma Oral Health Foundation to the symposium in recognition of Dr. Bragg's service and leadership. Read more about this honor here.

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Dental Checkup Provider Toolkit

OHCA Provider Helpline: 800-522-0114

Dental Prior Authorization Unit: 405-522-7401

Provider Resources

Web Alerts

Online Training


Dental Checkup Statement

Information contained within is subject to change. Be sure to check OHCA Provider LettersGlobal Messages and Web Alerts at for the most up-to-date information.

Dental Checkup Word of mouth

Here are a few hot topics creating buzz in the dental community:

  • Three New Posters and Shareable Images Now Available from the Campaign for Dental Health - The Campaign for Dental Health is offering three new posters and images (memes) in English and Spanish to help share positive messages about community water fluoridation, health equity, drinking water, and children’s oral health. You can download a shareable image or PDF for use on Twitter, Facebook, your website, and other social media channels. A limited number of printed 18" x 24" office posters are also available free of charge. To request copies, email CDH staff. Please include your address, which poster designs you would like to receive, what quantity, and which language you would like.

Order Publications

OHCA Calendar

Newsletter Archive


Dental Checkup At the root




Answers to your frequently asked questions (FAQs)

1.    Is the Caries Risk Assessment (CRA) form required?

Yes. It is required for orthodontics and should be submitted with the orthodontic prior authorization (PA) request. However, it is an educational tool for all dental providers and may open a dialogue between the parent/member and the dentist. 

OHCA encourages all dental homes to engage parent and member when completing the CRA.

2.    Since the Caries Risk Assessment is to be submitted with the orthodontic PA request, who fills out the form? The referring dentist or the orthodontist? 

The dental home is the preferred choice to complete the assessment, but the orthodontist may complete as a last resort.

3.    How do I submit for payment? 

Submit the CRA as a PA, via the OHCA Provider Portal or by mail. Mailed CRA submissions must have the HCA-13D and a completed ADA claim form attached. After PA is approved, you may file your claim. 

More details can be found on our Dental webpage.

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