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Spring 2018
A carryover bill from the first regular session of the Legislature has been passed and signed by the governor. HB 1270, also known as the HOPE Act, requires OHCA to contract with a private vendor to conduct a myriad of eligibility checks.
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Oklahoma explores plan
In accordance with Governor Fallin’s March directive, the OHCA will begin working on a waiver seeking approval from the Centers for Medicare & Medicaid Services (CMS) to implement work requirements for the Medicaid program. OHCA will have recommendations to the Governor within six months.
In addition to the governor's executive order, the OHCA is following companion legislation:
HB 2932 – Rep. Mulready – Specifies work requirements, with exclusions including parent/caretaker group with children under age one
- Referred to 2nd Senate Approp. committee
SB 1179 – Sen. Pugh – Aligns work requirements to Temporary Assistance for Needy Families (TANF), with exclusions including parent/caretaker group with children under age six
- Referred to House A&B committee
Oklahoma is one of more than 10 states that have expressed interest in adding the requirement. CMS has already approved work requirements in Indiana, Kentucky and Arkansas.
*Legislative updates current as of March 30, 2018.
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“Dental Policy and Prior Authorization” is just one of the
classes providers can join in the upcoming SoonerCare Provider Training
Workshops.
Statewide events kick-off May 1, in Durant, Okla. OHCA
highly recommends that all providers and their staff attend a workshop in their
area:
- Durant - May 1
- Tulsa - May 9 and 10
- Lawton - May 17
- OKC - May 23 and 24
- Guymon - June 20
“Dental Policy and Prior Authorization” offers a thorough
look at current OHCA dental policy, coverage for new procedures, and how to
submit a dental prior authorization (PA) on the SoonerCare Provider
Portal. Additional classes will help
providers overcome common obstacles when submitting claims, PAs or supporting
documentation (“SoonerCare Solutions”); explain how to arrange transportation
services for patients (“SoonerRide Non-Emergency Transportation”); and give
tips to make working with Third Party Liability (TPL) easier (“TPL Simplified”).
Please visit the OHCA Training
webpage for specific times, locations and to register. A complete
listing of classes and detailed course descriptions can also be found on the
Training page.
The spring 2018 SoonerCare Provider Training Workshop is hosted
by OHCA and DXC Technology.
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There is additional training available online specific to dental providers.
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On January 1, OHCA increased the reimbursement rate for Dental Procedure Code (CDT) D9999 from $274.95 to $895.00, and decreased the reimbursement rate for the procedures in APC Group A5164 from $1,197.60 to $895.00. These changes will help to increase the types of services and care our members can receive at outpatient facilities.
For more information about this rate change or if you have any questions, please call the OHCA Provider Helpline at 800-522-0114.
OHCA updated the SoonerCare dental fee schedule on Jan. 1, 2018. Providers can download and view the schedule in Excel or Adobe Acrobat (PDF) at www.okhca.org/feeschedules.
Oral health and heart disease seem like an unlikely pair; however,
recent studies have found a link between the two. Patients with periodontal
diseases resulting from poor oral hygiene are at greater risk for heart disease
than those with healthy gums. This is because bacteria in the mouth can
circulate elsewhere through the bloodstream — to places like the heart — and
cause inflammation and illnesses.
While poor oral hygiene and unmanaged oral diseases can increase
the risk for cardiovascular disease, another factor can dramatically intensify
that risk ¾ tobacco.
No matter the form — cigarettes, chew, hookah, etc. —
tobacco use leads to many oral health issues, including:
- cancers of the mouth and throat
- tooth decay
- gum disease
- mouth sores
- stained teeth
- bad breath
Tobacco is also linked to chronic illnesses like type 2 diabetes,
heart disease and cancer. So, when tobacco is mixed with poor oral hygiene,
it’s like adding fuel to the fire.
As an oral health care provider, you are in a powerful
position to protect patients from tobacco’s toll. By educating patients on the
connections between tobacco, oral health and heart disease, you can help them
understand the importance of quitting tobacco and maintaining healthy behaviors.
You can also help them live longer,
happier lives.
To help patients quit tobacco, talk to them about the free services
available from the Oklahoma Tobacco Helpline. The Helpline offers customizable
services and tools to help Oklahomans quit tobacco on their own terms.
Registrants receive nonjudgmental support through text, email, phone calls or
web coaching. Additionally, they’re eligible to receive at least two weeks of
nicotine replacement therapy, including patches, gum or lozenges.
To learn more about the Helpline and to access free
promotional materials (like fact sheets, brochures and posters), please visit
OKhelpline.com.
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Adapted from the American Heart
Association
Cardiac conditions put patients at increased risk for
developing endocarditis. However, the practice of routinely giving antibiotics
to patients at risk for endocarditis prior to a dental procedure is not
recommended EXCEPT for patients with the highest risk of adverse outcomes
resulting from infective endocarditis (IE) or bacterial endocarditis (BE). This
is according to members of the American College of Cardiology/American Heart Association
Task Force on Clinical Practice Guidelines and the American Heart Association’s
Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee together with
national and international experts on IE.
The committee could not exclude the possibility that an
exceedingly small number of cases, if any, of IE may be prevented by antibiotic
prophylaxis prior to a dental procedure. If such benefit from prophylaxis
exists, it should be reserved ONLY for those patients with cardiac conditions associated
with the highest risk of adverse outcomes from endocarditis, including:
- Prosthetic
cardiac valves, including transcatheter-implanted prostheses
and homografts
- Prosthetic
material used for cardiac valve repair, such as annuloplasty
rings and chords
- Previous
endocarditis
- Congenital
heart disease (CHD) only in the following categories:*
–
Unrepaired cyanotic CHD, including those with palliative
shunts
and conduits
–
Completely repaired congenital heart defect with prosthetic
material
or device, whether placed by surgery or catheter
intervention,
during the first six months after the procedure†
– Repaired CHD with residual shunts or
valvular regurgitation
at the
site or adjacent to the site of a prosthetic patch or
prosthetic
device (which inhibit endothelialization)
- Cardiac
transplantation recipients with valve regurgitation due to a
structurally abnormal valve
The American Heart Association (AHA) details antibiotic
prophylactic regimens for dental procedures and provides a potential lifesaving
resource for patients at increased risk for developing adverse outcomes from IE
in the Prevention of Infective Endocarditis
wallet card. The
Council on Scientific Affairs of the American Dental Association has approved
the recommendations as they relate to dentistry.
Footnotes:
* Except for the conditions listed above, antibiotic prophylaxis before dental procedures is not recommended for any other form of cardiac heart disease.
† Prophylaxis is reasonable because endothelialization of prosthetic material occurs within six months after the procedure.
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“You are real,”
said the little girl, eyes wide open looking at the tooth fairy, as she held
her quarter and the tooth she just had pulled.
This memory of one patient is one of many that keeps Sara
Gillum, OHCA dental analyst, coming back year after year to the Oklahoma Mission of Mercy (OkMOM). The 2018
event was held February 2-3 at the Choctaw Event Center in Durant, Okla.
OkMOM is an annual clinic designed to meet the oral health
needs of dental patients of all ages by providing free dental care to as many
adults and children as time, volunteers and supplies allow.
These patients are either uninsured, under-insured or simply do not have regular
access to dental care. From screenings to extractions, more than 13,490
patients have received dental services at OkMOM since 2010.
This year, more than 950 patients received treatment with the assistance of more than 1,390 volunteers. On average, each patient received $1,210 in donated care - an OkMOM record.
“The many people who actually thank you and tell you how much it means to them to be out of pain and how much they appreciate all of us volunteers make it so meaningful,” Gillum said. “It really tugs at your heart strings when they start crying because they are so thankful.”
OHCA Dental Services staff members have devoted their time to this effort for several years. Tracy Matthews, dental manager, participated for the sixth time in 2018.
For Matthews, the people she helps make the volunteer time memorable. “Being able to connect with patients from all walks of life, all ages, is amazing,” Matthews said.
“Seeing an empty arena transformed into a dental clinic – medical and dental triage, family clinic, oral surgery, restorations, hygiene – is an incredible experience,” Matthews added. “Every bit is donated – from the volunteers to food service.”
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Gillum has volunteered for the last eight years. Dr. Leon Bragg,
former OHCA dental director, told her about the event.
“Dr. Bragg told us about what services would be offered and
how many people would get dental work they so desperately needed,” Gillum said.
“I was very interested to see how all of this would take place and I enjoy
giving back when I can, so I signed up to be a runner. The rest is history. I
was hooked.”
The unity found in the OkMOM mission and experience excites Gillum.
“It really restores my faith in humanity to see so many come
together to give people a healthy smile.”
OkMOM is sponsored by the Oklahoma Dental Association, the
Oklahoma Dental Foundation and primarily funded by the Delta Dental of Oklahoma
Foundation. The Oklahoma State Department of Health endorses and supports the
mission of OkMOM.
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 Did you know?
The 2017 OHCA Annual Report is now available online. The report features member stories and Fast Facts, as well as many helpful infographics and stats on our programs, services and provider network.
For those seeking more in-depth information, the agency Primer and our Service Efforts and Accomplishments Report have recently been updated. They are also available on our website.
Be sure to visit www.okhca.org/reports to download PDFs of these reports and check out other agency studies, evaluations and more.
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OHCA Provider Helpline: 800-522-0114
Dental Prior Authorization Unit: 405-522-7401
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