Legislative updates; dental provider training; rate and fee changes; and more!

Legislative updates; dental provider training; rate and fee changes; and more!

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Oklahoma Health Care Authority Dental Checkup

Spring 2018

Legislative update

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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Medicaid work requirements executive order

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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Policy and PA guidance for dentists at spring SoonerCare Provider Workshops

Five happy health care providers sit in a training

“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.

There is additional training available online specific to dental providers.

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Dental Checkup For the record

Reminder: Reimbursement increase

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.

SoonerCare dental fee schedule

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.

Fighting heart disease with better oral health

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

Smiling female health care provider forms heart with her hands. Includes Helpline and OHCA logos.


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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Prevention of infective endocarditis and a resource for your patients

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. 



* 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.

OHCA Dental staff gets hands-on at statewide oral health event

Tracy Matthews and Sara Gillum proudly wear their 2018 OkMOM T-shirts, which they received for volunteering

“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.”

Oklahoma Mission of Mercy logo

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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OHCA: Making an impact

State Fiscal Year 2017 OHCA Annual Report

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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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 MessagesWeb Alerts and news releases at okhca.org for the most up-to-date information.

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**Editor’s note: The opinions in these articles are those of the author(s) and do not necessarily represent the views of SoonerCare Dental or the Oklahoma Health Care Authority.

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ADA webinars on opioid prescribing

White pills formed into a skull on wooden surface


April 25, the ADA will host a free webinar that addresses the opioid crisis and the practitioners’ role in the Drug Enforcement Administration’s (DEA) closed system and diversion of prescription opioids.

The webinar, "Federal Law, Regulations and the Dispensing of Controlled Substances," will cover:

  • The controlled substances most commonly abused.
  • The closed system of distribution enforced by the DEA.
  • The importance of inventories, records, reports and inspections.
  • How to recognize and prevent common methods of diversion.
  • Introducing resources available to practitioners.

For more information and/or to register, please visit the ADA website.

If you missed the February webinar, "Improving Opioid Prescribing: The CDC Guideline for Prescribing Opioids for Chronic Pain, and Considerations for Dentistry," an archived version is posted on the ADA Center for Professional Success website.

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