Dental program is major focus in OHCA budget request

Proposed changes for dental program; addressing no-shows; and how to get free smoking cessation resources for your patients

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Dental checkup

Winter 2019

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Adult dental addressed in SFY 2020 budget request

The Dec. 13, 2018, OHCA Board meeting offered a preliminary look at the agency's state fiscal year (SFY) 2020 budget request.

Among the priority line items was a program enhancement for Dental. OHCA is asking for funds to relax agency policy that limits adult dental services to emergency extractions only. Approval could help to increase the coverage to medically-necessary extractions. To implement this change, OHCA is requesting $605,102 state dollars, for a total of (state + federal dollars) $1,734,313.*

Additionally, OHCA is requesting funds to increase SoonerCare provider rates by 12.14 percent across the board (to 100 percent physician fee schedule). This is in an effort to restore reimbursement rates in the wake of budget cuts implemented during the last 10 years.

You can view the OHCA SFY20 Budget Request Detail by downloading the Dec. 13, 2018, board agenda from the public website.

OHCA leadership will present the SFY20 budget request to the state Legislature on January 29 at 1:30 p.m. More details will be shared when they become available.


*OHCA Budget Request Detail as printed on 11/19/2018 

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OHCA rulemaking season continues

The second round of OHCA’s permanent rulemaking kicked off January 16; the first set of proposed rules were made available for public comment in December. All proposed rules can be found online at The Proposed Changes webpage is designed to give all constituents an opportunity to review and make comments regarding proposed policy changes. We encourage you to review each proposed rule and give your input.

Rules being considered include, but are not limited to:

  • Suspended Claims Review and/or Prepayment Review (APA WF# 18-09)
    Proposed revisions add new general provider policies to define various review mechanisms used by OHCA to help ensure that reimbursements are for medically necessary, correctly and/or appropriately billed medical supplies and services. Comment Due Date: 02/15/2019   
  • Application Fees and Provider Screening (APA WF# 18-13)
    The proposed revisions to the general provider policies are added to establish provider enrollment application fees and other provider screening and enrollment requirements mandated by federal regulation. Comment Due Date: 02/15/2019   

As required by state statute, OHCA provides a Rule Impact Statement for each proposed rule. This includes the legal authority, possible impact to providers and/or members, projected budget impact and reason for the proposed changes. We also highlight all text changes.

Permanent rule recommendations will go to the Legislature and governor for action in the spring, with a projected implementation date of fall 2019.

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OHCA Permanent Rulemaking Infographic

See what it takes to change or make a new OHCA rule.

Click the image at left for more details on OHCA's rulemaking process.

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Update: SoonerCare community engagement requirements

OHCA Community Engagement Amendment handout

The Oklahoma Health Care Authority (OHCA) submitted the community engagement waiver amendment to the Centers for Medicare & Medicaid Services (CMS) on Dec. 7, 2018. The federal public comment period was open until Jan.18, 2019 at

On March 5, 2018, the governor of Oklahoma signed an executive order directing OHCA to apply for waiver and state plan amendments that would allow the state to implement community engagement requirements in the state Medicaid program (SoonerCare). In addition to the executive order, HB 2932 was passed by the state legislature, in the Oklahoma 56thSecond Legislature Session, and signed into law by Gov. Mary Fallin. HB 2932 directs OHCA to pursue modifications to Medicaid eligibility criteria so that recipients of SoonerCare coverage for certain Medicaid populations are conditional upon documentation of certain education, skills training, community engagement, or job activities.

Upon approval from CMS, the state of Oklahoma will implement community engagement requirements for certain individuals related to SoonerCare (Oklahoma Medicaid) eligibility. As a condition of eligibility for SoonerCare benefits, applicants or existing members, not otherwise exempted, aged 19-50 must provide verification of employment or community engagement in specified educational, job training or job search activities for an average of 80 hours per month. SoonerCare members who fail to meet the community engagement requirements for three months during a plan year will be disenrolled from SoonerCare until requirements are met. There is a three-month grace period before members are required to provide proof of community engagement; however, the member could also have a good cause exception.

More information about the amendment is available in this handout.


Certain individuals may be exempted from the above requirements. Please visit the OHCA Policy Change Blog for details.

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Note: Agency closure

OHCA offices will be closed on Feb. 18, 2019, in observance of Presidents' Day. The date has been declared as a holiday by the state of Oklahoma:

We will be happy to assist you during our regular office hours.

Thank you.

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Late fees in effect for license renewals

To avoid late fees, license renewals were due to the Oklahoma Board of Dentistry by Dec. 31, 2018.

To renew online or to access a print a renewal form, please visit

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STOP! Charges not allowed for no-shows

Gold dollar sign on a white background with red slash across it

Our federal oversight, the Centers for Medicare & Medicaid Services (CMS), prohibits providers from billing Medicaid members who miss scheduled appointments.

A missed appointment is not a distinct reimbursable SoonerCare (Oklahoma Medicaid) service, but a part of the provider's overall costs of doing business. The SoonerCare rate covers the cost of doing business, and providers may not impose separate charges on SoonerCare clients. Below is the Code of Federal Regulations that states that physicians who participate in Medicaid must accept Medicaid reimbursement as “payment in full."                                                       

§447.15   Acceptance of State payment as payment in full.

A State plan must provide that the Medicaid agency must limit participation in the Medicaid program to providers who accept, as payment in full, the amounts paid by the agency plus any deductible, coinsurance or copayment required by the plan to be paid by the individual. The provider may only deny services to any eligible individual on account of the individual's inability to pay the cost sharing amount imposed by the plan in accordance with §447.52(e). The previous sentence does not apply to an individual who is able to pay. An individual's inability to pay does not eliminate his or her liability for the cost sharing charge.

To learn what actions you may be allowed to take, please refer to OHCA Policies and Rules regarding SoonerCare on our website (

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New opioid limit in effect

Jan. 7, 2019, a new daily opioid Morphine Milligram Equivalent (MME) limit for SoonerCare pharmacy claims went into effect. This includes both short-acting and long-acting opioid formulations. Opioid MME daily totals exceeding 240 now require prior authorization (PA) with patient-specific, clinically significant reasoning why the member requires more than 240 MME per day.*

The quantity edit will progress in three phases, with the final phase scheduled to occur in July 2019. The end goal is a target of 100 MME or less.

Phase 2, planned for April 2019, is a180-MME limit; Phase 3, planned for July 2019, is a 100-MME limit

Providers can also access a patient’s MME totals by consulting the Oklahoma Prescription Monitoring Program (PMP) Aware system. OHCA encourages providers to access the PMP site and begin tapering (where appropriate) members who exceed the 100 MME threshold.

If a member requires daily MME totals exceeding 100, the provider can submit an MME override request via form PHARM-111, available on the OHCA Pharmacy Forms webpage (

If you have questions regarding this quantity edit, you can reach Pharmacy Services via the OHCA Provider Helpline at 800-522-0114, option 4.


*Medications provided for Medication-Assisted Treatment (MAT) will be exempt from this policy.

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SoonerRide survey reminder

Dental clinic receptionist talks holds phone to her ear at desk

Logisticare (SoonerRide/TripCare) needs your help to verify visits to your facility by SoonerCare members. Logisticare arranges non-emergency transportation for medically-necessary health care appointments.

OHCA has authorized Logisticare to conduct daily surveys on a small number of randomly-selected SoonerCare providers and members. Their calls are to confirm that you saw a member, as a patient, on a specific date and time. These surveys also help OHCA to satisfy federal requirements from the Centers for Medicare & Medicaid Services (CMS).

LogistiCare has a signed HIPAA agreement with OHCA. If contacted, please instruct your staff to cooperate with the LogistiCare representative by checking your records. Representatives will identify themselves and the purpose of the call.

We thank you in advance for your cooperation. If you have questions about these surveys, please call the OHCA Provider Helpline at 800-522-0114. 

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Encourage your patients to be tobacco-free in 2019

The beginning of a new year is the perfect time to talk to your patients about starting their tobacco-free journey.

Dental provider shows patient how to access free tobacco quit resources on an electronic tablet during an office visit.

As an oral health care provider, your guidance can play a large role in helping tobacco users start their quitting journey. Likely, you’ve seen tobacco’s toll on oral health up close:

  • Tooth decay
  • Gum disease
  • Mouth sores
  • Stained teeth
  • Bad breath

Even more detrimental, tobacco use also leads to cancers of the mouth and throat, as well as other chronic illnesses — things no amount of toothpaste, mouthwash or dental floss could ever cure. The only way to avoid the harmful effects of tobacco is to quit tobacco — and hearing this information from a trusted, reliable source could be the motivational push tobacco users need to take action.

To help you help your patients, the Oklahoma Tobacco Helpline (OTH) provides a variety of services, resources and support — all for FREE.

Patients can sign up at and choose from three distinct service plans, each catered to the individual’s needs. All Oklahomans over age 13, as well as SoonerCare members, are eligible to sign up for free OTH services.

On top of this, OTH also offers free promotional items — including posters, fact sheets and brochures for your office — which you can use to educate your patients even further.

This year help your patients enter 2019 with a fresh start. To learn more, and to download materials, visit

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February is National Children's Dental Health Month

Couple in bathroom with young boy brushing teeth

Help children brush up on their oral health skills!

February is National Children's Dental Health Month (NCDHM ). You can visit NCDHM online for a detailed planning guide for health care providers, children, their caregivers and teachers. The guide includes easy-to-do activities to help raise awareness about the importance of oral health. In addition, promotional posters in both English and Spanish are available for download or order.

NCDHM is brought to you by the American Dental Association (ADA). The 2019 NCDHM campaign slogan is "Brush and clean in between to build a healthy smile."

The National Institute of Dental and Craniofacial Research (NIDCR) also has free health education materials you can use for NCDHM events.

And, don't forget! Adults can learn how to help keep their child’s teeth in top shape by downloading our handy Dental Tips sheets:

Children can also download a fun SoonerCare Dental Coloring Sheet from our website.

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Regional Strategy Forums recap

Mission, Vision and Action - Symbolizing the building blocks of Strategy

In January 2018, OHCA published a strategic plan for 2018-2022 in accordance with Oklahoma statutes. Based on input from approximately 100 stakeholders and 100 agency employees, the plan articulated 10 primary strategies to drive OHCA’s programs and operations over the next five years. The plan is available at To update the plan for calendar year 2019, OHCA chose to seek additional input from stakeholders outside the metropolitan areas by holding Regional Community Strategy Forums.

OHCA held public forums in Durant, Enid, Lawton, Muskogee, Oklahoma City, Tulsa and Woodward. Approximately 200 people participated including SoonerCare members, providers and community leaders.

The forums consisted of brainstorming and small-group sessions. Groups were asked to review one of the five community-oriented strategies chosen from the plan (including objectives), suggest implementation actions and performance measures, and recommend any changes.

Each group then developed one to three implementation proposals for each strategy, with particular thought to the role that their community or organization could play in the implementation.

At the end of the forum, participants were asked to comment on anything related to the strategic plan or any other health-related subject.

In general, participants’ wishes reinforced both the vision and the strategies included in the current strategic plan. Moreover, most participants identified access and education as the main concerns for the health of rural residents and proposed a number of actions to improve one or both.

OHCA appreciates the time and input given by those who attended. We will continue to provide details and updates as the plan evolves.

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Statewide dental event marks 10 years of healthier smiles

OkMOM 10th Anniversary Logo

The Oklahoma Mission of Mercy (OkMOM) is a two-day, free dental clinic offering treatment to patients that are either uninsured, under-insured or would normally not have access to dental care. 2019 marks the 10th anniversary of this life-changing event, which will take place February 1 – 2 at Oklahoma Expo Hall in the OK State Fair Park (OKC). The clinic opens at 5 a.m. each day.

During OkMOM, patients receive a dental screening to identify their needs and determine a treatment plan. Each patient is then routed to the appropriate area(s) of the clinic: oral surgery, extractions, restorations, pediatrics and hygiene. 

There is no eligibility or income requirement, no identification or proof of citizenship required. Patients will be seen on a first-come, first-served basis.

Since 2010, Oklahoma Mission of Mercy has treated 14,454 patients, totaling more than $11 million in donated dental care.

To volunteer, donate or for more information, please visit OkMOM online at

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Take time to chat about nutrition

Apples help the body ... and teeth ... stay strong!

Healthy nutrition does a body good – and that includes one’s teeth. Calcium-rich foods, phosphorus (found in meat, dairy, legumes and nuts) and vitamin C all contribute to healthy teeth and gums. In fact, the American Dental Association (ADA) states that, “if your nutrition is poor, the first signs often show up in your mouth.”1

In addition to providing proper oral care and oral hygiene education, be sure to encourage patients to make smart food choices. Just sharing a few quick tips may help them to reduce the risk and pain of cavities:

  • Limit sugar and empty calories.
    They offer no nutritional value but wreak havoc on teeth. Sugar is food for mouth bacteria, a main factor in developing tooth decay. This includes drinks containing sugar, such as soda, juice or even sweetened coffee. Encourage patients to keep added sugar to a minimum.
  • Be careful! Some nutritious foods can harm tooth enamel, too!
    Acidic foods like tomatoes and citrus fruits (oranges, grapefruits) are healthy but can damage teeth. To enjoy them, the ADA suggests eating acidic foods as part of a meal, not by themselves.1 Moreover, sticky, dried fruits (like raisins) let sugar linger on teeth.1 Ask patients to select fresh fruit as a better choice.
  • Watch nutritional intake. is a website from the Center for Nutrition Policy and Promotion, a division of the U.S. Department of Agriculture. The website offers nutrition and calorie guidelines for a healthy, balanced diet. The Academy of Nutrition and Dietetics ( as well as the Centers for Disease Control and Prevention (CDC) also have information to help people eat and live healthier. Let your patients know about these important resources.
  • Drink fluoridated water.
    Water is essential to good health. It keeps the body hydrated and it can help the body absorb more nutrients.2 Water also helps to loosen and wash away food particles from teeth, but fluoridated water has the extra benefit of preventing tooth decay. What a wonder!

For patients who really struggle with nutrition and their weight, adults and children covered under SoonerCare may qualify for up to six (6) hours of nutritional counseling per year by a licensed registered dietitian. Ask them to contact their doctor for referral.


March is National Nutrition Month! Help make the most of it!




  1. American Dental Association. Nutrition: What You Eat Affects Your Teeth. (n.d.). Accessed January 23, 2019, from
  2. Eddis, Y. (n.d.). Nutrition Tips: How to Eat Healthy. Accessed January 23, 2019, from

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Dental Assistants Recognition Week

Femaie dental assistant smiling at camera as dentist treats patient in background

Bright smiles are not only for your patients. Be sure to observe Dental Assistants Recognition Week (DARW) in your office, March 3-9, by showing appreciation for the professionals who help you every day. Need ideas? Check out the online toolkit.

DARW is acknowledged by the American Dental Association, American Dental Assistants Association, Canadian Dental Assistants Association and Canadian Dental Association.

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Provider toolkit

OHCA Provider Helpline: 800-522-0114

Dental Prior Authorization Unit: 405-522-7401

Provider Resources

Web Alerts

Online Training

Order Publications

OHCA Calendar

Newsletter Archive 

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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.

Word of mouth

In the news ...


Here are a few topics:


**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. In addition, some of these articles may require registration or subscription to access. This listing is provided for informational purposes only.

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About OHCA


Our vision is for Oklahomans to be healthy and to have access to quality health care services regardless of their ability to pay.

OHCA Core Values:
Inclusiveness | Accountability | Engagement | Innovation | Integrity

The Oklahoma Health Care Authority does not discriminate on the basis of race, color, national origin, sex, religion, age or disability in employment or the provision of services.

Please submit any questions, comments or content suggestions to Kelli Brodersen ( in the OHCA Office of Creative Media & Design: 405-522-7504.

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