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The Health Care Authority's (HCA) new Dental Program newsletter provides helpful information, answers frequently asked questions, and increases provider understanding of the Apple Health (Medicaid) Dental Program. Please continue to share this newsletter with your colleagues and encourage them to subscribe.
Email the Dental Program with questions or topics you'd like covered in the newsletter.
Sign up for HCA's dental bulletins if you are not yet subscribed.
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Topic of the month: Apple Health Oral Health Advisory Workgroup
HCA is re-launching the Apple Health (Medicaid) Oral Health Advisory Workgroup in January 2025.
What is the workgroup?
The Apple Health Oral Health Advisory Workgroup will engage stakeholders to provide input in alignment with HCA’s Oral Health Roadmap to improve the Apple Health Dental Program. This new workgroup will focus on oral health throughout the lifespan, exploring both short- and long-term solutions.
Why is the workgroup being formed?
Dental providers are operating in silos with limited information about policies and processes of HCA’s fee-for-service (FFS) Apple Health Dental Program. There have been limited opportunities for providers and stakeholders to offer feedback to the Apple Health Dental Program. Many providers have the same questions and frustrations. With these concerns, HCA's Dental Program is establishing a new workgroup with representation from different provider types, specialties, and practice settings from across the state.
Working together is the best approach in addressing the many complex challenges in pursuit of oral health equity for Apple Health enrollees.
Next steps
HCA is concluding recruitment of workgroup participants, planning a kick-off meeting, and coordinating with the Medicaid Advisory Committee for inclusion of client voices and perspectives.
The HCA dental team has drafted a charter to guide the development of the workgroup's goals and scope. This is a learning process and we will engage in reflection, assessment, and make adjustments as necessary. Updates will be shared through this newsletter and other channels.
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Dental related services billing guide additions: clinical criteria
The Apple Health Dental Program is continuing to review and add relevant clinical criteria for a variety of covered services. The purpose is to:
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Align with evidence-based criteria, and
- Use the published general clinical criteria to support understanding for providers in the adjudication process and appropriate code selection and utilization.
- For example, the following were added in the October 1, 2024, Dental-Related Services Program Billing Guide:
- Clinical criteria for anterior indirect crown authorization (pages 40 – 41).
- Hyperlinks to current caries (page 37) and periodontal disease diagnosis and management guidelines (page 52).
Mobile anesthesia clarification
To become credentialed to provide mobile anesthesia services with HCA's Apple Health Dental Programs, you must have:
- A current, signed Core Provider Agreement (CPA) with HCA
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A separate, current mobile anesthesia contract.
For more information:
Persons with disabilities learning resource
The Center for Persons with Disabilities at Penn Dental Medicine offers an incredible library of resources and continuing education for providing oral health interventions for persons with disabilities.
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