Current through Register Vol. 24-18, September 15, 2024
(1) The oral health connections pilot project
is effective for dates of service from January 1, 2019, through December 31,
2023.
(2) The purpose of the oral
health connections pilot project is to test the effect that enhanced oral
health services have on the overall health of diabetic or pregnant medicaid
clients receiving services in Cowlitz, Spokane, and Thurston
counties.
(3) To be eligible for
the oral health connections pilot project, a client must:
(a) Be diabetic and age 21 or older;
or
(b) Be pregnant and 16 years of
age or older; and
(c) Be receiving
services under subsection (6) of this section in Cowlitz, Spokane, or Thurston
counties; and
(d) Be referred by a
nondental primary health care provider, managed care organization, or a
designated community organization to a qualified oral health connections pilot
project dental provider. For the purposes of this section, a designated
community organization is defined as an auxiliary group or groups that partner
with the agency and Arcora foundation to implement the oral health connections
pilot project or provide an attestation showing the client has been diagnosed
with diabetes or pregnancy, or both.
(4) A client who qualifies for the oral
health connections pilot project due to pregnancy may continue receiving
services through the duration of the maternity cycle as defined in WAC
182-533-0315,
but must be pregnant at the start of services.
(5) The following are excluded from the oral
health connections pilot project:
(a) Family
planning only programs under chapter 182-532 WAC; and
(b) Medical care services (MCS) program under
WAC
182-508-0005.
(6) Under the oral health
connections pilot project, the medicaid agency pays an enhanced rate for the
following services:
(a) One comprehensive oral
exam, per client, per provider in a five-year period;
(b) One periodic exam, per client, per
provider, every six months;
(c) One
complete series of intraoral radiographic images per client in a three-year
period;
(d) Four bitewing X-rays
(radiographs) once per client in a 12-month period;
(e) One adult prophylaxis, per client, every
six months;
(f) Periodontal scaling
and root planing - Four or more teeth per quadrant, once per quadrant per
client in a two-year period;
(g)
Periodontal scaling and root planing - Three or more teeth per quadrant, once
per quadrant per client in a two-year period;
(h) Up to three additional periodontal
maintenance visits in a 12-month period. At least 90 days must elapse following
periodontal scaling and root planing or at least 90 days must elapse following
initial periodontal maintenance, and then every 90 days afterwards for a total
of three additional periodontal maintenance visits per eligible client in a
12-month period;
(i) One fluoride
varnish application, per client, every six months; and
(j) One silver diamine fluoride treatment,
per tooth, per client, every six months.
(7) The services listed in subsection (6) of
this section are the only services the agency pays at the enhanced rate. The
agency pays for all other covered dental services at the standard
rate.
(8) To receive the enhanced
rate, dental providers must:
(a) Be enrolled
to participate in the oral health connections pilot project;
(b) Meet the qualifications in WAC
182-535-1070;
(c) Provide the services in Cowlitz, Spokane,
or Thurston counties; and
(d)
Complete training designed specifically for the oral health connections pilot
project.
(9) The agency
assigns a special identifier to providers who complete the training in
subsection (8)(d) of this section which allows them to receive the enhanced
rate.
