WAC 182-535-1270 Oral health connections pilot project

WAC 182-535-1270 Oral health connections pilot project

Effective March 26, 2022

1. The oral health connections pilot project is effective for dates 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 be:
   1. Be diabetic and age 21 or older; or
   2. Be pregnant and 16 years of age or older; and 
   3. Be receiving services under subsection (6) of this section in Cowlitz, Spokane, or Thurston counties; and
   4. 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:
   1. Family planning only programs under chapter 182-532 WAC and;
   2. 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:
   1. One comprehensive oral exam, per client, per provider in a five-year period;
   2. One periodic exam, per client, per provider, every six months;
   3. One complete series of intraoral radiographic images per client in a three-year period;
   4. Four bitewing x-rays (radiographs) once per client in a 12-month period;
   5. One adult prophylaxis, per client, every six months;
   6. Periodontal scaling and root planing – Four or more teeth per quadrant, once per quadrant per client in a two-year period;
   7. Periodontal scaling and root planing – Three or more teeth per quadrant, once per quadrant per client in a two-year period;
   8. 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;
   9. 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:
   1. Be enrolled to participate in the oral health connections pilot project;
   2. Meet the qualifications in WAC 182-535-1070;
   3. Provide the services in Cowlitz, Spokane, or Thurston counties; and
   4. 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 section (8)(d) of this section which allows them to receive the enhanced rate.