WSR 18-20-118
PROPOSED RULES
HEALTH CARE AUTHORITY
[Filed October 3, 2018, 8:02 a.m.]
Original Notice.
Preproposal statement of inquiry was filed as WSR 18-03-132.
Title of Rule and Other Identifying Information: WAC 182-535-1270 Oral health connections pilot project.
Hearing Location(s): On November 6, 2018, at 10:00 a.m., at the Health Care Authority (HCA), Cherry Street Plaza, Sue Crystal Conference Room 106A, 626 8th Avenue, Olympia, WA 98504. Metered public parking is available street side around building. A map is available at www.hca.wa.gov/documents/directions_to_csp.pdf or directions can be obtained by calling 360-725-1000.
Date of Intended Adoption: Not sooner than November 7, 2018.
Submit Written Comments to: HCA Rules Coordinator, P.O. Box 42716, Olympia, WA 98504-2716, email arc@hca.wa.gov, fax 360-586-9727, by November 6, 2018.
Assistance for Persons with Disabilities: Contact Amber Lougheed, phone 360-725-1349, fax 360-586-9727, telecommunication relay services 711, email amber.lougheed@hca.wa.gov, by November 2, 2018.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: This rule making is necessary to implement SSB 5883 which directs the agency to develop and implement a three-year pilot program to test the effect that enhanced dental benefits for adult medicaid clients with diabetes and pregnant medicaid clients have on access to dental care, health outcomes, and medical care costs. The pilot program must include enhanced reimbursement rates for specific current dental terminology codes for participating providers and an increase in the allowable number of periodontal treatments to up to four per calendar year.
Reasons Supporting Proposal: This rule making is necessary to implement SSB 5883. See purpose.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: HCA, governmental.
Name of Agency Personnel Responsible for Drafting: Amy Emerson, P.O. Box 42716, Olympia, WA 98504-2716, 360-725-1348; Implementation and Enforcement: Pixie Needham, P.O. Box 45502, Olympia, WA 98504-5502, 360-725-9967.
A school district fiscal impact statement is not required under RCW
28A.305.135.
A cost-benefit analysis is not required under RCW
34.05.328. RCW
34.05.328 does not apply to HCA rules unless requested by the joint administrative rules review committee or applied voluntarily.
The proposed rule does not impose more-than-minor costs on businesses. Following is a summary of the agency's analysis showing how costs were calculated. New WAC 182-535-1270 does not impose additional compliance costs or requirements on providers.
October 3, 2018
Wendy Barcus
Rules Coordinator
WAC 182-535-1270Oral health connections pilot project.
(1) The oral health connections pilot project is effective for dates of service from January 1, 2019, through December 31, 2021.
(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:
(a) Age twenty-one or older;
(b) Pregnant, diabetic, or both;
(c) Receiving services under this oral health pilot project in Cowlitz, Spokane, or Thurston counties; and
(d) Referred by a nondental primary health care provider 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.
(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 actually be pregnant at the start of services.
(5) The following are excluded from the oral health connections pilot project:
(a) Family planning only and TAKE CHARGE programs under chapter 182-532 WAC;
(b) Medical care services (MCS) program under WAC 182-508-0005; and
(c) Clients who are enrolled in both medicaid and medicare.
(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;
(b) One complete series of intraoral radiographic images per client in a three-year period;
(c) Four bitewing x-rays (radiographs) once per client in a twelve-month period;
(d) Periodontal scaling and root planing – Four or more teeth per quadrant, once per quadrant per client in a two-year period;
(e) Periodontal scaling and root planing - Three or more teeth per quadrant, once per quadrant per client in a two-year period; and
(f) Up to three additional periodontal maintenance visits in a twelve-month period. At least ninety days must elapse following periodontal scaling and root planing or at least ninety days must elapse following initial periodontal maintenance, and then every ninety days afterwards for a total of three additional periodontal maintenance visits per eligible client in a twelve-month period.
(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.