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Ohio Department of Medicaid Proposes Changes to Dental Reimbursement and Coverage Rule

Client Alert
July 29, 2024

The Ohio Department of Medicaid is proposing amendments to Ohio Administrative Code rule 5160-5-01 to do all of the following:

  • Procedure Code Updates
    • Update covered services based on new procedure codes added to the 2024 American Dental Association Code on Dental Procedures and Nomenclature.
  • Frequency Limitations and Coverage Clarifications
    • Amend frequency limitations, coverage clarifications, and service descriptions for: Dental exams, Prophylaxis, Imaging, Pin retention, Re-cementing, Re-bonding, Orthodontic treatments, Biopsy, Application of fluoride varnish.
  • Imaging Payments
    • Allow reimbursement for multiple bitewings taken in conjunction with a panoramic image.
  • Vaccine Administration
    • Discontinue payment for the administration of COVID-19 and human papillomavirus vaccines.
  • Pin Retention
    • Reimburse pin retention per tooth, with a maximum of three pins per tooth.
  • Re-cementing and Re-bonding Crowns
    • Remove the frequency limit for re-cementing and re-bonding crowns.
  • Orthodontic Treatment Payments
    • Ensure payment for comprehensive orthodontic treatment (D8080) covers the initial placement visit and the first quarter of treatment.
    • Allows seven calendar quarters of periodic orthodontic treatment visits (D8670) per course of treatment.
    • Prohibits reimbursement for D8670 in the same quarter as D8080.
  • Partial Dentures
    • Removes the restriction stating "A partial denture with a resin base may be covered only for a patient younger than 19".
  • Dental Evaluations and Prophylaxis
    • Clarifies that periodic dental evaluations and dental prophylaxis are covered once per 180 days for several special groups, including but not limited to:
      • Pregnant women
      • Foster children
      • Employed individuals with disabilities, regardless of age
    • Prior Authorization (PA) Requirements
      • The PA Required column will indicate when procedures are paid by report.
      • Prohibits reimbursement for excisional biopsies of salivary glands in conjunction with another biopsy on the same date of service.
    • Topical Fluoride Varnish Application
      • Adds the Current Procedural Terminology code for "Application of topical fluoride varnish by a physician or other qualified health care professional when performed in a nondental clinic or facility setting".

There will be a hearing on these proposed rule changes August 12, 2024. Please contact BMD Healthcare Member Daphne Kackloudis at dlkackloudis@bmdllc.com for questions or to help you prepare comments on the rules.

Ohio Department of MedicaidMedicaidHealthcare
Client Alert

Safer Federal Workforce Task Force - Guidance for Federal Contractors and Subcontractors

September 27, 2021The Safer Federal Workforce Task Force has issued its Guidance for Federal Contractors and Subcontractors (Guidance). Note that the Guidance applies only to “covered contracts,” which are contracts that include the clause (Clause) set forth in Sec. 2(a) of Executive Order 14042 (Ensuring Adequate COVID Safety Protocols for Federal Contractors). The Federal Acquisition Regulatory Council (FARC) is to conduct rulemaking and take related action to ensure that the Clause is incorporated into federal contracts. Until that happens, federal contractors likely will not see the Clause in its contracts. Following is a broad summary of the Guidance.Client Alert

Banking & Cannabis: The Next Frontier Webinar

September 23, 2021On Tuesday, September 21st, BMD’s own Banking and Cannabis Partner, Stephen Lenn, hosted a star-studded cast of panelists in a webinar titled Banking & Cannabis: Cannabis Lending, The Next Frontier. The webinar, which had to suspend registrations when hitting a maximum cap of 500, aimed to explore issues related to cannabis and banking, with a particular emphasis on lending. With the sponsorship and support of the Bankers Associations of Arizona, Colorado, Ohio and Utah, Steve was able to recruit an elite group of bankers, bank regulators, cannabis industry players, and cannabis regulators, who took the topic head on. The discussion kicked off with an opening from the keynote speaker, VP of Congressional Affairs for the American Bankers Association, Tanner Daniel.Client Alert

Is Your Bonus System Creating Wage and Hour Violations? A Hidden Impact of the Labor Shortages

September 22, 2021As employers struggle with attracting and retaining talent, many have turned to incentives such as Signing Bonuses and Retention Bonuses. In doing so, employers may be inadvertently exposing themselves to overtime law violations. Employers with non-exempt employees know that the Fair Labor Standards Act (FLSA) requires an overtime premium to non-exempt for work in excess of 40 hours per week. However, all too often, employers miscalculate the “regular rate” of pay, which is used for calculating the “overtime rate.” The miscalculation is becoming more prevalent in today’s market when employers fail to include supplemental compensation, such as certain Signing Bonuses and Retention Bonuses into the regular rate of pay. An example: A non-exempt employee is hired at a rate of $20 per hour, and also receives a retention bonus of $1,200 after working for 12 weeks. In her 11th week of work, employee works 50 hours. In her 14th week of work, employee works 50 hours. What is her paycheck in week 11? What is her paycheck in week 14?Client Alert

No Surprises Act – Notice Requirements

September 22, 2021On July 1, 2021, the Biden Administration passed an interim final rule: Part 1 of the “Requirements Related to Surprise Billing Act,” in an attempt to curb excessive costs patients are required to pay in relation to surprise billing. The rule is set to take affect January 1, 2022, and will only affect those who are enrolled in insurance via their employers, as federal healthcare programs already prohibit this type of billing.[1]Client Alert

El Contrato Escrito: La Herramienta Predilecta

July 23, 2021No existe mejor herramienta a una disputa contractual que un documento firmado por las partes en el cual se expongan las obligaciones y acuerdos entre éstas.
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