Resources

Client Alerts, News Articles, Blog Posts, & Multimedia

Everything you need to know about BMD and the industry.

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

A Potential Childcare Disruption for Rehired Employees

May 14, 2020As businesses reopen, employers with fewer than 500 employees need to brush up on the FFCRA Paid Leave rules, including a potential disruption to your return to operations.Client Alert

With Summer Vacation on the Way, Are Employees Still Entitled to Childcare Leave under EFMLEA?

May 13, 2020Distance learning/homeschooling is finally starting to wrap-up for millions of students across America, a perhaps welcomed end for many, and summer vacation will soon begin. As summer vacation begins, your employees may have questions as to whether they qualify for child care leave under the expanded FMLA (“EFMLEA”), which many employees used over the last few months to receive partial compensation while they were away from work to care for their children. Now, employers with fewer than 500 employees must take note of additional guidance recently published concerning qualification for childcare leave.Client Alert

Economic Impact Payment is Not Taxable Income

May 12, 2020The IRS stated that the economic impact payments are not considered taxable income. Therefore, individuals will not owe tax on the amount of economic impact payment received.Client Alert

Accommodating the Return to Work

May 8, 2020It has been two months since Ohio declared coronavirus an emergency, and although it is clear things will not be fully back to "normal" anytime soon, the state of Ohio is rolling out the reopening process for businesses with a number of new guidelines and restrictions.Client Alert

Relief for Employers from Unemployment Filings

May 8, 2020From the last 7 weeks, the total number of unemployment filings in the U.S. now totals 33.5 million, an unprecedented number comparable to the number of filings during the Great Depression. Although some state and federal funds are being used to supplement the unemployment funds, providing additional compensation to the unemployed, employers will be responsible for a very large portion of the total funds being doled out to employees.
Older posts
Newer posts