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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
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Corporate Transparency Act Update 3/14/24

March 14, 2024On March 1, 2024, a federal district court in the Northern District of Alabama concluded that the Corporate Transparency Act (“CTA”) exceeded Congressional powers and enjoined the Department of the Treasury from enforcing the CTA against the plaintiffs. National Small Business United v. Yellen, No. 5:22-cv-01448 (N.D. Ala.). On March 11, 2024, the U.S. Department of Justice appealed the district court’s decision to the Eleventh Circuit Court of Appeals.Client Alert

The Ohio State University Launches Its Accelerated Bachelor of Science in Nursing Program

February 27, 2024In response to Ohio’s nursing shortage, The Ohio State University College of Nursing is accepting applications for its new Accelerated Bachelor of Science in Nursing program (aBSN). Created for students with a bachelor’s degree in non-nursing fields, the aBSN allows such students to obtain their nursing degree within 18 months. All aBSN students will participate in high-quality coursework and gain valuable clinical experience. Upon completion of the program, graduates will be eligible to take the State Board, National Council of Licensure Exam for Registered Nursing (NCLEX-RN).Client Alert

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February 26, 2024Many physician practices and healthcare businesses are facing a new set of federal transparency requirements that require action now. The U.S. Department of Treasury Financial Crimes Enforcement Network (“FinCEN”) Beneficial Ownership Information Reporting Requirements (the “Rule”), which was promulgated pursuant to the 2021 bipartisan Corporate Transparency Act, is intended to help curb illegal finance and other impermissible activity in the United States.Client Alert

“In for a Penny, in for a Pound” is No Longer the Case for Florida Lawyers

February 19, 2024On April 1, 2024, newly adopted Rule 1.041 to the Florida Rules of Civil Procedures goes into effect which creates a procedure for an attorney to appear in a limited manner in civil proceedings.  Currently, when a Florida attorney appears in a civil proceeding, he or she is reasonable for handling all aspects of the case for their client.  This new rule authorizes an attorney to file a notice limiting the attorney’s appearance to particular proceedings or specified matters prior to any appearance before the court.  For example, an attorney can now appear for the limited purpose of filing and arguing a motion to dismiss.  Once the motion to dismiss is heard by the court, the attorney may file a notice of termination of limited appearance and will have no further obligations in the case.Client Alert

Enhancing Privacy Protections for Substance Use Disorder Patient Records

February 16, 2024On February 8, 2024, the U.S. Department of Health and Human Services (“HHS”) finalized updated rules to 42 CFR Part 2 (“Part 2”) for the protection of Substance Use Disorder (“SUD”) patient records. The updated rules reflect the requirement that the Part 2 rules be more closely aligned with the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) privacy, breach notification, and enforcement rules as mandated by the Coronavirus Aid, Relief, and Economic Security Act of 2020.
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