OK SPA 22-0040 Dental Services Reimbursement Methodology
The Oklahoma Health Care Authority proposes a state plan amendment (SPA) to update the rate methodology used to pay for dental services as the Agency was appropriated dollars within the state fiscal year 2023 budget to increase dental rates. The proposed rate methodology to pay dental services will continue to use a calculation of Relative Value Units (RVUs) times a Conversion Factor; however, the State will update the RVUs annually with the Optum Coding Relative Values for Dentists Data File and a new conversion factor which is different for children and adults. The current Conversion Factor is the same for all populations and has not been updated in several years. Dental providers will see a rate increase in the aggregate of over 5% for children and over 14% for adults through the new rate methodology. This update will improve the Agency’s ratio of Medicaid reimbursement to private dental insurance reimbursement to 73.02% which is over a 10% improvement; compared to other states, the new dental service rates will be over what New Mexico Medicaid pays for dental services and on par with what Colorado Medicaid pays.
Please view the draft SPA pages here: OK SPA 22-0040 and submit feedback via the comment box below.
Expedited 30-day Tribal Consultation Period: 8/26/2022 – 9/25/2022
Tribal Consultation Meeting: 9/6/2022
Circulation Date: 9/6/2022
Comment Due Date: 10/6/2022
Comments
Susan:
Dentists should not be allowed to use all dental cases to an ASC for treatment. They should be performing these in the office with Gas if necessary.
OHCA Response:
Thank you for your comment. The OHCA takes all comments under advisement.
Jenny Garcia Rocha:
When will a copy of the updated fees be released for use?
OHCA Response:
Thank you for your question, the fee schedule has been updated to include the D4910 with an effective date of 9/12/22. The 10/1/22 fee schedule will be posted in October.”
Dr. B:
Will children and adults continue to have the same fee schedule or will codes be reimbursed differently for the two populations?
OHCA Response:
Thank you for the question. There will be a variable rate for children/adults. These will be effective back dated to 10/1/2022 once we receive CMS approval
