Date: September 18, 2024
Attention: Primary Care Providers
Call to action: Due to an increase in the number of TCHP members utilizing emergency services for dental-related visits, we would like to remind providers of the importance and availability of preventive dental care for children receiving Texas Health Steps services.Statically speaking, by 6 to 8 years of age, 56% of all US children have experienced dental caries affecting the primary teeth. Not only do pediatric dental caries cause pain but they can also lead to more severe infections and affect children's normal growth and development. Source: National Library of Medicine.
Dental benefits availability:
- Dental services are available to children and adolescents age birth through 20 years who are enrolled in Medicaid’s Texas Health Steps and Comprehensive Care Program (CCP) services, including Supplemental Security Income (SSI) recipients.
- Health and Human Services Commission (HHSC) provides dental services through a managed care model that includes Medicaid. Three Dental Maintenance Organizations (DMOs) that offer coverage statewide are DentaQuest, MCNA Dental and UnitedHealthcare Dental. Members can find their DMO on the back of their ‘Your Texas Benefits Medicaid Card.’
- For help with finding a dentist for a TCHP Member click here and scroll to ‘Find a Dental Provider.’
- Medicaid non-emergency transportation covers visits to the dentist, as well as medical visits
Care Coordination Contact information for arranging specialty dental services for STAR Kids members/members with special needs.
- Hours 8AM to 5PM CT, Monday—Friday
- Phone: 832-828-1430 or 844-780-1154
How this impacts providers: Texas Health Steps medical providers are required to refer children for dental care to establish a dental home at preventive medical checkups at age 6 months and to make referrals for new and existing patients at each subsequent preventive medical checkup until establishment of a dental home is confirmed.
The primary care medical provider should encourage parents to make an appointment with a dentist even if their child’s teeth look healthy or even if they do not yet have any erupted teeth. Primary care medical providers and staff can remind patients about the availability of non-emergency medical transportation if patients have difficulty accessing transportation. Click here for more information on the transportation assistance options available to TCHP Members.
Certification and education:
Texas Health Steps enrolled physicians, physician assistants, and advanced practice registered nurses can provide Oral Evaluation and Fluoride Varnish (OEFV) in the Medical Home, which offers limited services aimed at improving the oral health of children from 6 through 35 months of age. For more information on how to become certified to provide OEFV services, visit https://www.hhs.texas.gov/providers/health-services-providers/texas-health-steps/medical-providers/oral-evaluation-fluoride-varnish-medical-home.
Texas Health Steps has updated their online provider education course titled, “Oral Health for Primary care Providers.” The goal of this module is to equip Texas Health Steps providers and other health-care professionals with the necessary tools to implement legal requirements and best practices in assessing and promoting the oral health of children ages birth through 20 years. To access the course go to https://www.txhealthsteps.com/656-oral-health-primary-care-providers.
Dental Services HEDIS & Billing Information:
- OED (Oral Evaluation, Dental Services)
- Description – The percentage of members under 21 years of age who received a comprehensive or periodic oral evaluation with a dental provider during the measurement year.
- CDT codes – D0120, D0145, D0150
- TFC (Topical Fluoride for Children)
- Description – The percentage of members 1–4 years of age who received at least two fluoride varnish applications during the measurement year
- Codes – D1206 (CDT), 99188 (CPT)
Next step for Providers: PCPs should share this reminder with their staff and follow the guidance outlined in this communication to encourage the dental health of their patients.
If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.
For access to all provider alerts: https://www.texaschildrenshealthplan.org/providers/provider-news/provider-alerts.
