Medicaid THSteps Dental Policy Review
The Texas Health and Human Services Commission (HHSC) recently asked TAPD to provide input for their review of the Texas Health Steps Dental Preventive Services Policy. TAPD believes that HHSC needs to complete a comprehensive review by convening a work group to review all dental policies; however, TAPD did submit four preventative codes to help HHSC begin process.
Click the download button to see TAPD’s recommendations.
TAPD Legislative Spotlight—William (Bill) Steinhauer, DDS
Name: William (Bill) Steinhauer, DDS
Position: Legislative Director
Number of years in practice: 35 as a Pediatric Dentist
Where you went to dental school and completed residency: University of Texas Dental School at San Antonio (both)
Number of years as a TAPD member: 37 (I started as a student member.)
What made you decide to get involved as a member of the TAPD Legislative Committee: It is my passion to advocate for children and their Oral Health needs.
What is your goal for the legislative session:
1) To not have cuts in the Medicaid Dental fees;
2) to have the legislature direct HHS to partner with representatives of: organized dentistry, academia, OIG, and the DMOs for a thorough “top-to-bottle” review of the benefits and limitations of the Texas Medicaid dental program;
3) to make sure any Teledentistry legislation that may be passed this session, is designed to assist our patients to access quality care, and not be the victims of providers looking to bill for services that provide no real benefit to the patient, or even lead them to believe they are receiving a level
of care which they are not.
What have you learned in your time as a TAPD member: If TAPD is not at the table when healthcare in general, and pediatric dentistry specifically, is under discussion by any governmental body, dentistry will always be an afterthought.
What surprised you the most about the legislative process: How uninformed some legislators are and how financial contributions are often required to get access to the right people.
What are you most proud of about TAPD: We are the most involved dental specialty organization in the State, and have been able to partner with the TDA on so many issues.
As a reminder, effective January 1, 2021, the Texas Health and Safety Code § 481.0755 requires that prescriptions for controlled substances be issued electronically, except in limited circumstances, or unless a waiver has been granted by the Texas State Board of Dental Examiners.
A dentist may apply for a waiver from the electronic prescribing (e-prescribing) requirement if the dentist prescribes fewer than 25 prescriptions per year, faces economic hardship, or has technological limitations.
TAPD has confirmed that the e-prescribing requirement only applies to controlled substances. If a dentist does not prescribe controlled substances, he/she is not required to e-prescribe and therefore does not need a waiver. However, if a dentist prescribes between 1-24 controlled substances, he/she would be eligible for a waiver if he/she submits the waiver form.
To request a waiver, please fill out a waiver form and submit it to firstname.lastname@example.org. Once approved, waivers will be issued for a period of one year. For more information please visit https://tsbde.texas.gov/e-prescribing-waiver/
2020 Medicaid Question & Answer Session Agenda
VIRTUAL ZOOM MEETING DECEMBER 5, 2020 12:00 pm – 3:00 pm
- Welcome & Intro
- Overview of Medicaid
- Centers for Medicare and Medicaid Services (CMS)
- Texas Health and Human Services Commission (HHSC)
- Texas Medicaid Healthcare Partnership (TMHP)
- Current Texas Medicaid Discussion Points
- Fee Setting
- Top to Bottom Benefits Review
- Esthetic Crowns
- Claim Processing
- Prior Authorization
- Assignment of Main Dentist
- Medical Necessity
- Frew Lawsuit
- Hospital and General Anesthesia Coverage
- Public Marketing Policy
- Office of the Inspector General (OIG)
- Fraud, Waste & Abuse
- Question and Answering
TAPD Anesthesia Jurisprudence Exam
The Texas State Board of Dental Examiners (TSBDE) adopted 22 Tex. Admin. Code § 110.2 – Sedation Anesthesia Permit and 22 Tex. Admin. Code § 110.9 – Anesthesia Permit Renewal at their meeting last week. These rules were adopted in response to the TSBDE’s 2017 Sunset legislation (SB 313).
The rules require the completion of an anesthesia jurisprudence exam prior to applying for a Sedation/Anesthesia Permit. If you already hold a permit for nitrous oxide, Level 1, Level 2, Level 3 or Level 4 sedation/anesthesia, you must complete an anesthesia jurisprudence exam once every five years in conjunction with the jurisprudence exam required under § 104.1. The anesthesia jurisprudence exam will be part of the existing jurisprudence exam and will not be a separate exam.
It is our understanding that the anesthesia jurisprudence exam is not yet finalized. We expect the rules to go into effect in mid-October, and will send out additional guidance once we receive it form TSBDE.
Governor Abbott Expands Capacity For Certain Services In Texas, Announces Guidance For Nursing Home, Long-Term Care Visitations
Today, Gov. Abbott held a press conference to discuss the status of the COVID-19 pandemic in Texas. He noted the positivity rate continues to decrease across the state because Texans are staying home when they are sick, social distancing, wearing masks and practicing good hand washing hygiene. The governor expects Texas to receive millions of rapid 15 minute COVID tests in the next month, which will play a large role in keeping the spread of COVID-19 down.
Hospital capacity remains the most accurate metric we have in evaluating COVID-19. When hospitalizations are high, the state needs to react and put in place restrictions. When hospitalizations are down, the state can implement reopening policies.
Because hospitalizations are down in most regions in Texas, the governor announced the loosening of some restrictions in 19 out of 22 hospital regions in Texas. In Trauma Service Areas where COVID-19 hospitalizations are less than 15% of all hospitalizations, the region can increase its capacity restrictions from 50% to 75% for retail, restaurants, libraries and office buildings beginning Monday, September 22. In these regions, beginning September 24, nursing home facilities can also allow a primary caregiver to visit a patient. Bars throughout Texas must remain closed.
Effective immediately in regions where hospitalizations for COVID are less than 15% of all hospitalizations, there are no restrictions on elective procedures. All hospitals, however, must reserve at least 10% of their capacity for COVID-19 treatment. Individual hospitals within a hospital system consisting of more than one member hospital may reserve less than 10 percent capacity, so long as the hospital system’s cumulative reserved capacity within the same Trauma Service Area is at least 10%.
Regions with more than 15% COVID hospitalizations, including the Rio Grande Valley, Laredo and Victoria, cannot expand their restrictions. This includes: Calhoun, Cameron, DeWitt, Goliad, Hidalgo, Jackson, Jim Hogg, Lavaca, Starr, Victoria, Webb, Willacy and Zapata counties.
View the Governor’s Executive Order related to expanded capacity of certain services.
View the Governor’s Executive Order related to hospital capacity.
New Human Trafficking CE Required for Dental Providers
New Human Trafficking CE Required for Dental Providers
The Texas State Board of Dental Examiners has posted guidance on the newly required human trafficking prevention training for healthcare providers. This training is required for all dental health care personnel, including dentists, hygienists and dental assistants applying for license renewal on or after September 1, 2020. Licensees must continue to complete an approved course each subsequent renewal cycle.
This new training requirement is a result of House Bill 2059, which passed during the 2019 legislative session. Health care practitioners are in a unique position to intervene in human trafficking. Victims and survivors of human trafficking may be seen at local clinics, emergency departments, or other medical settings and the health care team’s actions can make a life-saving difference. This training is meant to provide you with a variety of resources to inform and support planning for that critical response.
This one hour course is completely free and will apply to the 24 hours of CE required for each biennial renewal cycle.
To read TSBDE’s full memo, please visit: https://tsbde.texas.gov/new-human-trafficking-prevention-training-required/
Provider Relief Fund: Medicaid/CHIP and Dental Deadline Extended
The U.S. Department of Health & Human Services (HHS) announced that providers participating in state Medicaid programs, the Children’s Health Insurance Program (CHIP) and/or Medicaid/CHIP-managed care programs now have until Aug. 3, 2020, to apply for funding under the approximately $15 billion Public Health and Social Services Emergency Fund (Provider Relief Fund) Medicaid and CHIP Distribution (Medicaid and CHIP Distribution).
Similarly, on July 20, 2020, HHS also extended the deadline until Aug. 3, 2020, for dental providers to apply for Provider Relief Fund payments (Dental Distribution).
For more information, please visit: https://www.mcguirewoods.com/client-resources/Alerts/2020/7/provider-relief-fund-medicaid-chip-dental-deadline-extended-more-funds-hard-hit-hospitals
TAPD Officer Spotlight—Angela Lopez-Loverich
Name: Angela Lopez-Loverich
Number of years in practice: Eight: two practicing general dentistry and six as a board certified pediatric dentist.
Where you went to dental school and completed residency: The University of Texas Health Science Center San Antonio-Doctorate of Dental Surgery and The University of Texas Health Science Center San Antonio-Certificate of Specialty in Pediatric Dentistry.
Number of years as a TAPD member: Eight
What made you decide to get involved as a TAPD officer: I decided to pursue an officer position because I wanted to have a voice and positively impact the future of pediatric dentistry. When I first completed my residency program and was a new member, I learned how much
legislation shapes our profession.
What is your goal for the year: My goal for this year is to learn as much as I can from my fellow executive board members, Dr. Ben Morgan and Dr. Steve Siedow, to prepare myself for the future. I will also be working on navigating our CE committee during this pandemic in order to continue to provide quality CE from a distance.
What have you learned in your time as a TAPD member: I have learned how important organized dentistry is for the welfare of our profession—without it, our profession would be in the hands of others who do not fully understand patient care.
What surprised you the most about the legislative process: While the amount of organization and persistence needed to bring about real change for our profession is daunting, we are fortunate to have such a dedicated group representing Texas pediatric dentists.
What are you most proud of about TAPD: We continue to grow our numbers and strengthen TAPD, which indicates that our members see a value in what we do for them. We are on the frontline of decision making in our state and help control the direction of pediatric dentistry. We gain so much knowledge from one another as active pediatric dentists working in different climates. Our leadership and board members donate their time to better our future as pediatric dentists. We have also started to create CE of great value to our members while still having fun.