123-1260-09242026.pdf: OAR 410-123-1260 rule amended to clarify that the Oregon Medicaid Dental Service list is for supplemental reference only, not compliance or benefit determinations. No public comment was received.

Oregon Health Authority (OHA) filed Permanent Administrative Order DMAP 38-2026 on September 23, 2026, amending OAR 410-123-1260, effective September 24, 2026. The amendment reorganizes and clarifies the Coverage, Limitations, and Exclusions rule governing Oregon Health Plan (OHP) dental and denturist services provided on a fee-for-service basis. The core clarification distinguishes between sources that govern compliance and sources that serve as supplemental reference only. Under the amended rule, providers of OHP dental and denturist services must comply with OAR Chapter 410, Division 120 and Division 123 rules, must be licensed and enrolled as Medicaid providers per OAR 410-120-1260, and must make records available for audit per OAR 410-123-1620. Compliance with Chapter 410 rules does not supersede applicable state, local, or federal law, including licensure requirements. Covered services are defined by funded lines on the HERC Prioritized List as identified in OAR 410-141-3830 and approved ancillary procedure codes at the Oregon data portal. The amended rule expressly designates the Oregon Medicaid Dental Services procedure code supplemental reference, the Medical-Dental Fee Schedule, the Prioritized List website, and the ADA Current Dental Terminology (CDT) code book as sources for supplemental guidance only, not to be used for benefit coverage determinations. Previously, the Oregon Medicaid Covered Dental Services list appeared in the rule without this limiting designation; the amendment adds explicit language restricting its use to reference purposes. The rule retains and renumbers detailed coverage criteria for diagnostic, preventive, restorative, endodontic, periodontal, and prosthodontic services, including frequency limitations, prior authorization requirements, and EPSDT provisions. All coverage limitations and exclusions remain subject to EPSDT review under Chapter 410, Division 151, which requires case-by-case review for EPSDT medical necessity and dental appropriateness. No public comment was received during the notice period opened August 5, 2026.