Texas Medicaid Updates TMPPM for OEFV Services
The Texas Medicaid & Healthcare Partnership (TMHP) initiated a vital adjustment to Texas Medicaid Provider Procedures Manual (TMPPM) sections detailing Oral Evaluation and Fluoride Varnish (OEFV) operations in medical home facilities. These new guidelines starting April 1, 2025 bring enhanced requirements clarity to healthcare providers delivering the offered services.
The Texas Medicaid & Healthcare Partnership (TMHP) detailed that this change directly affects subsection 4.3.13.1 within the Children’s Services Handbook of the TMPPM. Under the new guidelines:
Healthcare providers associated with Texas Health Steps medical checkups need to finish the required benefit education while maintaining Texas Health Steps Dental certification for providing OEFV services.
The primary care provider (PCP) must conduct the intermediate oral evaluation, although they can delegate the execution of all other OEFV service components.
Through this update, Texas Medicaid-managed care organizations (MCOs) receive a reminder that they need to deliver every medically necessary Medicaid-covered service to the members who enroll. Medical care organizations (MCOs) implement different administrative procedures than traditional Medicaid fee-for-service programs, which include prior authorization, precertification, referrals, and encounter and claims data submission. Each provider must get the exact compliance requirements from the MCO that serves the member.
Additional information about these updates can be provided through the TMHP Contact Center at 800-925-9126.
The revision process focuses on simplifying medical home oral health services by establishing both provider training requirements and certification qualifications. Each provider giving OEFV must closely examine the modifications to verify Texas Medicaid compliance.
