The Texas Medicaid & Healthcare Partnership (TMHP) has announced an upcoming update to the Texas Medicaid Provider Procedures Manual (TMPPM), specifically within the Children’s Services Handbook, Section 4.3.13.1 – “Oral Evaluation and Fluoride Varnish (OEFV) in the Medical Home.”
This update goes into effect on November 1, 2025, and provides additional clarity on Provider qualifications and service delivery expectations for OEFV services in the medical home setting under Texas Health Steps (EPSDT).
Key Updates:
1. OEFV Provider Eligibility
- Only Texas Health Steps medical checkup Providers who have completed the required OEFV benefit education and are certified by Texas Health Steps may deliver and bill for OEFV services.
2. Scope of Practice and Delegation
- The intermediate oral evaluation must be performed by the certified OEFV provider.
- All other components of the OEFV service may be delegated to other qualified staff members within the provider’s practice.
Questions?
Providers should contact Community First Health Plans if they have questions about administrative procedures, including prior authorization, precertification, referrals, or claims and encounter data filing.
For additional information on this policy update, you may also contact the TMHP Contact Center at 800-925-9126 or visit TMHP.com to view the Texas Medicaid Provider Procedures Manual (TMPPM).
Action: Providers are encouraged to share this information with their staff. If you have any questions about this notice, please email Provider Relations at ProviderRelations@cfhp.com or call 210-358-6030. You can also contact your Provider Relations Representative directly.
To access all Provider alerts:
- Log into the Community First Provider Portal
- Go to CommunityFirstHealthPlans.com/Provider-News
- Sign up for the Community First Provider eNewsletter