OAR 410-123-1060
Definition of Terms

(1) “Acute” has the meaning as provided in OAR 410-120-0000 (Acronyms and Definitions).
(2) “Ambulatory Surgical Center (ASC)” has the meaning as provided in OAR 410-120-0000.

(3)

“Ancillary Service” has the meaning as provided in OAR 410-120-0000 (Acronyms and Definitions).

(4)

“Anesthesia” refers to the Oregon Board of Dentistry administrative rules (OAR chapter 818, division 026).

(5)

“Anesthesia Services” has the same meaning as OAR 410-120-0000 (Acronyms and Definitions) and means administration of anesthetic agents to cause loss of sensation to the body or body part.

(6)

“By Report (BR)” has the meaning as provided in OAR 410-120-0000 (Acronyms and Definitions).
(7) “Current Dental Terminology (CDT)” means a listing of descriptive terms identifying dental procedure and nomenclature used by the American Dental Association.
(8) “Citizen/Alien-Waived Emergency Medical” has the meaning as provided in OAR 410-120-0000 (Acronyms and Definitions). The acronym “CAWEM” has the same meaning.

(9)

“Co-Payments” means the portion of a claim or medical, dental, or pharmaceutical expense that a client must pay out of their own pocket to a provider or a facility for each service. It is usually a fixed amount that is paid at the time service is rendered. (See OAR 410-120-1230 Client Copayment.)

(10)

“Covered Services” has the meaning as provided in OAR 410-120-0000 (Acronyms and Definitions).

(11)

“COVID-19 Emergency” means the period: 1. Starting on the earliest of any COVID-19 public health emergency affecting the delivery of health care services and declared by the Secretary of HHS pursuant to 42 U.S.C. § 247d, by the Governor of Oregon, or by OHA; and 2. Ending on the latest of any COVID-19 public health emergency affecting the delivery of health care services and declared by the Secretary of HHS pursuant to 42 U.S.C. § 247d, by the Governor of Oregon, or by OHA. OHA will publish guidance on the CCO Contracts Website regarding the duration of the COVID-19 Emergency. This pertains to leniencies under HIPAA and delivery modalities provided in telehealth/teledentistry due to the COVID-19 Emergency. See OAR 410-120-1990 (Telehealth).

(12)

“Dental” means having to do with the teeth.

(13)

“Dental Emergency Services” has the meaning as provided in OAR 410-120-0000 (Acronyms and Definitions).

(14)

“Dental Hygienist” has the meaning as provided in OAR 410-120-0000 (Acronyms and Definitions).

(15)

“Dental Hygienist with Expanded Practice Dental Hygiene Permit (EPDH)” has the meaning as provided in OAR 410-120-0000 (Acronyms and Definitions).
(16) “Dental Practitioner” means an individual licensed pursuant to state law to engage in the provision of dental services within the scope of the practitioner’s license and certification.
(17) “Dental Services” has the meaning as provided in OAR 410-120-0000 (Acronyms and Definitions), and means services provided within the scope of practice as defined under state law by or under the supervision of a dentist or dental hygienist or denture services provided within the scope of practice as defined under state law by a denturist or Limited Access Permit (LAP).

(18)

“Dental Services Documentation” means meeting the requirements of the Oregon Dental Practice Act statutes, administrative rules for client records and requirements of OAR 410-120 1360 Requirements for Financial, Clinical and Other Records, and any other documentation requirements as outlined in OAR chapter 410 division 123 (Dental rules).
(19) “Dental Emergency Condition” means a condition based on the presenting symptoms (not the final diagnosis) as perceived by a prudent layperson (rather than a Health Care Professional) and includes cases in which the absence of immediate medical attention would not in fact have had the adverse results. Dental Emergency Condition may include but is not limited to severe tooth pain, unusual swelling, or an avulsed tooth.
(20) “Dental Urgent Care” focuses on the management of conditions that require immediate attention to relieve severe pain and/or risk of infection and to alleviate the burden on hospital emergency departments. These should be treated as minimally invasively as possible. Examples of Dental Urgent Care Conditions include: Severe dental pain from pulpal inflammation; Pericoronitis or third-molar pain; Surgical post-operative osteitis; Dry socket dressing changes; Abscess, or localized bacterial infection resulting in localized pain and swelling; Tooth fracture resulting in pain or causing soft tissue trauma; Dental trauma with avulsion/luxation; Dental treatment required prior to critical medical procedures; Final crown/bridge cementation if the temporary restoration is lost, broken or causing gingival irritation; Biopsy of abnormal tissue; Extensive dental caries or defective restorations causing pain, managed with interim restorative techniques when possible (silver diamine fluoride, glass ionomers); Suture removal; Denture adjustment on radiation/ oncology patients; Denture adjustments or repairs when function impeded; Replacing temporary filling on endo access openings in patients experiencing pain; Snipping or adjustment of an orthodontic wire or appliances piercing or ulcerating the oral mucosa.
(21) “Dentally Appropriate” as provided in OAR 410-120-0000 (Acronyms and Definitions), means health services, items, or dental supplies:
(a) Recommended by a licensed health provider practicing within the scope of their license;

(b)

Safe, effective and appropriate for the patient based on standards of good dental practice and generally recognized by the relevant scientific or professional community based on the best available evidence;
(c) Not solely for the convenience or preference of an OHP client, member or a provider of the service, item or dental supply; and
(d) The most cost effective of the alternative levels or types of health services, items, or supplies that are covered services that can be safely and effectively provided to a client or member in the Division or MCE’s judgement.
(e) All Covered Services must be Dentally Necessary or Dentally Appropriate for the Member or Client, but not all Dentally Necessary or Dentally Appropriate services are Covered Services.
(22) “Dentist” has the meaning as provided in OAR 410-120-0000 (Acronyms and Definitions).

(23)

“Denturist” has the meaning as provided in OAR 410-120-0000 (Acronyms and Definitions).

(24)

“Distant Site” means the site where the dentist is being contacted for consultation by the originating site.

(25)

“Division” has the meaning as provided in OAR 410-120-0000 (Acronyms and Definitions).

(26)

“Emergency Medical Condition” has the same meaning as OAR 410-120-0000 (Acronyms and Definitions) and means a condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate attention to result in placing the health of the individual (or with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy, serious impairment to bodily functions or serious dysfunction of any bodily organ or part.

(27)

“Emergency Services” has the meaning as provided in OAR 410-120-0000 (Acronyms and Definitions) and means health services from a qualified provider necessary to evaluate or stabilize an emergency dental or medical condition, including inpatient and outpatient treatment that may be necessary to assure within reasonable medical probability that the patient’s condition is not likely to materially deteriorate from or during a client’s discharge from a facility or transfer to another facility.
(28) “Fee-for-Service Provider” has the meaning as provided in OAR 410-120-0000 (Acronyms and Definitions).
(29) “Hospital Dentistry” means dental services normally done in a dental office setting but due to specific client need (as detailed in OAR 410-123-1490 (Hospital Dentistry)) are provided in an ambulatory surgical center, inpatient or outpatient hospital setting under general anesthesia, or IV conscious sedation, if appropriate.
(30) “Managed Care Entity (MCE)” has the meaning as provided in OAR 410-141-3500 (Definitions).
(31) “Managed Care Organization (MCO)” has the meaning as provided in OAR 410-120-0000 (Acronyms and Definitions).
(32) “Medical Practitioner” means an individual licensed pursuant to state law to engage in the provision of medical services within the scope of the practitioner’s license and certification.
(33) “Medicament” means a substance or combination of substances intended to be pharmacologically active, specially prepared to be prescribed, dispensed, or administered to prevent or treat disease.
(34) “Originating Site” means the site where the patient is located, and dental care providers are working and performing services in conjunction with a dentist who is not at that site, all while using telehealth technology.
(35) “Physician” has the meaning as provided in OAR 410-120-0000 (Acronyms and Definitions).

(36)

“Prepaid Ambulatory Health Plans” has the meaning provided in 42 CFR §438.2. The acronym “PAHP” has the same meaning.
(37) “Prepaid Health Plan” and “PHP” each has the meaning as provided in OAR 410-120-0000 (Acronyms and Definitions).
(38) “Primary Care Dentist (PCD)” as stated in OAR 410-120-0000 (Acronyms and Definitions), means a dental practitioner responsible for supervising and coordinating initial and primary dental care within their scope of practice for their members.
(39) “Primary Care Provider (PCP)” as stated in OAR 410-120-0000 (Acronyms and Definitions), means any enrolled medical assistance provider who has responsibility for supervising, coordinating, and providing initial and primary care within their scope of practice for identified clients. PCPs initiate referrals for care outside their scope of practice, consultations, and specialist care and assure the continuity of medically appropriate client care. A Federally qualified PCP means a physician with a specialty or subspecialty in family medicine, general internal medicine, or pediatric medicine as defined in OAR 410-130-0005 (Federally Qualified Primary Care Provider).
(40) “Prior Authorization” has the meaning as provided in OAR 410-120-0000 (Acronyms and Definitions). The acronym “PA” has the same meaning.
(41) “Procedure Codes” means the procedure codes set forth in OAR chapter 410, division 123 that refer to Current Dental Terminology (CDT), unless otherwise noted. Codes listed in this rule and other documents incorporated in rule by reference are subject to change by the American Dental Association (ADA) without notification.
(42) “Provider” has the meaning as provided in OAR 410-120-0000 (Acronyms and Definitions).
(43) “Referral” as stated in OAR 410-120-0000 (Acronyms and Definitions), means the transfer of total or specified care of a client from one provider to another. As used by the Authority, the term referral also includes a request for a consultation or evaluation or a request or approval of specific services.
(44) “Standard of Care” means what reasonable and prudent practitioners would do in the same or similar circumstances.
(45) “Teledentistry” means the modalities specified in OAR 410-123-1265 (Teledentistry), using electronic and telecommunications technologies, for the distance delivery of dental care services and clinical information designed to improve a patient’s health status and to enhance delivery of the health care services and clinical information.
(46) “Telehealth” means for the purposes of OAR 410-123-1265 (Teledentistry), OAR 410-120-1990 (Telehealth) and as specified in ORS 679.543 (Use of telehealth by dental care provider), a variety of methods using electronic and telecommunications technologies for the distance delivery of health care services, including dental care services and clinical information designed to improve a patient’s health status and to enhance delivery of the health care services and clinical information.

Source: Rule 410-123-1060 — Definition of Terms, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=410-123-1060.

Last Updated

Jun. 8, 2021

Rule 410-123-1060’s source at or​.us