1. (1) The Authority covers Hemoglobin A1c (HbA1c) testing for at risk members per scope of practice for Oregon licensed oral health providers.
2. (2) Although not presumed to be a standard of care, testing serves as a resource for licensed oral health providers which supports identification of those members with HbA1c levels that are above the “normal range", and that can affect periodontal status, wound healing, infection control and other conditions of the oral environment.

3. (3) Licensed oral health providers must share the HbA1c test results with the member’s primary care provider (PCP) to promote care collaboration and avoid duplication, and:

   1. (a) Establish bi-directional communication with the member’s PCP to communicate test results and initiate a referral for evaluation, diagnosis, treatment, and collaboration of care; and
   2. (b) Communicate progress of treatment and oral health status.

4. (4) Licensed oral health providers must comply with OAR 410-130-0680, as it pertains to blood testing, and 42 CFR §493 and OAR 333-024-0005 through 333-024-0055, as it pertains to Clinical Laboratory Improvement Amendments (CLIA):

   1. (a) Information about CLIA in Oregon including enrollment requirements and processes is located on the Authority’s Clinical Laboratory Regulation webpage https://www.oregon.gov/oha/PH/LaboratoryServices/ClinicalLaboratoryRegulation/Pages/index.aspx;
   2. (b) In order to perform HbA1c testing, Oregon licensed oral health providers and facilities must apply for a Certificate of Waiver (CMS-116 application form), available on the CLIA webpage; and
   3. (c) Waived tests are not exempt from CLIA certification. For more information, refer to https://www.cms.gov/medicare/quality/clinical-laboratory-improvement-amendments.
5. (5) In determining the need for HbA1c testing, licensed oral health providers must use best clinical judgement when considering member risk factors based on appropriate, consensus-based guidelines.

6. (6) Release of Information (ROI):

   1. (a) Licensed oral health providers must ensure a member’s ROI is on file in the member’s record;

   2. (b)  If the member does not have a PCP, licensed oral health providers must:

      1. (A) Inform the member of the test findings and direct them toward resources containing more information and encourage the member to become a patient of record with a PCP for their other health needs; and
      2. (B) Document actions in the member’s record, with follow-up at the next visit.
   3. (c) Referrals must be tracked and documented in the member’s record;
   4. (d) Licensed oral health providers must provide sufficient information regarding the purpose of the test and the procedure, including their relevance to both oral and general health, so that a member can make an informed decision; and
   5. (e) Members may decline testing.

Statutory/Other Authority

ORS 679.543 & 414.065

Statutes/Other Implemented

ORS 414.065

History

DMAP 93-2025, amend filed 12/22/2025, effective 01/01/2026
DMAP 139-2024, amend filed 12/06/2024, effective 01/01/2025
DMAP 63-2024, minor correction filed 02/21/2024, effective 02/21/2024
DMAP 50-2021, amend filed 12/24/2021, effective 01/01/2022
DMAP 65-2019, adopt filed 12/26/2019, effective 01/01/2020