The pilot ended. The rule survived.

Washington’s Oral Health Connections pilot ended on December 31, 2023, but the diabetes-specific periodontal-maintenance intervention survived as a narrower statewide rule effective January 1, 2024.

When the record keeps the lifecycles separate, a program can end while one intervention inside it becomes a permanent rule. The cohort, geography, and reimbursement route can disappear without making the surviving intervention disappear with them.

The public source chain contains both facts at once. The Washington Health Care Authority’s Oral Health Connections pilot evaluation describes a pilot for adults with diabetes or pregnancy-related eligibility in Cowlitz, Spokane, and Thurston counties. The CMS-approved WA-26-0002 state plan amendment says the Oral Health Connections pilot ended on December 31, 2023. The permanent rule filing, WSR 23-20-129, amended WAC 182-535-1088 so Apple Health clients age 21 and older with a current diabetes diagnosis could receive periodontal maintenance once every three months when criteria are met. The current WAC 182-535-1088 still carries that diabetes lane.

The pilot ended. The rule survived. The two statements can be true together.

If you run a business: When you shut down an initiative, track what happened to each piece of it separately. A program and the practices inside it have different lifecycles, and a record that only says it ended loses the parts that quietly survived. Keep the lineage so the next person knows which part died, which narrowed, and which still governs the work.

The evaluation did not prove the intervention failed

HCA reported low utilization during the original three-year pilot period. From January 1, 2019, through December 31, 2021, 17,697 eligible Apple Health clients were in scope. Only 176 clients received 423 procedures from participating Oral Health Connections providers, and $21,392.93 was billed.

Those numbers matter. They should not be inflated into a clinical-effectiveness verdict.

The same report names implementation constraints. COVID disruption limited participation. Provider participation was low. Billing challenges interfered with use. Patient identification remained difficult. Reimbursement adequacy was an open issue. The report also describes training, certification, referral, care coordination, and claims-system work that had to hold together before the benefit could appear as delivered care.

That makes the utilization result implementation evidence. It shows that the observed pilot did not reliably convert eligibility into observed use during the measured period. It leaves clinical effectiveness unresolved for adults with diabetes and for pregnant clients, does not establish reduced medical cost, and says nothing about whether a statewide successor improved access after January 2024.

Preserve the evaluation as a program-performance source, not a universal answer. It can support a finding that the pilot struggled to reach patients and providers. It cannot answer later questions about clinical outcomes, access, cost, or statewide execution.

What survived was narrower

The successor rule is not the pilot in statewide clothing.

The current rule covers Apple Health clients age 21 and older with a diagnosis of diabetes. It allows periodontal maintenance once every three months when evidence criteria are met. Those criteria include radiographic evidence of periodontal disease, supporting medical-necessity documentation, complete periodontal charting within the required period, a definitive diagnosis of periodontal disease, and a clinical condition that meets current published periodontal guidelines.

The successor did not preserve the pilot’s pregnancy cohort, three-county geography, wraparound-services model, provider-certification route, or enhanced-rate claim.

The HCA provider alert made the narrower rule visible before the effective date. It told dental providers that, for dates of service on and after January 1, 2024, Apple Health clients age 21 and over with diabetes and periodontal disease would be eligible for up to four periodontal-maintenance procedures in a twelve-month period.

The alert supports rule survival, not pilot survival.

An operator record that only says “Oral Health Connections continued” or “Oral Health Connections ended” loses the decision. The pilot lifecycle and the intervention lifecycle diverged. The current workflow has to know which part died, which part narrowed, and which evidence now governs action.

The current record needs source roles

The operator problem is source role, not source count. The program evaluation says what the pilot tried, how it performed during the reported period, and which implementation problems HCA named. The CMS-approved SPA supplies termination evidence for the pilot and the payment-method context for fee schedules. WSR 23-20-129 supplies the permanent rule action that moved the diabetes-specific frequency intervention into WAC 182-535-1088. The current WAC supplies live rule text. The July 1, 2026 Dental-Related Services Program Billing Guide supplies the current billing route. The July 1, 2026 dental fee workbook supplies the current fee row.

Those sources should not be flattened into one note. They have different jobs.

In the July 2026 billing guide, D4910 in the adult diabetes lane uses expedited prior authorization number 870001655. The guide also requires diagnosis evidence and current health-history evidence. That turns the surviving rule into current work: confirm age, preserve the diabetes diagnosis, preserve periodontal evidence, check timing since scaling or root planing when relevant, use the right EPA route, and keep the source version attached.

The July 2026 fee workbook lists the adult D4910 fee as $69 with EPA for ages 21 and older with a diabetes diagnosis. The January 1, 2026 dental fee workbook also lists the adult D4910 amount as $69. That supports the narrow comparison between the January and July 2026 snapshots, not continuity across every intervening fee-schedule version.

The distinction matters because payment evidence can be overread. The fee row supports current payment, not pilot survival. The rule shows legal survival, not improved access. The provider alert gives pre-effective-date notice, not utilization. The program evaluation governs reported pilot performance, not current billing conditions. Each source can govern only the claim it is fit to support.

What remains unproved

The reviewed sources do not prove that the statewide successor improved access, provider participation, utilization, clinical outcomes, or cost after January 2024. That requires post-2024 claims or utilization evidence with a period and denominator.

Until that evidence exists, the honest statement is narrower. Washington terminated the Oral Health Connections pilot after December 31, 2023. Washington preserved one diabetes-specific periodontal-maintenance intervention as a statewide Apple Health rule effective January 1, 2024. The current billing path uses EPA 870001655 for D4910 when the adult diabetes and evidence criteria are met. The July 2026 fee workbook keeps the adult D4910 fee at $69.

That is enough to act, but only if the operator keeps the lineage.

Hadto’s ontology work is built for this kind of boundary. Domain experts can train apprentices into owner capacity when the work system preserves authority, intervention lineage, evidence duties, authorization route, payment version, and unresolved proof. A pile of disconnected documents keeps senior judgment private. The experienced operator remembers that the pregnancy cohort did not carry forward, that the enhanced-rate route ended, that the WAC lane survived for adult diabetes, and that current evidence still has to be attached before a claim is ready.

That memory should live in the company, not in one person’s head.

The decision is not hard once records are separate. Treat the pilot lifecycle, each intervention inside it, and the current operating rule as different records before deciding that a benefit ended, survived, or became usable.

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Source evidence used in this note: Washington Health Care Authority, Oral Health Connections extended pilot project results. CMS, Washington SPA WA-26-0002. Washington State Register, WSR 23-20-129. Current WAC 182-535-1088. HCA Apple Health provider alert for increased periodontal-maintenance frequency. HCA Dental-Related Services Program Billing Guide, July 1, 2026. HCA Dental fee workbook, January 1, 2026. HCA Dental fee workbook, July 1, 2026.