ADEA State Update

CMS Issues Informational Bulletin on Oral Health

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On July 10, the Centers for Medicare and Medicaid Services (CMS) released an informational bulletin providing an update on the CMS Oral Health Initiative and other oral health related items. 

As you may recall in April 2010, CMS through its Oral Health Initiative (OHI) established two performance goals: (1) increase by 10 percentage points the proportion of Medicaid and Children’s Health Insurance Program (CHIP) children ages 1 to 20 (enrolled for at least 90 days) who receive a preventative dental service; and (2) increase by 10 percentage points the proportion of Medicaid and CHIP children ages 6 to 9 (enrolled for at least 90 days) who receive a sealant on a permanent molar tooth. These two performance goals are to be accomplished over five years by federal fiscal year (FFY) 2015. 

The informational bulletin recently released announced that between FFY11 and FFY12, fifteen states achieved at least a two percentage point improvement on their CMS Oral Health Initiative preventative dental services goal. While fifteen states have met or exceeded their first year incremental goal, the remaining 36 states fell short. As a result, the CMS bulletin provides a variety of resources to states to help them achieve their OHI goals, including a CMS supported publication titled, Improving Oral Health Care Delivery in Medicaid and CHIP: A Toolkit for States. Additionally, CMS has established the CMS Learning Lab: Improving Oral Health Through Access, a series of technical assistance webinars focusing on improving the delivery of oral health services to children enrolled in Medicaid and CHIP.  

Finally, CMS uses the information bulletin to clarify certain policies regarding dental workforce innovations. Specifically, the bulletin notes the following (this list is not exhaustive):

  • Services provided by non-dentists such as primary care medical practitioners, or by dental professionals not under the supervision of a dentist, are considered by Medicaid to be ‘oral health services’ provided by a licensed practitioner.
  • References the distinction between ‘dental service’ and ‘oral health service’ as an important one in the context of reporting dental utilization data to CMS.
  • Services performed by new types of dental professionals such as dental therapists and community dental health practitioners are considered to be ‘dental services’ if the dental professional has some sort of supervisory relationship or agreement or affiliation with a dentist. Services performed by new types of dental professionals are considered to be ‘oral health services’ if no such relationship, agreement or affiliation with a dentist exists.
  • States may also allow dental professionals who are permitted by the terms of their license to practice without dental supervision to enroll as Medicaid providers and bill Medicaid directly for their services.
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