ADEA State Update

CMS Issues an Informational Bulletin on Oral Health Initiatives and Other Dental Issues

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On April 18, the Center for Medicaid and Children’s Health Insurance Program (CHIP) Services (CMCS) within the Centers for Medicare & Medicaid Services (CMS), issued an informational bulletin setting baselines and goals for children enrolled in Medicaid and CHIP. Specifically, the bulletin states the following goals:

  • Increase by ten percentage points, from FY 2011, the percentage of children ages 1-20 who have been enrolled in Medicaid for at least 90 continuous days and who have received a preventive dental service. The target date for this goal is FY 2015.
  • Increase by ten percentage points the percentage of children ages 6-9 who have been enrolled in Medicaid for at least 90 continuous days and who have received a sealant on a permanent molar.

CMCS previously asked state Medicaid agencies to develop Oral Health Action Plans as a roadmap to achieving certain goals, such as increases in the number of children enrolled in Medicaid. The bulletin encourages states that have not submitted plans to do so.

Additionally, the bulletin provides information on two new codes for dental providers. The October 2012 version of the American Dental Association’s Current Dental Terminology (CDT) includes two new codes for diagnostic services that do not specify a dentist as the rendering provider. CMCS believes these services will support states in their efforts to maximize the ability of all healthcare professionals, operating within the scope of state practice acts, to serve Medicaid and CHIP enrollees. The two new codes are:

  • D0190 – Screening of a patient. A screening, including state or federally mandated screenings, to determine an individual’s need to be seen by a dentist for a diagnosis.
  • D0191 – Assessment of a patient. A limited clinical inspection that is performed to identify possible signs of oral or systemic disease, malformation, or injury, and the potential need for referral for diagnosis and treatment.

A state that chooses to cover and pay for these services through CHIP would not need to submit a State Plan Amendment (SPA) reflecting the change. Likewise, a state that already covers and pays for these services through Medicaid, but does not use the D0190 and D0191 billing codes, would not need to submit a SPA.

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