DEPARTMENT OF HEALTH & HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, Maryland   21244-1850 
 
 
CMCS Informational Bulletin  
 
 
DATE:     April 18, 2013 
 
FROM:    Cindy Mann, Director  
    Center for Medicaid and CHIP Services  
 
SUBJECT:   CMS Oral Health Initiative and Other Dental-Related Items 
 
 
CMS Oral Health Initiative: Setting Baselines and Goals 
 
Ensuring access to quality dental care for children enrolled in Medicaid and the Childrens Health 
Insurance Program (CHIP) is a priority for the Center for Medicaid and CHIP Services (CMCS).   
 
States efforts over the past decade have resulted in improved access to dental care for children 
covered by Medicaid and CHIP. Over the past five years, almost half (24) of all states achieved at 
least a ten percentage point increase in the proportion of enrolled children who received a preventive 
dental service during the reporting year. The bar chart shows the ten states with the most 
improvement.  
 
  Top Ten Improving States on Proportion of Medicaid Children  
Receiving a Preventive Dental Service 
FFY 2007-FFY 2011 
 
60.0%
50.0%
40.0%
30.0%
FY 2007
FY 2011
20.0%
10.0%
0.0%
Connecticut Arkansas Louisiana District of Maryland Colorado Nevada New Jersey New Texas US Total
Columbia Hampshire
+23.0 +22.7 +20.4 +19.6 +19.2 +17.8 +17.3 +16.2 +15.2 +13.8 +10.1
Source: FY 2000-2011 CMS-416 reports, Line 1, Line 1b, 12b
Note: Only preliminary FY 2011 data for Idaho, Kentucky and Ohio were available as of April 1, 2013. Estimates for these states are included in 
theNational figure for FY 2011, but they are otherwise excluded from this analysis.
 
      Page 2  CMCS Informational Bulletin 
 
Despite this improvement, fewer than half of enrolled children nationally are receiving at least one 
preventive dental service in a year, and there remains a wide variation across states.  Maps illustrating 
the variation across states are included as Figures 14 and 15 in the Secretarys 2012 Annual Report 
on the Quality of Care for Children in Medicaid and CHIP. (See http://www.medicaid.gov/Medicaid-
CHIP-Program-Information/By-Topics/Quality-of-Care/Downloads/2012-Ann-Sec-Rept.pdf.)  
 
Over the past several years, CMCS has been working with federal and state partners, the dental and 
medical provider communities, childrens advocates and other stakeholders to expand the number of 
dental professionals participating in Medicaid and to increase the awareness of the need for dental 
care among beneficiaries in order to continue to improve childrens access to dental care, with an 
emphasis on prevention. 
 
Much of this work is taking place in the context of the CMS Oral Health Initiative, launched in April 
2010.  We have set two goals, both of which we aspire to achieve at a national level as well as in 
individual states.  
 
1.  Increase by ten percentage points, from FY 2011, the percentage of children ages 1-20 
enrolled in Medicaid for at least 90 continuous days that received a preventive dental 
service.   
The target date for this goal is FY 2015.  
 
2.  Increase by ten percentage points the percentage of children ages 6-9 enrolled in Medicaid 
for at least 90 continuous days that received a sealant on a permanent molar.  
(CMCS has not yet set a baseline year or a target date for this goal as we are continuing to 
assess the reliability of the data.)  
 
CMCS has invited state Medicaid agencies to develop Oral Health Action Plans as a roadmap to 
achieving these goals. Many states have already submitted their Action Plans; the remaining states 
are encouraged to do so. Action Plans may be submitted using either a CMS-developed Oral Health 
Action Plan Template or a user-friendly template developed by the Medicaid-CHIP State Dental 
Association, available 
at: http://www.medicaiddental.org/docs/MSDA_State_Oral_Health_Action_Plan_tool.pdf.  
Completed Action Plans may be submitted to Dr. Lynn Mouden, CMS Chief Dental Officer, via 
email at lynn.mouden@cms.hhs.gov, with a copy to your CMS Regional Office contact person. Any 
questions about the Action Plans may be directed to Dr. Mouden by email or at 410-786-4126. 
 
Using the data reported by states on the FY 2011 CMS Form 416, CMCS has calculated baseline and 
goal percentages for the preventive dental service measure for the nation as a whole and for each state 
Medicaid program (including CHIP programs that are Medicaid expansions). The national baseline is 
42 percent, and the goal is 52 percent. We will be communicating each states baseline and goal 
individually to state Medicaid Directors.  (CMS will set baselines and goals for separate CHIP 
      Page 3  CMCS Informational Bulletin 
 
programs later this year, based on FY 2012 data submitted through the CHIP Annual Report 
Template System (CARTS).)  
 
The CMCS dental team is available to provide technical assistance to states by request. In addition, 
we have launched a quarterly series of technical assistance webinars, entitled The CMS Learning 
Lab: Improving Oral Health Through Access. Recordings of past webinars are available 
here: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Dental-
Care.html.  The topics include Developing State Oral Health Action Plans Using State Data, 
Successful Beneficiary Outreach Strategies, and Quality Improvement Processes: An Introduction for 
Medicaid and CHIP Dental Programs. 
 
Two New Codes Support State Efforts to Improve Access to Dental Services 
 
The October 2012 version of the American Dental Associations 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 individuals 
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. A state must submit a SPA and make public notice, however, if it wishes 
either to begin coverage and payment for these dental services or to change the existing payment 
rates. CMS is available to work with states on updating their Medicaid state plans.   
Coverage and payment in CHIP does not require the submission of a SPA.  
 
These services, when delivered under either Medicaid or CHIP, must be claimed on the CMS-64 at a 
states regular match rate.  As a means of promoting increased access to timely dental care in 
Medicaid and CHIP, we encourage states to choose to cover and reimburse for these two services.  
 
In many states, public health programs already provide these services for Medicaid- and CHIP-
enrolled children using other funding sources. Billing Medicaid and CHIP for these services will 
enhance the total funding available to serve low-income children enabling more children to be served.  
In addition, knowing that reimbursement is available could encourage more providers and programs 
      Page 4  CMCS Informational Bulletin 
 
to begin to perform these services.  Such expansion would help more children with dental disease to 
connect with dentists for needed treatment.  
 
An important corollary would be improved data reporting on dental and oral health services for 
Medicaid and CHIP.  Screening and assessments that are currently performed, but neither claimed 
nor reimbursed, are not reported on the CMS Form 416.  Reimbursing for these services would help 
to remedy that gap. When either of these services is performed by or under the supervision of a 
dentist it would be considered to be a dental service within the rubric of the CMS Form 416, and 
would be reportable on lines 12a (any dental service), 12e (diagnostic service), and 12g (any dental or 
oral health service) of the Form 416.  Supervision includes, but is not limited to, direct, indirect, 
general and public health supervision as well as collaborative practice models.  When either service is 
performed by a non-dental professional, or by a dental professional not under the supervision of a 
dentist, it would be considered to be an oral health service and reportable on lines 12f (oral health 
service) and 12g (any dental or oral health service) of the Form 416. 
 
If you have any questions about implementing billing for these new codes, please contact Dr. Lynn 
Mouden at lynn.mouden@cms.hhs.gov.