Table 3.

Examples of language in state Medicaid dental provider documents that is consistent with the EPSDT standard on individualized flexibility that meets medical necessity and reflects compliance with CMS directives ^a

Dental provider resource	Best practice	State
Periodicity schedule	“The AAPD and DACP [Oklahoma Health Care Authority Dental Advisory Committee on Periodicity, the Oklahoma Medicaid agency] emphasize the importance of very early professional intervention and the continuity of care based on the individualized needs of the child.” b	Oklahoma
	“As in all medical care, dental care must be based on the individual needs of the member and the professional judgement [sic] of the oral health provider.” c	Arizona
Dental provider manual section on covered services	“When a Medicaid eligible member requires medically necessary services, those services may be covered by Medicaid. Necessary health care, diagnostic services, treatment or other measures described in Section 1905 (a) of the Social Security Act to correct or ameliorate defects, physical or mental illness or conditions discovered by screening services are available based on medical necessity. Prior authorization may be required before providing services. More information on expanded services is provided throughout this manual.” d	Utah
	“It is strongly recommended that the Dental Periodicity Schedule be used as a guide for the provision of services with the understanding that services may be provided more frequently as medically indicated.” e	Illinois
Fee schedule	“Children under 21 years of age are eligible for all medically necessary dental services. For children under 21 years of age who require medically necessary dental services beyond the fee schedule limits, the dentist should request a waiver of the limits, as applicable, through the waiver process.” f	Pennsylvania
	“MaineCare will cover all medically necessary dental services for members under age twenty-one (21) pursuant to Section 94 of the MaineCare Benefits Manual, Early and Periodic Screening, Diagnostic, and Treatment Services.” g	Maine

Abbreviations: AAPD, American Academy of Pediatric Dentistry; CMS, Centers for Medicare & Medicaid Services; EPSDT, Early and Periodic Screening, Diagnostic and Treatment.

^aData source: CMS Informational Bulletin. ¹⁶

^bOklahoma Health Care Authority. ²⁸

^cArizona Health Care Cost Containment System. ²⁹

^dDivision of Medicaid and Health Financing. ³⁰

^eIllinois Department of Healthcare and Family Services Dental Program. ³¹

^fPennsylvania Department of Human Services. ³²

^gMaine Department of Health and Human Services. ³³