Review the state agency’s program and administrative documents for the following:

1. Adopt a dental-specific periodicity schedule and make it widely available and easily accessible to dental providers and patients/families.

2. Review the periodicity schedule for language pertaining to EPSDT and inherent flexibility in the Medicaid and CHIP programs.

3. Wherever specific services and their indications and frequency are described in the dental provider manual (most often in a “covered services” or similarly titled section), clear directions should be given to dental providers about the accommodations that should and must be made in terms of frequency and intensity of services for children who have a high risk of caries or extensive treatment needs that exceed what is specified in the periodicity schedule, as well as detailed directions to ensure payment for same.

4. Fee schedules should include a general statement on flexibility, reminding dental providers of the inherent flexibility for risk-adjusted care and their ability for increased reimbursement for medically necessary service delivery.

5. Fee schedules should include instructions for preventive service frequency and payment allowances for children with a high risk of caries.

6. Ensure that fee schedules and payment policies are aligned with periodicity schedules such that fee schedules/payment policies allow for payment of each covered service at the same ages as are specified in the periodicity schedule.

Abbreviations: CHIP, Children’s Health Insurance Program; CMS, Centers for Medicare & Medicaid Services; EPSDT, Early and Periodic Screening, Diagnostic and Treatment.

^aData source: CMS Informational Bulletin. ¹⁶