e-mail Print Share

Program/Plan Level Dental Quality Measures

Considering Measures?: Why Adopt DQA Measures

Measures: Medicaid and Dental Plan Assessments

Please refer to the DQA User Guide before implementing these measures. All DQA measures undergo annual review. Please ensure you use the correct version for the measurement year. 

Version Date
Use “2017” version if you are using claims data from 2016.
Use “2016” version if you are using claims data from 2015.

If you are unsure of the correct version, please contact the DQA Staff at dqa@ada.org.

“Dental” vs. “Oral Health” Services
 
For the purpose of measurement, based on definitions from the Centers for Medicare & Medicaid Services
Dental” services refer to services provided by or under the supervision of a dentist
Oral health” services refer to services provided by other personnel e.g. pediatricians. 

Refer to User Guide below for more detail. 

Resources:

Evaluating Utilization

Utilization of Services (NQF# 2511): Percentage of all enrolled children under age 21 who received at least one dental service within the reporting year.

Preventive Services for Children at Elevated Caries Risk: Percentage of all enrolled children who are at “elevated” risk (i.e., “moderate” or “high”) who received a topical fluoride application and/or sealants within the reporting year.

Treatment Services:  Percentage of all enrolled children who received a treatment service within the reporting year.

Evaluating Quality of Care

Oral Evaluation (NQF# 2517): Percentage of enrolled children under age 21 who received a comprehensive or periodic oral evaluation within the reporting year.

Topical Fluoride for Children at Elevated Caries Risk (NQF# 2528): Percentage of enrolled children aged 1–21 years who are at “elevated” risk (i.e., “moderate” or “high”) who received at least 2 topical fluoride applications within the reporting year.

Sealants for 6–9 Year-Old Children at Elevated Caries Risk (NQF# 2508): Percentage of enrolled children in the age category of 6–9 years at “elevated” risk (i.e., “moderate” or “high”) who received a sealant on a permanent first molar tooth within the reporting year.

Sealants for 10-14 Year-Old Children at Elevated Caries Risk (NQF# 2509): Percentage of enrolled children in the age category of 10-14 years at “elevated” risk (i.e., “moderate” or “high”) who received a sealant on a permanent second molar tooth within the reporting year.

Care Continuity: Percentage of all children enrolled in two consecutive years who received a comprehensive or periodic oral evaluation in both years.

Usual Sources of Care: Percentage of all children enrolled in two consecutive years who visited the same practice or clinical entity in both years.

Ambulatory Care Sensitive Emergency Department Visits for Dental Caries in Children (NQF# 2689): Number of emergency department visits for caries-related reasons per 100,000 member months for all enrolled children

Follow-Up after Emergency Department Visits for Dental Caries in Children (NQF# 2695): Percentage of ambulatory care sensitive Emergency Department (ED) visits for dental caries among children 0–20 years in the reporting period for which the member visited a dentist within (a) 7 days and (b) 30 days of the ED visit.

Evaluating Cost

Per Member Per Month Cost of Clinical Services: Total amount that is paid on direct provision of care (reimbursed for clinical services) per member per month for all enrolled children during the reporting year.

Additional Measures - Tested Not Approved

In order to ensure only appropriate measures are implemented, DQA undertakes rigorous testing process that adheres to NQF’s endorsement criteria. Not all measures meet these criteria. This section provides details on the testing results of these measures that have been tested but not been approved. 

Measures tested at the Program level but not approved include:

(1) Tooth Mortality - the percentage of children under age 10 years who had an extraction of a permanent molar within the reporting year, and 
(2) Treatment Following Sealant - the percentage of children who received a restoration, endodontic treatment or extraction within 24 months of fissure sealant placement on the same tooth.