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CMS issues guidance for pediatric dental periodicity schedules

May 09, 2018 Baltimore — The Centers for Medicare and Medicaid Services on May 4 released an informational bulletin that discusses the importance of state Medicaid and Children's Health Insurance Programs properly implementing their pediatric dental periodicity schedules in order to ensure children's access to critical dental coverage.

In the guidance, CMS said states should ensure that their fee schedules and payment policies are aligned with periodicity schedules.

"The fee schedule and payment policies in the state must align with the periodicity schedule regarding both age and frequency to ensure providers are able to be reimbursed for recommended care," said CMS. "In states that provide dental benefits through managed care plan arrangements, states should ensure that the managed care plans' fee schedules and payment polices align with the state's periodicity schedule. This holds true whether a state contracts for dental services through managed care organizations, prepaid ambulatory health plans or other managed care plan arrangement."   

The agency also said that the periodicity schedule "should be treated as a 'floor' for coverage of dental services, not a 'ceiling.' "

CMS also said that "…[D]ental care necessary to correct or ameliorate an individual child's condition must be covered (and reimbursed) even when these services fall outside of the standard scope and even when the frequency of services is greater than specified in the periodicity schedule or coverage policy."

To read the guidance in full, visit medicaid.gov.