preventive care that they need . Population estimates for Pennsylvania based on age indicate that there are approximately 750,000 children under 5 years of age in the state . 3 More than 245,000 of those children ( 33 percent , approximately 1 in 3 ) are between the ages of 1 and 5 , should have experienced eruption of primary teeth and are eligible for MA dental benefits . 4 Children eligible for MA are eligible to receive necessary dental services from birth until their 21 st birthday . However , this cohort of younger children has historically demonstrated a disproportionately low rate of utilization of dental services , including preventive services . Faced with this same dilemma in their populations , many states have sought innovative methods to get needed preventive services to these young children . Use of medical professionals who are already involved with this population has been identified as one option . Available national survey data has indicated that only 1.5 percent of infants and 1-yearolds had a dental visit annually , while 89 percent of the same group had an office-based physician visit . 5 Given this level of contact , the involvement of the primary care practitioner and staff as allies in the battle of caries detection and preventive intervention appears to be advantageous if there are no legal preclusions . Investigation as to compliance with Pennsylvania statute indicated that topical application of fluoride varnish by a physician , certified registered nurse practitioner ( CRNP ), or registered nurse under direction of a physician is within the respective scope of practice for each professional group . OMAP recognizes oral health care for children and adults as a priority , and in addition to the fluoride varnish initiative , has implemented other programmatic changes in recent years aimed at improving access to care , especially for children . In September 2008 , OMAP issued a Medical Assistance ( MA ) Bulletin announcing updates to the Early and Periodic Screening , Diagnosis and Treatment ( EPSDT ) Program Periodicity Schedule . Included among the various updates were two dental-related changes . The first added dental risk assessments and referral to a dental home as a required component of the periodic screens occurring at 12 months , 18 months , 24 months and 30 months of age . This move marked a change in the timing of the first dental screen required , moving it two years earlier on the schedule and aligning the requirement with AAP , ADA and AAPD guidelines . The second change added referral to a dental home as a required component of every periodic screen , beginning at three years of age – again highlighting to physicians the importance of oral healthcare throughout childhood . The bulletin also outlined the specific parameters of what actions constitute a meaningful referral to a dental home . OMAP issued another MA Bulletin in April 2009 that announced the implementation of the Pediatric Dental Periodicity Schedule outlining recommendations to MA-participating dentists based on American Academy of Pediatric Dentistry guidelines for timely delivery of preventive services for children . Of particular note was reinforcement to the dental community of the recommendation that the dental home be established no later than 12 months of age .
Through this multi-pronged approach , OMAP is attempting to create an environment of increased awareness of the issues and collaborative effort between health professionals in both the medical and dental communities across the State to more effectively address and prevent early childhood caries .
What are the program details ? In order for an MA-participating physician or certified registered nurse practitioner ( CRNP ) to become eligible for reimbursement for the topical application of fluoride varnish through the Pennsylvania Medical Assistance Program ( MA ), they must demonstrate completion of an appropriate training curriculum in oral evaluation technique ( including the detection of dental caries ) and the topical application of fluoride varnish . To simplify and standardize this process , with the assistance of the PDA in review of the curriculum , OMAP identified a one-hour CME credit course available on the AAP website as the preferred means for practitioners to acquire reportable documentation of having met the training requirement . The course is available at no charge to the individual practitioner and provides an official certificate of completion upon passing a post-test for the course . Upon receipt of the CME certificate , the practitioner submits a copy of the certificate to OMAP via the Division of Enrollment in the Bureau of Fee for Service Programs . The practitioner is then eligible to bill OMAP for topical fluoride varnish application for their patients who are eligible MA consumers under five years of age . As referenced earlier , these children are seen more frequently by primary care practitioners during their first years of life under the EPSDT program . Once a practitioner identifies a child with erupted teeth and no history of a recent visit to a dental home , it is expected under EPSDT that a meaningful referral to a dental home is attempted by the practitioner in addition to the topical application of fluoride varnish . If the child returns to the physician ’ s office for the next EPSDT screen visit without having experienced a dental visit in the interim ,
September / October 2010 • Pennsylvania Dental Journal
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