Terminology Talk

By Dr. Mark Jurkovich, Chairperson of Clinical Subworkgroup

Measure reporting going National.

While several NADP colleagues have been reporting quality measures related to Medicaid programs, it has been on a state-by-state basis, to the state Medicaid departments. The introduction of the 2024 Center for Medicare and Medicaid Services (CMS) Child Core Set measures will have an impact on all our members working with Medicaid programs, anywhere in the United States.  Beginning with the 2024 reporting year, all states will be required to report all measures included in the Child Core Set, along with the behavioral health-related measures in the Adult Core Set.  The 2024 Child Core Set includes three measures related to oral health and dental care.

Reporting of the Child Core Set measures to CMS will be through the various state Medicaid agencies.  These agencies may have a variety of methods or tools for obtaining the data. It is a safe assumption that the source of data used by state Medicaid agencies will come from participating plans.  Dental plans administering Medicaid benefits will be expected to supply data that can be used to calculate the three Child Core Set measures that relate to oral health.

The good news is that the measures being used were developed by the Dental Quality Alliance (the NADP is an active and voting member).  They are process measures derived from claims and administrative data, so the reporting burden may be somewhat eased for plans.

The three Child Core Set measures are:

1. Oral Evaluation Dental Services,
2. Topical Fluoride for Children, and
3. Sealant Receipt on Permanent First Molars.

More information can be found at this government site:

(https://www.medicaid.gov/medicaid/quality-of-care/performance-measurement/adult-and-child-health-care-quality-measures/childrens-health-care-quality-measures/index.html). In addition, the Child and Core Set Workgroup, facilitated by Mathematica, has recommended the inclusion of two oral health-related measures in the Medicaid Adult Core Set for 2025. While it is anticipated that these measures will be approved for inclusion, they are currently under consideration by CMS.  There has been no formal announcement. If approved they will be included in the 2025 Adult Core Set, however, states will not be required to report them to CMS. These measures are:

• Oral Evaluation During Pregnancy
• Ambulatory Care Sensitive Emergency Department Visits for Non-Traumatic Dental Conditions in Adults.

Both measures may require additional coordination with the medical plan(s) you may be working with.  The latter may be primarily derived from the medical plan information.  Both are process measures, relying on claims and administrative data.

NADP remains very active in monitoring, reporting to the membership, and working to make sure the measures developed and used have value, are evidence-based, and can realistically be reported without undue burden.