Crosswalk document for Changes

Crosswalk document for Changes to

Instructions and Form CMS 416

Changes to Form CMS 416

• Line 12 of the form was expanded to include lines 12d, 12e and 12f. Line 12d was added to collect the number of children receiving diagnostic dental services. The form currently collects preventive dental and treatment services. Line 12e was added to collect the number of children who receive oral health services by non-dentists (e.g., pediatricians, dental hygienists) due to the growing number of States that allow providers other than dentists to furnish some types of oral health services to children. Line 12f was added to capture the total number of dental and oral health services provided by dentists and non-dentists. Line 12a remains the same to capture only services provided by or under the supervision of a dentist.

Changes to the Form CMS 416 Instructions

• The instructions for Line 6 were updated to reflect that State or local codes are no longer allowable and to include language acknowledging that some codes will be changing in January 2009. We are unable to include those codes at this time because the 2009 CPT codes have not been released.

• Additional instructions were added for Line 12 to include the calculations and purpose for reporting on lines 12d, 12e and 12 f.

• The instructions for Line 14 were revised to reflect clarifications in the codes to be used to collect the lead screening data and to allow the use of the HEDIS lead measure for data collection purposes.

Change in Burden

There should not be an additional burden for the changes in this document for lines 6 and 12 as States are already collecting the data to be included and will simply distribute that data on different lines. The changes were necessary to accommodate a need for more specific dental data and to preliminarily notify States of the change in CPT codes.

The instructions for line 14 were clarified and there is no change to the information reported.