Collection of Dental Benefit Information

Dear State Health Official:
The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA),
Public Law 111-3, reauthorizes the Children’s Health Insurance Program (CHIP) under
title XXI of the Social Security Act (the Act).
As you know, CHIPRA includes many provisions aimed at improving coverage for
children. CMS is working closely with the Health Resources Services Administration
(HRSA), who administers the IKN website, to implement these provisions of CHIPRA by
the August 4, 2009 deadline. Section 501(e) of CHIPRA directs the Secretary to work
with States on two projects having to do with access to dental care.
The first project is to provide a “current and accurate list of all dentists and providers
within each State that provide dental services to children” enrolled in the Medicaid and
CHIP State plan (or waiver). HHS will work with States, pediatric dentists, and other
dental providers to include information through the Insure Kids Now (IKN) website
(http://www.insurekidsnow.gov/) and via information provided on the hotline. This
listing is required to be posted no later than August 4, 2009, and must be updated at least
quarterly.
The second project is for CMS and HRSA to work with States to include on the Insure
Kids Now website a description of the dental services provided under each Medicaid and
CHIP State plan (or waiver). This listing is also required to be posted no later than
August 4, 2009 and must be updated at least annually. The information available on the
IKN website will also be available on the IKN Hotline (1-877-KIDS-NOW). It is
necessary that staff in the State answering phone calls transferred from (877) KIDSNOW are able to provide information to Medicaid/CHIP enrollees on how to access
covered oral health services. It is recommended that your staff have access to the IKN
website or an alternative data source that can easily supply this information.
In order to meet these statutory deadlines, the information on oral health providers and on
benefits is to be provided, as described below, no later than July 15.
To that end, the attached draft dental data collection instrument and draft benefits
template was created to assist States in this process. CMS is in the process of obtaining
the required Office of Management and Budget (OMB) clearance under the Paperwork
Reduction Act (PRA) for the information collection required by the statute.
Dental Benefit Information
CMS is providing a draft dental benefit template (Attachment A) that outlines the
information that States must submit regarding their dental benefit packages. For
Medicaid programs, a State must indicate that dental services are provided to those below
age 21 in accordance with the requirements of section 1905(r) of title XIX of the Social
Security Act regarding Early and Periodic Screening, Diagnostic and Treatment (EPSDT)
services. States with a CHIP Medicaid expansion program are also required to provide
EPSDT services and should indicate accordingly. States with separate CHIP programs or
for the separate part of a combination program are required to complete the draft dental

benefit template as instructed. The States will submit the dental benefit information
(Attachment A) via their CHIP eRoom using the add files procedure described in
Appendix A of the Provider Data Submission Technical Information document
(Attachment B).
Oral Health Provider Information
Given that States manage their provider data in a variety of ways and may need time to
collect the data necessary to comply with these requirements, CMS is providing the list of
data elements to facilitate State office planning. Technical guidance for submitting this
information is provided in Attachment B. Please submit one record for each physical site
location where the dentist provides service. The elements which will be collected for
each dental provider on the IKN website follow:
National Provider Identifier (NPI) or State Medicaid Number (Required – but will
not to be published on the IKN website)
Provider Affiliation (Required)
 Private Practice
 Community Health Center
 Health Department
 Other
Provider First Name (Required)
Provider Middle Name (Optional)
Provider Last Name (Required)
Group or Clinic Name (Practice Name) for the physical site (if applicable).
Active Status (Required)
 Yes
 No
Active Date (Optional)
Inactive Date (Optional)
Facility Name (Optional)
Provider Physical Site Street Address (Required)
Provider Physical Site City (Required)
Provider Physical Site State (Required)
Provider Physical Site ZIP Code (Required)
Phone Number (Required)
FAX Number (Optional)
Languages Spoken (Optional)
Provider Specialty (Required)
 General Dentist
 Pediatric Dentist
 Oral Surgeon
 Orthodontist
 Endodontist

 Periodontist
Accepts New Patients (Required)
 Yes
 No
Can Accommodate Special Needs (Required)
 Yes
 No
Website Address (Optional)
Affiliation with Managed Care Plans (Optional)
CMS and HRSA will use eRoom, a secure website for sharing electronic project data and
information. Each State will be part of the IKN eRoom community and have access to the
common data and restricted access to their own State information and data. Only
personnel from your State (and system administrators) will be able to access your State’s
IKN eRoom. Each State will be provided with eRoom accounts (maximum 2). For HRSA
to establish accounts the States need to provide first and last name, email address, and
phone number to Julie Baitty of HRSA at [email protected].
To accommodate differing State processes, CMS has identified three options for creating
and submitting the required data. These alternatives are briefly described below:
1) Creation of the data files from a State’s automatic data processing (ADP) system
2) Use of a CMS and HRSA provided Microsoft Access desktop database tool
(States would download from the IKN eRoom), and
3) Entry of data in an uncomplicated web data table in the State’s eRoom.
The draft desktop data collection instrument is currently under OMB review. Only after
CMS obtains the necessary PRA number from OMB, will States be required to provide
the information included in the data fields of these Access files. The documents
describing the technical information concerning the three data submission options are
attached as a more detailed description of the data elements.
We appreciate your assistance in fulfilling this CHIPRA requirement regarding your
initial submission. CMS and HRSA will work together to provide information via
technical assistance calls and additional written guidance, if necessary.
If you have any questions, please contact Nancy Goetschius at 410-786-0707.
Attachments