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The Role of Medical Providers

1.2 Provider Eligibility and Training

Fluoride Varnish brochure

Materials for Health Providers

The Maryland Department of Health's Office of Oral Health provides information and support for health providers participating in Maryland's Mouths Matter: Fluoride Varnish and Oral Health Screening Program for Kids. Materials include a manual on procedures, policies, and protocols; Medicaid billing and reimbursement information; sample forms; and consumer brochures.

The program, Maryland’s Mouths Matter: Fluoride Varnish and Oral Health Screening Program for Kids, established July 1, 2009, provides Medicaid reimbursement to Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) medical providers for applying fluoride varnish to the teeth of children ages 9 months through age 5.

EPSDT Medical Providers

To be eligible for reimbursement for fluoride application, a provider must meet the following criteria:

  • Be an EPSDT-certified physician or nurse practitioner licensed to practice in Maryland.
  • Participate in the Maryland Medicaid Program, and provide services in accordance with the rules and regulations of the program.
  • Successfully complete the fluoride varnish curriculum post-tests with at least 80 percent accuracy.

Medical Extenders

Designated EPSDT medical “extenders” also may apply fluoride varnish. In Maryland, a designated EPSDT medical extender is defined as anyone who meets both of the following conditions:

  • Is working under the supervision of an EPSDT-certified physician, physician assistant, or nurse practitioner licensed to practice in Maryland.
  • Is legally allowed to administer medical immunizations in Maryland (e.g., registered nurses, licensed practical nurses, and other medical personnel).

Medical extenders must receive training on fluoride varnish application and be employed by an EPSDT medical provider who has met the criteria for participating in the program. Medical extenders can be trained directly by their EPSDT medical provider or may complete this course. In public health clinics, medical extenders can apply fluoride varnish with standing orders from their EPSDT medical provider. Medical extenders cannot seek reimbursement for the provision of this service under the Maryland Medicaid Program.

Dentists and Dental Hygienists

Maryland’s state dental practice act includes an oral health screening and application of fluoride varnish as approved functions for licensed dentists and dental hygienists. Additional training is not required to perform these functions or to seek reimbursement for the application of fluoride varnish if a dentist or dental clinic is enrolled as a provider in the Maryland Medicaid Program. Dentists and dental hygienists, however, may find the course a helpful review and it may offer new strategies for working with children.