Brief Description of Measure:
​CMS74: Primary Caries Prevention Intervention as Offered by Primary Care Providers, including Dentists:
Percentage of children, 6 months - 20 years of age, who received a fluoride varnish application during the measurement period

Description of Issue:
The measure steward and measure developer are proposing to limit the CMS74 dental measure to reporting by dentists only and remove primary care providers due to concerns with primary care providers being able to bill the services. This would require an update to the logic and measure header. The logic would limit the eligible encounter for the denominator to the clinical oral evaulation value set. The measure title, clinical recommendation statement, and references will be updated to reflect this change. 

Proposed Solution:

//Current measure title:
Primary Caries Prevention Intervention as Offered by Primary Care Providers, including Dentists

//Proposed measure title:
Primary Caries Prevention Intervention as Offered by Dentists

//Current clinical recommendation statement:
........The USPSTF [US Preventive Services Task Force] recommends that primary care clinicians apply fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption. (B recommendation)

//Proposed clinical recommendation statement:
......Remove this paragraph completely

//Current initial population language:
Children, 6 months - 20 years of age, with a visit during the measurement period

//Proposed initial population language:
Children, 6 months - 20 years of age, with a clinical oral evaluation during the measurement period

//Current logic for Qualifying Encounters definition:
( ["Encounter, Performed": "Office Visit"]
  union ["Encounter, Performed": "Preventive Care - Established Office Visit, 0 to 17"]
  union ["Encounter, Performed": "Preventive Care- Initial Office Visit, 0 to 17"]
  union ["Encounter, Performed": "Preventive Care Services - Established Office Visit, 18 and Up"]
  union ["Encounter, Performed": "Preventive Care Services-Initial Office Visit, 18 and Up"]
  union ["Encounter, Performed": "Clinical Oral Evaluation"]
  union ["Encounter, Performed": "Telephone Visits"]
  union ["Encounter, Performed": "Online Assessments"] )  ValidEncounter
  where ValidEncounter.relevantPeriod during "Measurement Period"

//Proposed change for Qualifying Encounters definition:
( ["Encounter, Performed": "Clinical Oral Evaluation"]
  )  ValidEncounter
  where ValidEncounter.relevantPeriod during "Measurement Period"

//Current value set:
valueset "Office Visit" (2.16.840.1.113883.3.464.1003.101.12.1001)  
valueset "Online Assessments" (2.16.840.1.113883.3.464.1003.101.12.1089)  
valueset "Telephone Visits" (2.16.840.1.113883.3.464.1003.101.12.1080) 
valueset "Preventive Care - Established Office Visit, 0 to 17" (2.16.840.1.113883.3.464.1003.101.12.1024)
valueset "Preventive Care Services - Established Office Visit, 18 and Up" (2.16.840.1.113883.3.464.1003.101.12.1025)
valueset "Preventive Care Services-Initial Office Visit, 18 and Up" (2.16.840.1.113883.3.464.1003.101.12.1023)
valueset "Preventive Care- Initial Office Visit, 0 to 17" (2.16.840.1.113883.3.464.1003.101.12.1022)  
 
//Proposed value set:
Remove the value sets listed above 

Rationale for Change:
Limiting this measure to reporting by dentists will alleviate concerns with primary care providers being able to bill the services.