Brief description of measure CMS74: Primary Caries Prevention Intervention as Offered by Dentists: Percentage of children, 6 months - 20 years of age, who received a fluoride varnish application during the measurement period as determined by a dentist. Description of issue The measure developer proposes requiring two fluoride varnish applications during the measurement period. To accomplish this, the description of the measure will be updated to account for two fluoride applications within the measurement period as opposed to one fluoride application, as will the logic. The Measure Developer proposes requiring two fluoride applications within a 12 month period as opposed to one fluoride application every 6 months, even if this may have negative impacts on performance. Goal of review Obtain clinical feedback

Proposed solution ​//Header before Description: Percentage of children... who received a fluoride varnish application during the measurement period Numerator: Children who receive a fluoride varnish application during the measurement period //Header after Description: Percentage of children... who received two fluoride varnish applications during the measurement period Numerator: Children who receive two fluoride varnish applications during the measurement period //Logic before define "Numerator":   exists ["Procedure, Performed": "Fluoride Varnish Application for Children"] FluorideApplication     where Global."NormalizeInterval" ( FluorideApplication.relevantDatetime, FluorideApplication.relevantPeriod ) during day of "Measurement Period" //Logic after define "Numerator":   Count(["Procedure, Performed": "Fluoride Varnish Application for Children"] FluorideApplication       where Global."NormalizeInterval"(FluorideApplication.relevantDatetime, FluorideApplication.relevantPeriod)during day of "Measurement Period"  )>= 2 Rationale for change This change would align the measure with current evidence, clinical recommendations, and with the Topical Fluoride for Children measure used in the Medicaid Child Core Set as well as the Topical Fluoride for Children measure stewarded by the Dental Quality Alliance (DQA). For example, the Topical Fluoride for Children Measure in the Medicaid Child Core Set specifies “Percentage of enrolled children ages 1 through 20 who received at least two topical fluoride applications as: (1) dental or oral health services, (2) dental services, and (3) oral health services within the measurement year.”   Review of evidence and guidelines suggest that updating the measure to account for two fluoride varnish applications per year is warranted. This change was also supported by the dental expert work group (EWG) and American Association of Public Health Dentistry (AAPHD).