REVISED Provider Alert – New Measure – Topical Fluoride Varnish for Children (TFL-CH) and HPSJ’s Topical Fluoride Varnish & Supplementation Benefit Reminder
| Date: | July 26, 2023 |
| To: | Health Plan of San Joaquin (HPSJ) Contracted Primary Care Providers (PCP) |
| From: | HPSJ |
| Type: | Informational |
| Subject: | REVISED Provider Alert – New Measure – Topical Fluoride Varnish for Children (TFL-CH) and HPSJ’s Topical Fluoride Varnish & Supplementation Benefit Reminder |
| Business: | Medi-Cal Managed Care |
The following is a revision to information posted April 13, 2023, regarding Topical Fluoride Varnish for Children (TFL-CH), a new measure for the 2023 California Department of Health Care Services Managed Care Accountability Set (MCAS), and a reminder regarding the Medi-Cal Topical Fluoride Varnish and Supplementation Benefit.
Quality Measure: Topical Fluoride Varnish for Children (TFL-CH)
Children 1 – 21 years old should receive at least 2 topical fluoride applications each year.
Topical Fluoride Varnish does not require a Prior Authorization for children up to
age 6. Fluoride Varnish Treatment Guidelines:
• Children up to 72 Months of age
• Physicians or other qualified health care professionals may apply topical fluoride varnish
• Up to 3 fluoride applications are covered up to three times a year. For more information, please see the Medi-Cal Provider Manual for Dental Benefits:
https://files.medi-cal.ca.gov/pubsdoco/publications/masters-mtp/part2/dental.pdf
Prescription coverage for fluoride drops and tablets are available for Medi-Cal members up to age 21. Some prescriptions may require authorization and have age requirements.
• Visit the Medi-Cal Rx website for information on covered prescriptions, days supplied and age limitations: https://medi-calrx.dhcs.ca.gov/home/
Fluoride Varnish Guidelines:
• The U.S. Prevention Service Task Force (USPSTF) recommends that PCPs prescribe oral fluoride supplementation starting at 6 months for children whose water supply is deficient in fluoride in addition to applying fluoride varnish to primary teeth of all infants and children starting at the age of primary tooth eruption.
San Joaquin and Stanislaus County do not have fluoridated water for residents.
• The American Academy of Pediatrics (AAP)/Bright Futures Periodic Schedule recommends fluoride varnish application at least once every 6 months for all children and every 3 months for children at high risk for caries. For more information on the AAP guidelines please visit:
https://downloads.aap.org/AAP/PDF/periodicity_schedule.pdf?_ga=2.13498551.1214927896.1688148460-1174335812.1688148456
• The American Dental Association (ADA) recommends that children at increased risk for caries should receive a professional fluoride treatment every 6 months.
Need training? HPSJ can help: Contact your provider services representative or e-mail healtheducation@hpsj.com to schedule training for fluoride varnish application for staff. HPSJ is proud to work with our Public Health Local Oral Health Programs in Stanislaus and San Joaquin County to bring fluoride varnish training to your clinics. For more information on fluoride for your patients visit:
https://www.hpsj.com/healthy-smiles/fluoride/
If you have questions or need assistance, please call our Provider Services team at (209) 942-6340. You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan of San Joaquin and our services is always available on our website https://www.hpsj.com/.