‘Resolve, To Adjust Reimbursement Rates for Dental Services and Improve Access to Dental Care under the MaineCare Program’
Amend the resolve by striking out the title and substituting the following:
Amend the resolve by striking out everything after the title and before the summary and inserting the following:
‘Sec. 1. Reimbursement rate rules. Resolved: That the Department of Health and Human Services shall annually review and incrementally adjust equally in each of the next 5 years following the effective date of this resolve the reimbursement rates under the MaineCare program for dental codes D0120, D0140, D0150, D0220, D0272, D0330, D1110, D1120, D1208, D1351, D2140, D2150, D2160, D2330, D2331, D2332, D2391, D2392, D2393, D3330, D7140 and D7210 until the reimbursement rates reflect the 10th percentile of the fees for the New England region in the most recent "Survey of Dental Fees" published by the American Dental Association. After the reimbursement rates reach the 10th percentile, the department shall amend its rule Chapter 101: MaineCare Benefits Manual to require that the rates be adjusted annually for inflation in accordance with the United States Department of Labor, Bureau of Labor Statistics Consumer Price Index. Rules adopted pursuant to this section are routine technical rules pursuant to the Maine Revised Statutes, Title 5, chapter 375, subchapter 2-A; and be it further
Sec. 2. Dental services for pregnant women. Resolved: That, by January 1, 2016, the Department of Health and Human Services shall amend its rule Chapter 101: MaineCare Benefits Manual, Chapter II, Section 25 to cover diagnostic and preventive services to pregnant women and postpartum women for one year after the birth to ameliorate conditions or reduce complications that exist because of or are exacerbated by the pregnancy or that, if left untreated, could adversely affect fetal or child development; and be it further
Sec. 3. Dental services to avoid more costly medical or dental care. Resolved: That, by January 1, 2016, the Department of Health and Human Services shall amend its rule Chapter 101: MaineCare Benefits Manual, Chapter II, Section 25 to cover adult dental services provided to avoid more costly medical or dental care; and be it further
Sec. 4. Notice to MaineCare members and providers of dental services. Resolved: That the Department of Health and Human Services shall provide to MaineCare members and providers of dental services notice of changes in benefits to MaineCare members pursuant to rule changes under sections 2 and 3; and be it further
Sec. 5. Stakeholder group. Resolved: That prior to adopting rules pursuant to section 3, the Department of Health and Human Services shall convene a stakeholder group to identify dental services necessary to avoid more costly medical or dental care. The stakeholder group must consist of members representing dentists, federally qualified health centers, dental hygienists, hospitals and a clinical health system with experience in adult oral health initiatives; and be it further
Sec. 6. Appropriations and allocations. Resolved: That the following appropriations and allocations are made.
HEALTH AND HUMAN SERVICES, DEPARTMENT OF (FORMERLY DHS)
Medical Care - Payments to Providers 0147
Initiative: Provides funding to incrementally adjust the MaineCare reimbursement rates for certain dental services annually over the next 5 years until the rates reach the 10th percentile of the fees for the New England region.
| GENERAL FUND | 2015-16 | 2016-17 |
|
All Other
|
$839,452 | $2,238,539 |
 |
|
|
| GENERAL FUND TOTAL | $839,452 | $2,238,539 |
| FEDERAL EXPENDITURES FUND | 2015-16 | 2016-17 |
|
All Other
|
$1,409,281 | $3,758,083 |
|
|
|
| FEDERAL EXPENDITURES FUND TOTAL | $1,409,281 | $3,758,083 |
Medical Care - Payments to Providers 0147
Initiative: Provides funding to add restorative, diagnostic and preventive dental services to pregnant women and postpartum women for one year after delivery.
| GENERAL FUND | 2015-16 | 2016-17 |
|
All Other
|
$301,113 | $602,225 |
|
|
|
| GENERAL FUND TOTAL | $301,113 | $602,225 |
| FEDERAL EXPENDITURES FUND | 2015-16 | 2016-17 |
|
All Other
|
$505,511 | $1,011,023 |
|
|
|
| FEDERAL EXPENDITURES FUND TOTAL | $505,511 | $1,011,023 |
Office for Family Independence Z020
Initiative: Provides funding for the automated client eligibility system changes, testing and oversight to add restorative, diagnostic and preventive dental services to pregnant women and postpartum women for one year after delivery.
| GENERAL FUND | 2015-16 | 2016-17 |
|
All Other
|
$5,600 | $0 |
|
|
|
| GENERAL FUND TOTAL | $5,600 | $0 |
| OTHER SPECIAL REVENUE FUNDS | 2015-16 | 2016-17 |
|
All Other
|
$5,600 | $0 |
|
|
|
| OTHER SPECIAL REVENUE FUNDS TOTAL | $5,600 | $0 |
Office of MaineCare Services 0129
Initiative: Provides funding for the Maine integrated health management solution changes, testing and oversight to add restorative, diagnostic and preventive dental services to pregnant women and postpartum women for one year after delivery.
| GENERAL FUND | 2015-16 | 2016-17 |
|
All Other
|
$41,556 | $0 |
|
|
|
| GENERAL FUND TOTAL | $41,556 | $0 |
| FEDERAL EXPENDITURES FUND | 2015-16 | 2016-17 |
|
All Other
|
$124,667 | $0 |
|
|
|
| FEDERAL EXPENDITURES FUND TOTAL | $124,667 | $0 |
| HEALTH AND HUMAN SERVICES, DEPARTMENT OF (FORMERLY DHS) | ||
| DEPARTMENT TOTALS | 2015-16 | 2016-17 |
|
GENERAL FUND
|
$1,187,721 | $2,840,764 |
|
FEDERAL EXPENDITURES FUND
|
$2,039,459 | $4,769,106 |
|
OTHER SPECIAL REVENUE FUNDS
|
$5,600 | $0 |
|
|
|
| DEPARTMENT TOTAL - ALL FUNDS | $3,232,780 | $7,609,870 |
summary
This amendment is the majority report of the committee. It clarifies that increases to reimbursement rates of the dental codes in the resolve are to be made in 5 equal increases. The amendment requires the Department of Health and Human Services to amend the rules under Chapter 101: MaineCare Benefits Manual, Chapter II, Section 25 to cover diagnostic and preventive services to pregnant women and postpartum women and dental services necessary to avoid more costly medical or dental care as identified by a stakeholder group. It requires the Department of Health and Human Services to provide information concerning adult dental benefits to adult MaineCare members and providers. It requires the department to adopt rules by January 1, 2016 relating to dental coverage for pregnant women and postpartum women and for services provided to avoid more costly medical or dental care. The amendment also adds an appropriations and allocations section. The amendment also changes the title and adds a fiscal note.
FISCAL NOTE REQUIRED
(See attached)