PLEASE NOTE: Legislative Information cannot perform research, provide legal advice, or interpret Maine law. For legal assistance, please contact a qualified attorney.
An Act To Implement an Oral Health Capitation System for Children on MaineCare
Be it enacted by the People of the State of Maine as follows:
Sec. 1. 22 MRSA §3174-LL  is enacted to read:
§ 3174-LL.  Capitated oral health for children
The department shall establish and implement a capitated oral health program for children in the MaineCare program, referred to in this section as “the program.” The program must provide comprehensive oral health services that promote access to primary oral health care. The program must encourage oral health provider participation, ensure accountability without undue administrative burden, achieve cost-effective use of resources, target higher-needs children and lead to improved oral health outcomes. The program must be administered through a contract with the department that is paid on a capitated basis by the MaineCare program.
 
1.  Levels of treatment.     The program must provide the following levels of oral health treatment:
 
A.  Diagnostic, preventive and disease management services, including health promotion, risk assessment, primary prevention and disease suppression;
 
B.  Basic restorative care;
 
C.  Advanced restorative care; and
 
D.  Catastrophic care, including orthodontia.
 
2.  Administration.     The program must use a standardized oral health claims form in wide use throughout the country and standard enrollment verification.
 
3.  Accountability.     The program must include accountability mechanisms, performance indicators and measures and outcome assessments.
 
4.  Reimbursement.     The program must provide reimbursement to dentists and other providers that is market-based and fee-for-service.
 
5.  Rulemaking.     The department shall adopt rules to implement this section. Rules adopted pursuant to this subsection are routine technical rules as defined by Title 5, chapter 375, subchapter 2-A.
 
SUMMARY
This bill enacts a capitated comprehensive oral health program for children under the MaineCare program. The program must provide 4 levels of oral health treatment: diagnostic, preventive and disease management services, including health promotion, risk assessment, primary prevention and disease suppression; basic restorative care; advanced restorative care; and catastrophic care, including orthodontia. The program must provide market-based fee-for-service reimbursement for dentists and other providers. The bill requires the Department of Health and Human Services to adopt rules for implementation and designates the rules as routine technical rules.