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An Act To Improve Dental Health for Maine Children and Adults with Low Incomes
Be it enacted by the People of the State of Maine as follows:
Sec. 1. 22 MRSA §3174-F, sub-§1, as amended by PL 1997, c. 159, §§1 and 2 and PL 2003, c. 689, Pt. B, §6, is further amended to read:
 
1. Coverage provided.   The Department of Health and Human Services shall provide the following dental services, reimbursed under the United States Social Security Act, Title XIX, or successors to it, to individuals 21 years of age and over, limited to:
 
A. Acute surgical care directly related to an accident where traumatic injury has occurred. This coverage will only be provided for the first 3 months after the accident;
 
B. Oral surgical and related medical procedures not involving the dentition and gingiva;
 
C. Extraction of teeth that are severely decayed and pose a serious threat of infection during a major surgical procedure of the cardiovascular system, the skeletal system or during radiation therapy for a malignant tumor;
 
D. Treatment necessary to relieve pain, eliminate infection or prevent imminent tooth loss; and
 
F. Other dental services, including fullFull and partial dentures, medically necessary to correct or ameliorate an underlying medical condition, if the department determines that provision of those services will be cost-effective in comparison to the provision of other covered medical services for the treatment of that condition.; and
 
G.  Other comprehensive preventive, diagnostic and restorative dental services that are medically necessary to maintain good oral and overall health in accordance with rules adopted by the department.
Sec. 2. 22 MRSA §3174-U, as enacted by PL 1999, c. 301, §1, is repealed and the following enacted in its place:
§ 3174-U. Medicaid reimbursement for dental services; dental incentive payment program
 
1.  Annual reimbursement review.     The department shall conduct an annual review of the adequacy of reimbursement rates for dental services for dentists who provide care for a disproportionate number of patients whose care is reimbursed through the federal Medicaid program and the Cub Care program established in section 3174-T. By December 31, 1999, the department shall report to the joint standing committee of the Legislature having jurisdiction over health and human services matters on the results of the study, including the costs in General Fund and other money.
 
2.  Dental incentive payment program to expand access to dental services for MaineCare members.     For the purpose of increasing access to dental care for children and adults receiving MaineCare services, a dental incentive payment program is established and administered by the department.
 
A.  The department shall develop the dental incentive payment program by rule. The dental incentive payment program must reward dentists who significantly increase the number of MaineCare members that enroll as patients or who provide dental services to a disproportionate number of MaineCare members. For fiscal year 2019-20 and annually thereafter, the department shall provide $1,000,000 in incentive funding to dentists. The $1,000,000 in incentive funding can include reimbursements to dentists through the federal Medicaid program and the Cub Care program established in section 3174-T.
 
B.  Annually, the department shall establish a dental access benchmark against which progress in increasing access to dental care for MaineCare members through the incentive payment program is measured.
 
C.  Beginning in fiscal year 2021-22 and annually thereafter, the department shall review the effectiveness of the dental incentive payment program in meeting the benchmarks established pursuant to paragraph B. If the program fails to meet the established benchmarks, the department shall:
 
(1) Convene a working group to recommend improvements to the dental incentive payment program that will better ensure effectiveness in increasing access to dental care for MaineCare members. The working group must consist of members representing MaineCare members, a statewide dental association, a statewide dental hygienists association, a statewide primary care association and other persons with policy expertise or experience in promoting access to dental care for individuals with low incomes; and
 
(2) Adopt rules to restructure the dental incentive payment program. When adopting rules, the department shall consider the recommendations of the working group pursuant to subparagraph (1) and the department's experience with the dental incentive payment program and the experience of other states with similar programs.
 
D.  The department shall adopt rules to implement this section. Rules adopted pursuant to this paragraph are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A.
Sec. 3. Dental incentive payment program; rulemaking; working group.
1. Rulemaking. By January 1, 2020, the Department of Health and Human Services shall adopt an emergency rule to implement provisions of the Maine Revised Statutes, Title 22, section 3174-U, subsection 2. When adopting rules, the department shall consider recommendations provided by a working group pursuant to subsection 2.
2. Working group. No later than October 1, 2019 and prior to adopting rules pursuant to subsection 1 to implement provisions of the Maine Revised Statutes, Title 22, section 3174-U, subsection 2, the Department of Health and Human Services shall convene a working group to make recommendations to the department for the design of a dental incentive payment program that will significantly increase the number of MaineCare members that become patients of dental providers or for dentists that provide dental services to a disproportionate number of MaineCare members. The working group must consist of members representing MaineCare members, a statewide dental association, a statewide dental hygienists association, a statewide primary care association and other persons with policy expertise or experience in promoting access to dental care for individuals with low incomes.
Sec. 4. Rulemaking; coverage for adult dental services. By January 1, 2020, the department shall adopt routine technical rules as defined in the Maine Revised Statutes, Title 5, chapter 375, subchapter 2-A to implement the provisions of Title 22, section 3174-F, subsection 1.
 
SUMMARY
This bill adds access to comprehensive medically necessary preventive, diagnostic and restorative dental services to the limited dental services currently available to MaineCare members 21 years of age and over. It also establishes a dental incentive payment program for dentists to increase access to dental care for MaineCare members, including children, and requires the Department of Health and Human Services to convene a working group to make recommendations on the design of the program. It provides for the establishment of benchmarks to measure the effectiveness of the dental incentive payment program over time.