Legislative Document No. 519 H.P. 376 House of Representatives, January 31, 2019
An Act To Expand Adult Dental Health Insurance Coverage
Reference to the Committee on Health and Human Services suggested and ordered printed.
ROBERT B. HUNT Clerk
Presented by Representative BROOKS of Lewiston. Cosponsored by Representatives: BERRY of Bowdoinham, STANLEY of Medway.
Printed on recycled paper 1 Be it enacted by the People of the State of Maine as follows:
2 PART A 3 Sec. A-1. 22 MRSA §3174-F, as amended by PL 1997, c. 159, §§1 and 2 and PL 4 2003, c. 689, Pt. B, §6, is further amended to read:
5 §3174-F. Coverage for adult dental services
6 1. Coverage provided. The Department of Health and Human Services shall 7 provide comprehensive dental services, reimbursed under the United States Social 8 Security Act, Title XIX, or successors to it, to individuals 21 years of age and over, 9 limited to: eligible for the MaineCare program. 10 A. Acute surgical care directly related to an accident where traumatic injury has 11 occurred. This coverage will only be provided for the first 3 months after the 12 accident; 13 B. Oral surgical and related medical procedures not involving the dentition and 14 gingiva; 15 C. Extraction of teeth that are severely decayed and pose a serious threat of infection 16 during a major surgical procedure of the cardiovascular system, the skeletal system or 17 during radiation therapy for a malignant tumor; 18 D. Treatment necessary to relieve pain, eliminate infection or prevent imminent 19 tooth loss; and 20 F. Other dental services, including full and partial dentures, medically necessary to 21 correct or ameliorate an underlying medical condition, if the department determines 22 that provision of those services will be cost-effective in comparison to the provision 23 of other covered medical services for the treatment of that condition. 24 2. Demonstration projects. The department shall promptly take all appropriate 25 steps to obtain necessary waivers, if necessary, from the federal Department of Health 26 and Human Services that enable the State to provide within the limits of available funds, 27 on a demonstration basis, comprehensive dental services to Medicaid-eligible individuals 28 who are 21 years of age or older in public or private, nonprofit clinic settings. The 29 department's goal in pursuing these waivers or demonstration projects not requiring 30 waivers is to determine whether providing services in these settings promotes cost 31 effectiveness or efficiency or promotes other objectives of the federal Social Security 32 Act, Title XIX. 33 By January 15, 1992, the department shall report to the joint standing committee of the 34 Legislature having jurisdiction over health matters regarding the progress of its efforts 35 under this subsection. The report must outline the department's progress and recommend 36 further action required in pursuit of any demonstration project under this subsection. 37 3. Comprehensive dental services defined. For the purposes of this section, 38 "comprehensive dental services" means any services necessary to maintain oral health
Page 1 - 129LR0547(01)-1 1 and prevent disease, restore oral structures to health and function and treat emergency 2 conditions.
3 Sec. A-2. Department of Health and Human Services to apply for 4 approval. Before January 1, 2020, the Department of Health and Human Services may 5 apply to the federal Department of Health and Human Services, Centers for Medicare and 6 Medicaid Services for any necessary waivers or state plan amendments to reimburse for 7 comprehensive dental services as required in the Maine Revised Statutes, Title 22, section 8 3174-F.
9 PART B 10 Sec. B-1. 24 MRSA §2317-B, sub-§20, as amended by PL 2013, c. 575, §3, is 11 further amended to read:
12 20. Title 24-A, chapters 68 and 68-A. Long-term care insurance, nursing home 13 care insurance and home health care insurance, Title 24-A, chapters 68 and 68-A; and
14 Sec. B-2. 24 MRSA §2317-B, sub-§21, as enacted by PL 2013, c. 575, §4 and 15 affected by §10, is further amended to read:
16 21. Title 24-A, sections 2765-A and 2847-U. The practice of dental hygiene by a 17 dental hygiene therapist, Title 24-A, sections 2765-A and 2847-U.; and
18 Sec. B-3. 24 MRSA §2317-B, sub-§22 is enacted to read: 19 22. Title 24-A, section 4320-L. Coverage for comprehensive dental services, Title 20 24-A, section 4320-L.
21 Sec. B-4. 24-A MRSA §4320-L is enacted to read: 22 §4320-L. Coverage for comprehensive dental services
23 1. Definition. As used in this section, unless the context otherwise indicates, 24 "comprehensive dental services" means any services necessary to maintain oral health 25 and prevent disease, restore oral structures to health and function and treat emergency 26 conditions.
27 2. Required coverage. A carrier offering a health plan in this State shall provide 28 coverage for comprehensive dental services.
29 3. Limits; coinsurance; deductibles. A health plan that provides coverage for the 30 services required by this section may contain provisions for maximum benefits and 31 coinsurance and reasonable limitations, deductibles and exclusions to the extent that these 32 provisions are not inconsistent with the requirements of this section.
33 4. Coordination of benefits with dental insurance. If an enrollee eligible for 34 coverage under this section is also eligible for coverage under a dental insurance policy or 35 contract, the insurer providing dental insurance is the primary payer responsible for 36 charges under subsection 2 and the carrier is the secondary payer.
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