Legislative Document No. 1955 H.P. 1399 House of Representatives, January 8, 2020
An Act To Promote Cost-effectiveness in the MaineCare Program and Improve the Oral Health of Maine Adults and Children
Approved for introduction by a majority of the Legislative Council pursuant to Joint Rule 203. Reference to the Committee on Health and Human Services suggested and ordered printed.
ROBERT B. HUNT Clerk
Presented by Representative GATTINE of Westbrook. Cosponsored by Senator SANBORN, L. of Cumberland and Representatives: CRAVEN of Lewiston, MARTIN of Eagle Lake, MEYER of Eliot, Senators: BREEN of Cumberland, GRATWICK of Penobscot.
Printed on recycled paper 1 Be it enacted by the People of the State of Maine as follows:
2 Sec. 1. 22 MRSA §3174-F, sub-§1, as amended by PL 1997, c. 159, §§1 and 2 3 and PL 2003, c. 689, Pt. B, §6, is further amended to read:
4 1. Coverage provided. The Department of Health and Human Services shall 5 provide the following dental services, reimbursed under the United States Social Security 6 Act, Title XIX, or successors to it, to individuals 21 years of age and over, limited to: 7 A. Acute surgical care directly related to an accident where traumatic injury has 8 occurred. This coverage will only be provided for the first 3 months after the 9 accident; 10 B. Oral surgical and related medical procedures not involving the dentition and 11 gingiva; 12 C. Extraction of teeth that are severely decayed and pose a serious threat of infection 13 during a major surgical procedure of the cardiovascular system, the skeletal system or 14 during radiation therapy for a malignant tumor; 15 D. Treatment necessary to relieve pain, eliminate infection or prevent imminent 16 tooth loss; and 17 F. Other dental services, including full Full and partial dentures, medically necessary 18 to correct or ameliorate an underlying medical condition, if the department 19 determines that provision of those services will be cost-effective in comparison to the 20 provision of other covered medical services for the treatment of that condition.; and 21 G. Other comprehensive preventive, diagnostic and restorative dental services that 22 are medically necessary to maintain good oral and overall health in accordance with 23 rules adopted by the department. 24 Sec. 2. Department of Health and Human Services to work with 25 providers to encourage participation. The Department of Health and Human 26 Services shall work with providers of oral health care and dental services to encourage 27 participation in the MaineCare program to ensure access to the services required by the 28 Maine Revised Statutes, Title 22, section 3174-F, subsection 1.
29 Sec. 3. Department of Health and Human Services to develop a public 30 education campaign. The Department of Health and Human Services shall develop 31 public education materials and strategies for distribution of those materials including:
32 1. Materials provided to adult MaineCare members who receive dental services 33 pursuant to the Maine Revised Statutes, Title 22, section 3174-F, subsection 1 on the 34 necessity of dental services for children and infants, the recommended timetable for 35 services to children and information relating to oral health care and dental providers who 36 provide services to children in the MaineCare program; and
37 2. Materials provided to MaineCare members who are aging out of children's 38 coverage under the MaineCare program and who are eligible to enroll as an adult
Page 1 - 129LR2909(01)-1 1 MaineCare member regarding the availability of the comprehensive adult dental benefit 2 under the Maine Revised Statutes, Title 22, section 3174-F, subsection 1.
3 The department shall engage stakeholders, including providers of pediatric medical 4 services and oral health care and dental services, in developing materials for distribution 5 and strategies for the distribution of those materials required under this section.
6 Sec. 4. Report. The Department of Health and Human Services shall determine 7 the costs of the comprehensive adult dental benefit under the Maine Revised Statutes, 8 Title 22, section 3174-F, subsection 1 and the savings from reduced hospital emergency 9 room visits and prescription drug costs from the provision of the comprehensive adult 10 dental benefit for a period of 5 years beginning with the effective date of this Act. The 11 costs and savings must be provided in a report to the joint standing committees of the 12 Legislature having jurisdiction over health and human services matters and appropriations 13 and financial affairs no later than January 1, 2026.
14 SUMMARY 15 This bill adds comprehensive, medically necessary preventive, diagnostic and 16 restorative dental services to the limited dental services currently available to MaineCare 17 members 21 years of age and over. It requires the Department of Health and Human 18 Services to work with providers of oral health care and dental services to encourage 19 participation in the MaineCare program. It requires the department to develop 20 educational materials and strategies for the distribution of those educational materials 21 relating to the importance of dental services for children and the availability of the 22 comprehensive adult dental benefit to children covered by the MaineCare program who 23 are aging out of the program. The department is required to provide a 5-year report on 24 costs and savings relating to the comprehensive adult dental benefit to the joint standing 25 committees of the Legislature having jurisdiction over health and human services matters 26 and appropriations and financial affairs no later than January 1, 2026.
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