An Act To Implement an Oral Health Capitation System for Children on MaineCare

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.

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.