‘Resolve, To Establish a Stakeholder Group To Develop an Adult Dental Benefit under MaineCare’
Amend the bill by striking out everything after the title and inserting the following:
‘Sec.
1. Department of Health and Human Services to convene stakeholder group. Resolved: That the Department of Health and Human Services shall convene a stakeholder group, no later than October 1, 2019, to develop a plan for an adult preventive, comprehensive, diagnostic and restorative dental benefit under MaineCare.
1. Requirements of the plan. The plan must consider and include the following:
A. Dental procedures and services that are aligned with evidence-based care, are medically necessary to maintain good oral and overall health and are appropriate to be included in an adult dental benefit under MaineCare;
B. Current MaineCare expenditures for emergency dental care;
C. Projected expenditures for an adult dental benefit under MaineCare that includes preventive, comprehensive, diagnostic and restorative dental services;
D. Anticipated cost savings resulting from reduced use of hospital emergency departments and prescription medication related to the relief of pain and infection as a result of the implementation of the benefit described in paragraph C;
E. Delivery and provider reimbursement models that will best ensure adequate access to high-quality dental care for all MaineCare enrollees, improve provider participation, achieve healthy outcomes and promote fiscal and administrative efficiency for the long-term success of the plan;
F. Service delivery methods including fee-for-service state administration and risk-based dental managed care organization carve-out models. The stakeholder group shall take into account differences among dental practice settings, including any differences in service delivery, payment methods and reimbursement amounts between private practices, community dental clinics, federally qualified and similarly situated health centers and hospital-affiliated providers;
G. Strategies to improve oral health education for MaineCare; and
H. Metrics to measure outcomes, including measures of provider participation and use of services.
2. Stakeholder group. The stakeholder group consists of the Commissioner of Health and Human Services or the commissioner's designee and 12 other members, appointed by the commissioner as follows:
A. Two members of the commissioner's choosing;
B. One member of a statewide organization representing dentists;
C. One member of a statewide organization representing dental hygienists;
D. One member representing federally qualified health centers;
E. One member representing a nonprofit dental clinic;
F. One member representing a nonprofit dental managed care organization;
G. One member with policy expertise or experience in promoting access to dental care for individuals with low incomes;
H. One member representing a philanthropic organization concerned with oral health;
I. One member with experience in public health policy and experience in oral health; and
J. Two MaineCare members who would benefit from access to an adult dental benefit.
3. Report. The department shall submit the plan developed pursuant to subsection 2 in a report to the Joint Standing Committee on Health and Human Services no later than January 2, 2020. The committee is authorized to report out a bill regarding the report in the Second Regular Session of the 129th Legislature.