HP1399, LD 1955, item 1, An Act To Promote Cost-effectiveness in the MaineCare Program and Improve the Oral Health of Maine Adults and Children

An Act To Promote Cost-effectiveness in the MaineCare Program and Improve the Oral Health of Maine Adults and Children

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 full Full 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. Department of Health and Human Services to work with providers to encourage participation. The Department of Health and Human Services shall work with providers of oral health care and dental services to encourage participation in the MaineCare program to ensure access to the services required by the Maine Revised Statutes, Title 22, section 3174-F, subsection 1.

Sec. 3. Department of Health and Human Services to develop a public education campaign. The Department of Health and Human Services shall develop public education materials and strategies for distribution of those materials including:

1. Materials provided to adult MaineCare members who receive dental services pursuant to the Maine Revised Statutes, Title 22, section 3174-F, subsection 1 on the necessity of dental services for children and infants, the recommended timetable for services to children and information relating to oral health care and dental providers who provide services to children in the MaineCare program; and

2. Materials provided to MaineCare members who are aging out of children's coverage under the MaineCare program and who are eligible to enroll as an adult MaineCare member regarding the availability of the comprehensive adult dental benefit under the Maine Revised Statutes, Title 22, section 3174-F, subsection 1.

The department shall engage stakeholders, including providers of pediatric medical services and oral health care and dental services, in developing materials for distribution and strategies for the distribution of those materials required under this section.

Sec. 4. Report. The Department of Health and Human Services shall determine the costs of the comprehensive adult dental benefit under the Maine Revised Statutes, Title 22, section 3174-F, subsection 1 and the savings from reduced hospital emergency room visits and prescription drug costs from the provision of the comprehensive adult dental benefit for a period of 5 years beginning with the effective date of this Act. The costs and savings must be provided in a report to the joint standing committees of the Legislature having jurisdiction over health and human services matters and appropriations and financial affairs no later than January 1, 2026.

summary

This bill adds 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 requires the Department of Health and Human Services to work with providers of oral health care and dental services to encourage participation in the MaineCare program. It requires the department to develop educational materials and strategies for the distribution of those educational materials relating to the importance of dental services for children and the availability of the comprehensive adult dental benefit to children covered by the MaineCare program who are aging out of the program. The department is required to provide a 5-year report on costs and savings relating to the comprehensive adult dental benefit to the joint standing committees of the Legislature having jurisdiction over health and human services matters and appropriations and financial affairs no later than January 1, 2026.

HP1399 LD 1955	Session - 129th Maine Legislature		LR 2909 Item 1
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