Resolve, Directing the Department of Health and Human Services To Implement an Oral Health Capitated Care System for Children Covered by MaineCare and the Children's Health Insu'rance Program
Maine Legislature, Session 124, LD 1086
Committee: Health and Human Services
Sponsors: MILLS

,FIRST REGULAR SESSION-2009 
Legislative Document 
No. 108.6 
S.P. 
In Senate, March 17,2009 
Resolve, Directing the Department of Health and Human Services 
To Implement an Oral Health Capitated Care System for Children 
Covered by MaineCare and the Children's Health Insu'rance 
Program 
Reference to the Committee on Health and Human Services suggested and ordered printed. 
Presented by Senator MILLS of Somerset. 
Printed on recycled paper 
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JOY J. O'BRIEN 
Secretary of the Senate 
Preamble. Whereas, there is a perennial shortage of dental services for children 
covered by MaineCare and the State Children's Health Insurance Program, known as 
SCHIP; and 
Whereas, tooth decay is the most common chronjc disease of childhood, 5 times 
more frequent than asthma; and 
Whereas, children in lower-income homes consistently suffer more tooth decay, yet 
children with the greatest need have the least access to care; and 
Whereas, children in lower-income homes are predisposed to dental disease because 
of dietary, behavioral and socio-environmental factors that overwhelm the limited 
preventive interventiQns available to them; and 
Whereas, a major contributor to the overuse of emergency rooms is the treatment of 
acute and painful dental conditions in children; and 
Whereas, pain from untreated dental caries is a major contributor to poor school 
performance; and 
Whereas, there are few dentists willing or able to provide dental care under 
MaineCare on a fee-for-service basis; and 
Whereas, needy children are. unable to find a nearby dental medical office from 
which to receive continuity of care and follow-up for acute and preventive services; and 
Whereas, the complexity of the state payment system is a factor in discouraging 
dentists from participating in care funded by MaineCare and SCHIP; and 
Whereas, excessive travel distances and the opportunity for only sporadic dental 
care contributes to missed appointments, loss· of continuity in care and substantial 
inconvenience,to cooperating dental practices; and 
Whereas, a properly structured capitated care system would relieve the system of 
many of its present deficiencies, expand opportunities for continuous and effective care, 
and reduce overuse of emergency rooms; now, therefore, be it 
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Sec. 1. Capitated care system. Resolved: That the Department' of Health and 
Human Services shall establish and implement a 4-tiered capitated oral care system for 
children covered by MaineCare and SCHIP as described in 'the report entitled "Pediatric 
Dental Care in CHIP and Medicaid: Paying for What Kids Need; Getting Value for State 
Payments" published in July 1999 by the Milbank Memorial Fund; and be it further 
Sec. 2. Levels of care. Resolved: That the capitated oral care system under 
section 1 be based on assigning each child's initial needs into one of 4 levels of care: 
1. Diagnostic, preventive and disease management services; 
2. Basic restorative care; 
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3. Advanced restorative care; and 
4. Catastrophic care; and be it further 
Sec. 3. Payment. Resolv'ed: That periodic payments be established for each 
level of care under section 2 in order to relieve dental practices of the burden of filing 
fee-for-service forms; and be it further 
Sec. 4. Rulemaking. Resolved: That the Department of Health and Human 
Services shall adopt rules to implement the provisions of this resolve. Rules adopted 
pursuant to this section are routine teclmical rules as defined by the Maine Revised 
Statutes, Title 5, chapter 375, subchapter 2-A. 
SUMMARY 
This resolve directs the Department of Health and Human Services to establish and 
implement a 4-tiered capitated oral care system for children covered by MaineCare and 
SCHIP based on assigning each child's initial needs into one of 4 levels of care: 
diagnostic, preventive and disease management services; basic restorative care; advanced 
restorative care; and catastrophic care.