Resolve, Directing the Department of Health and Human Services To Adjust Reimbursement Rates for Dental Services under the MaineCare Program
Maine Legislature, Session 127, LD 0860
Committee Amendment CA_A_S235 (Senate)

COMMITTEE AMENDMENT" A" to S.P. 304, L.D. 860, "Resolve, Directing the 
Department of Health and Human Services To Adjust Reimbursement Rates for Dental 
Services under the MaineCare Program" 
Amend the resolve by striking out the title and substituting the following: 
'Resolve, To Adjust Reimbursement Rates for Dental Services and Improve Access 
to Dental Care under the MaineCare Program' 
Amend the resolve by striking out everything after the title and before the summary 
and inserting the following: 
'Sec. 1. Reimbursement rate rules. Resolved: That the Department of Health 
and Human Services shall annually review and incrementally adjust equally in each of the 
next 5 years following the effective date of this resolve the reimbursement rates under the 
MaineCare program for dental codes D0120, D0140, D0150, D0220, D0272, D0330, 
Dl110, D1120, Dl208, D1351, D2140, D2150, D2160, D2330, D2331, D2332, D2391, 
D2392, D2393, D3330, D7140 and D7210 until the reimbursement rates reflect the 10th 
percentile of the fees for the New England region in the most recent "Survey of Dental 
Fees" published by the American Dental Association. After the reimbursement rates 
. reach the 10th percentile, the department shall amend its rule Chapter 101: MaineCare 
Benefits Manual to require that the rates be adjusted annually for inflation in accordance 
with the United States Department of Labor, Bureau of Labor Statistics Consumer Price 
fudex. Rules adopted pursuant to this section are routine technical rules pursuant to the 
Maine Revised Statutes, Title 5, chapter 375, subchapter 2-A; and be it further 
Sec. 2. Dental services for pregnant women. Resolved: That, by January 1, 
2016, the Department of HeaIth and Human Services shall amend its rule Chapter 101: 
MaineCare Benefits Manual, Chapter II, Section 25 to cover diagnostic and preventive 
services to pregnant women and postpartum women for one year after the birth to 
ameliorate conditions or reduce complications that exist because of or are exacerbated by 
the pregnancy or that, if left untreated, could adversely affect fetal or child development; 
and be it further 
COMMITTEE AMENDMENT 
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6, 
COMMITTEE AMENDMENT" f1 "to S.P. 304, L.D. 860 
Sec. 3. 
Dental services to avoid more costly medical or dental care. 
Resolved: That, by January 1, 2016, the Department of Health and Human Services 
shall amend its rule Chapter 101: MaineCare Benefits Manual, Chapter II, Section 25 to 
cover adult dental services provided to avoid more costly medical or dental care; and be it 
further 
Sec. 4. Notice to MaineCare members and providers of dental services. 
Resolved: 
That the Department of Health and Human Services shall provide to 
MaineCare members and providers of dental services notice of changes in benefits to 
MaineCare members pursuant to rule changes under sections 2 and 3; and be it further 
Sec. 5. Stakeholder group. Resolved: That prior to adopting rules pursuant to 
section 3, the Department of Health and Human Services shall convene a stakeholder 
group to identify dental services necessary to avoid more costly medical or dental care. 
The stakeholder group must consist of members representing dentists, federally qualified 
health centers, dental hygienists, hospitals and a clinical health system with experience in 
adult oral health initiatives; and be it further 
Sec. 6. 
Appropriations and allocations. Resolved: 
That the following 
appropriations and allocations are made. 
HEALTH AND HUMAN SERVICES, DEPARTMENT OF (FORMERLY DHS) 
Medical Care ~ Payments to Providers 0147 
Initiative: Provides funding to incrementally adjust the MaineCare reimbursement rates 
for certain dental services annually over the next 5 years until the rates reach the 10th 
percentile of the fees for the New England region. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
FEDERAL EXPENDITURES FUND 
All Other 
FEDERAL EXPENDITURES FUND TOTAL 
2015-16 
$839,452 
$839,452 
2015-16 
$1,409,281 
$1,409,281 
2016-17 
$2,238,539 
$2,238,539 
2016-17 
$3,758,083 
$3,758,083 
Medical Care - Payments to Providers 0147 
Initiative: Provides funding to add restorative, diagnostic and preventive dental services 
to pregnant women and postpartum women for one year after delivery. 
COMMITTEE AMENDMENT 
COM1vlITTEE AMENDMENT" A "to S.P. 304, L.D. 860 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
FEDERAL EXPENDITURES FUND 
All Other 
FEDERAL EXPENDITURES FUND TOTAL 
Office for Family Independence Z020 
2015-16 
$301,113 
$301,113 
2015-16 
$505,511 
$505,511 
2016-17 
$602,225 
$602,225 
2016-17 
$1,011,023 
$1,011,023 
fuitiative: Provides funding for the automated client eligibility system changes, testing 
and oversight to add restorative, diagnostic and preventive dental services to pregnant 
women and postpartum women for one year after delivery. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
OTHER SPECIAL REVENUE FUNDS 
All Other 
OTHER SPECIAL REVENUE FUNDS TOTAL 
Office of MaineCare Services 0129 
2015-16 
$5,600 
$5,600 
2015-16 
$5,600 
$5,600 
2016-17 
$0 
$0 
2016-17 
$0 
$0 
fuitiative: Provides funding for the Maine integrated health management solution 
changes, testing and oversight to add restorative, diagnostic and preventive dental 
services to pregnant women and postpartum women for one year after delivery. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
FEDERAL EXPENDITURES FUND 
All Other 
FEDERAL EXPENDITURES FUND TOTAL 
2015-16 
$41,556 
$41,556 
2015-16 
$124,667 
$124,667 
COMMITTEE AMENDMENT 
2016-17 
$0 
$0 
2016-17 
$0 
$0 
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COMMITTEE AMENDMENT" A "to S.P. 304, L.D. 860 
HEALTH AND HUMAN SERVICES, 
DEPARTMENT OF (FORMERLY DRS) 
DEPARTMENT TOTALS 
GENERAL FUND 
FEDERAL EXPENDITURES FUND 
OTHER SPECIAL REVENUE FUNDS 
DEPARTMENT TOTAL-ALL FUNDS 
SUMMARY 
2015-16 
$1,187,721 
$2,039,459 
$5,600 
$3,232,780 
2016-17 
$2,840,764 
$4,769,106 
$0 
$7,609,870 
This amendment is the majority report of the committee. It clarifies that increases to 
reimbursement rates of the dental codes in the resolve are to be made in 5 equal increases. 
The amendment requires the Department of Health and Human Services to amend the 
rules under Chapter 101: MaineCare Benefits Manual, Chapter II, Section 25 to cover 
diagnostic and preventive services to pregnant women and postpartum women and dental 
services necessary to avoid more costly medical or dental care as identified by a 
stakeholder group. It requires the Department of Health and Human Services to provide 
information concerning adult dental benefits to adult MaineCare members and providers. 
It requires the department to adopt rules by January 1, 2016 relating to dental coverage 
for pregnant women and postpartum women and for services provided to avoid more 
costly medical or dental care. 
The amendment also adds an appropriations and 
allocations section. The amendment also changes the title and adds a fiscal note. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Revised: 06105/15 
;:b/ac:.. 
127th lVIAINE LEGISLATURE 
LD 860 
LR 1699(02) 
Resolve, Directing the Department of Health and Human Services To Adjust Reimbursement Rates 
for Dental Services under the MaineCare Program 
Fiscal Note for Bill as Amended by Committee Amendment ''Pf' (s -,'). ~ 5 ") 
Committee: Health and Human Services 
Net Cost (Savings) 
General Fund 
Appropriations/ AlIo cations 
General Fund 
Federal Expenditures Fund 
Other Special Revenue Funds 
Revenue 
Federal Expenditures Fund 
Other Special Revenue Funds 
Fiscal Detail and Notes 
Fiscal Note Required: Yes 
Fiscal Note 
FY 2015-16 
$1,187,721 
$1,187,721 
$2,039,459 
$5,600 
$2,039,459 
$5,600 
FY 2016-17 
$2,840,764 
$2,840,764 
$4,769,106 
$0 
$4,769,106 
$0 
Projections 
FY 2017-18 
$3,960,033 
$3,960,033 
$6,648,148 
$0 
$6,648,148 
$0 
Projections 
FY 2018-19 
$5,079,303 
$5,079,303 
$8,527,189 
$0 
$8,527,189 
$0 
The bill includes General Fund appropriations to the Department of Health and Human Services (DHHS) of 
$1,187,721 in fiscal year 2015-16 and $2,840,764 in fiscal year 2016-17 to incrementally adjust the MaineCare 
reimbursement rates for certain dental services annually over the next 5 years until the rates reach the 10th percentile 
of the fees for the New England region in the most recent "Survey of Dental Fees" published by the American Dental 
Association, to add restorative, diagnostic and preventive dental services to pregnant and postpmillm women for one 
year after delivery, and to cover Automated Client Eligibility System (ACES) and Maine Integrated Health 
Managment Solution changes, testing and Office ofInformation Technology oversight. Federal Expenditures Fund 
allocations will also be required for the FMAP match. An Other Special Revenue Funds allocation is also included in 
fiscal year 2015-16 to allow expenditure ofDHHS allocation plan revenue received for ACES changes. 
LR1699(02) - Fiscal Note - Page 1 of 1