An Act To Improve Dental Health for Maine Children and Adults with Low Incomes
Maine Legislature, Session 129, LD 1453
Committee: Health and Human Services
Sponsors: GATTINE, BREEN, CRAVEN, HYMANSON, JORGENSEN, MARTIN, TEPLER, MOORE
Amends: 22 MRSA §3174-F, 22 MRSA §3174-U

Legislative Document
No. 1453
H.P. 1065
House of Representatives, April 2, 2019
An Act To Improve Dental Health for Maine Children and Adults 
with Low Incomes
Reference to the Committee on Health and Human Services suggested and ordered printed.
ROBERT B. HUNT
Clerk
Presented by Representative GATTINE of Westbrook.
Cosponsored by Senator BREEN of Cumberland and
Representatives: CRAVEN of Lewiston, HYMANSON of York, JORGENSEN of Portland, 
MARTIN of Eagle Lake, TEPLER of Topsham, Senators: MOORE of Washington, 
SANBORN, L. of Cumberland.
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Sec. 2.  22 MRSA §3174-U, as enacted by PL 1999, c. 301, §1, is repealed and the 
following enacted in its place:
§3174-U.  Medicaid reimbursement for dental services; dental incentive payment 
program
1.  Annual reimbursement review.  The department shall conduct an annual review 
of the adequacy of reimbursement rates for dental services for dentists who provide care 
for a disproportionate number of patients whose care is reimbursed through the federal 
Medicaid program and the Cub Care program established in section 3174-T.  By 
December 31, 1999, the department shall report to the joint standing committee of the 
Legislature having jurisdiction over health and human services matters on the results of 
the study, including the costs in General Fund and other money.
2.  Dental incentive payment program to expand access to dental services for 
MaineCare members.  For the purpose of increasing access to dental care for children 
and adults receiving MaineCare services, a dental incentive payment program is 
established and administered by the department.
A.  The department shall develop the dental incentive payment program by rule.  The 
dental incentive payment program must reward dentists who significantly increase 
the number of MaineCare members that enroll as patients or who provide dental 
services to a disproportionate number of MaineCare members.  For fiscal year 2019-
and annually thereafter, the department shall provide $1,000,000 in incentive 
funding to dentists.  The $1,000,000 in incentive funding can include reimbursements 
to dentists through the federal Medicaid program and the Cub Care program 
established in section 3174-T.
B.  Annually, the department shall establish a dental access benchmark against which 
progress in increasing access to dental care for MaineCare members through the 
incentive payment program is measured.
C.  Beginning in fiscal year 2021-22 and annually thereafter, the department shall 
review the effectiveness of the dental incentive payment program in meeting the 
benchmarks established pursuant to paragraph B.  If the program fails to meet the 
established benchmarks, the department shall:
(1)  Convene a working group to recommend improvements to the dental 
incentive payment program that will better ensure effectiveness in increasing 
access to dental care for MaineCare members.  The working group must consist 
of members representing MaineCare members, a statewide dental association, a 
statewide dental hygienists association, a statewide primary care association and 
other persons with policy expertise or experience in promoting access to dental 
care for individuals with low incomes; and
(2)  Adopt rules to restructure the dental incentive payment program.  When 
adopting rules, the department shall consider the recommendations of the 
working group pursuant to subparagraph (1) and the department's experience with 
the dental incentive payment program and the experience of other states with 
similar programs.
D.  The department shall adopt rules to implement this section.  Rules adopted 
pursuant to this paragraph are routine technical rules as defined in Title 5, chapter 
375, subchapter 2-A.
Sec. 3.  Dental incentive payment program; rulemaking; working group.
1.  Rulemaking.  By January 1, 2020, the Department of Health and Human Services 
shall adopt an emergency rule to implement provisions of the Maine Revised Statutes, 
Title 22, section 3174-U, subsection 2.  When adopting rules, the department shall 
consider recommendations provided by a working group pursuant to subsection 2.
2.  Working group.  No later than October 1, 2019 and prior to adopting rules 
pursuant to subsection 1 to implement provisions of the Maine Revised Statutes, Title 22, 
section 3174-U, subsection 2, the Department of Health and Human Services shall 
convene a working group to make recommendations to the department for the design of a 
dental incentive payment program that will significantly increase the number of 
MaineCare members that become patients of dental providers or for dentists that provide 
dental services to a disproportionate number of MaineCare members.  The working group 
must consist of members representing MaineCare members, a statewide dental 
association, a statewide dental hygienists association, a statewide primary care 
association and other persons with policy expertise or experience in promoting access to 
dental care for individuals with low incomes.
Sec. 4.  Rulemaking; coverage for adult dental services.  By January 1, 2020, 
the department shall adopt routine technical rules as defined in the Maine Revised 
Statutes, Title 5, chapter 375, subchapter 2-A to implement the provisions of Title 22, 
section 3174-F, subsection 1.
SUMMARY
This bill adds access to 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 also establishes a dental incentive 
payment program for dentists to increase access to dental care for MaineCare members, 
including children, and requires the Department of Health and Human Services to 
convene a working group to make recommendations on the design of the program.  It 
provides for the establishment of benchmarks to measure the effectiveness of the dental 
incentive payment program over time.