An Act To Expand Adult Dental Health Insurance Coverage
Maine Legislature, Session 129, LD 0519
Committee: Health and Human Services
Sponsors: BROOKS, BERRY, STANLEY
Amends: 22 MRSA §3174-F, 24 MRSA §2317-B, 24-A MRSA §4320-L, 32 MRSA §18353

Legislative Document
No. 519
H.P. 376
House of Representatives, January 31, 2019
An Act To Expand Adult Dental Health Insurance Coverage
Reference to the Committee on Health and Human Services suggested and ordered printed.
ROBERT B. HUNT
Clerk
Presented by Representative BROOKS of Lewiston.
Cosponsored by Representatives: BERRY of Bowdoinham, STANLEY of Medway.
Be it enacted by the People of the State of Maine as follows:
PART A
Sec. A-1.  22 MRSA §3174-F, as amended by PL 1997, c. 159, §§1 and 2 and PL 
2003, c. 689, Pt. B, §6, is further amended to read:
§3174-F.  Coverage for adult dental services
1.  Coverage provided.  The Department of Health and Human Services shall 
provide comprehensive 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: eligible for the MaineCare program.
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 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.
2.  Demonstration projects.  The department shall promptly take all appropriate 
steps to obtain necessary waivers, if necessary, from the federal Department of Health 
and Human Services that enable the State to provide within the limits of available funds, 
on a demonstration basis, comprehensive dental services to Medicaid-eligible individuals 
who are 21 years of age or older in public or private, nonprofit clinic settings.  The 
department's goal in pursuing these waivers or demonstration projects not requiring 
waivers is to determine whether providing services in these settings promotes cost 
effectiveness or efficiency or promotes other objectives of the federal Social Security 
Act, Title XIX.
By January 15, 1992, the department shall report to the joint standing committee of the 
Legislature having jurisdiction over health matters regarding the progress of its efforts 
under this subsection.  The report must outline the department's progress and recommend 
further action required in pursuit of any demonstration project under this subsection.
3.  Comprehensive dental services defined.  For the purposes of this section, 
"comprehensive dental services" means any services necessary to maintain oral health 
and prevent disease, restore oral structures to health and function and treat emergency 
conditions.
Sec. A-2.  Department of Health and Human Services to apply for 
approval.  Before January 1, 2020, the Department of Health and Human Services may 
apply to the federal Department of Health and Human Services, Centers for Medicare and 
Medicaid Services for any necessary waivers or state plan amendments to reimburse for 
comprehensive dental services as required in the Maine Revised Statutes, Title 22, section 
3174-F.
PART B
Sec. B-1.  24 MRSA §2317-B, sub-§20, as amended by PL 2013, c. 575, §3, is 
further amended to read:
20.  Title 24-A, chapters 68 and 68-A.  Long-term care insurance, nursing home 
care insurance and home health care insurance, Title 24-A, chapters 68 and 68-A; and
Sec. B-2.  24 MRSA §2317-B, sub-§21, as enacted by PL 2013, c. 575, §4 and 
affected by §10, is further amended to read:
21.  Title 24-A, sections 2765-A and 2847-U.  The practice of dental hygiene by a 
dental hygiene therapist, Title 24-A, sections 2765-A and 2847-U.; and
Sec. B-3.  24 MRSA §2317-B, sub-§22 is enacted to read:
22.  Title 24-A, section 4320-L.  Coverage for comprehensive dental services, Title 
24-A, section 4320-L.
Sec. B-4.  24-A MRSA §4320-L is enacted to read:
§4320-L.  Coverage for comprehensive dental services
1.  Definition.  As used in this section, unless the context otherwise indicates, 
"comprehensive dental services" means any services necessary to maintain oral health 
and prevent disease, restore oral structures to health and function and treat emergency 
conditions.
2.  Required coverage.  A carrier offering a health plan in this State shall provide 
coverage for comprehensive dental services.
3.  Limits; coinsurance; deductibles.  A health plan that provides coverage for the 
services required by this section may contain provisions for maximum benefits and 
coinsurance and reasonable limitations, deductibles and exclusions to the extent that these 
provisions are not inconsistent with the requirements of this section.
4.  Coordination of benefits with dental insurance.  If an enrollee eligible for 
coverage under this section is also eligible for coverage under a dental insurance policy or 
contract, the insurer providing dental insurance is the primary payer responsible for 
charges under subsection 2 and the carrier is the secondary payer.
5.  Application.  The requirements of this section apply to all policies, contracts and 
certificates executed, delivered, issued for delivery, continued or renewed in this State on 
or after January 1, 2020. For purposes of this section, all contracts are deemed to be 
renewed no later than the next yearly anniversary of the contract date.
PART C
Sec. C-1.  32 MRSA §18353 is enacted to read:
§18353.  Charity care or financial assistance to persons without access to 
comprehensive dental services
Beginning on or after January 1, 2020, as a condition of renewal of a license to 
practice, a dentist must demonstrate that the dentist has adopted a policy to provide 
charity care or financial assistance to a person without access to comprehensive dental 
services under the MaineCare program or health or dental insurance.  The board may 
prescribe by rule reasonable guidelines for policies to be adopted and implemented by a 
dentist with respect to the provision of comprehensive dental services through charity 
care or financial assistance activities.  Rules adopted pursuant to this section are routine 
technical rules as defined in Title 5, chapter 375, subchapter 2-A.
SUMMARY
This bill expands the availability of coverage for comprehensive dental services.
Part A of the bill broadens the scope of required coverage under the MaineCare 
program for adults. Under current law, coverage for adults over age 21 is limited to 
certain services.
Part B of the bill requires health insurance carriers to provide coverage for 
comprehensive dental services. Part B applies to policies and contracts issued or renewed 
on or after January 1, 2020.
Part C of the bill requires dentists as a condition of license renewal to adopt and 
implement policies to provide comprehensive dental services through charity care or 
financial assistance to persons without MaineCare coverage or private health insurance.  
Part C also authorizes the Board of Dental Practice to adopt rules relating to this 
requirement.