An Act To Improve Dental Health for Maine Children and Adults with Low Incomes
Maine Legislature, Session 130, LD 0072
Committee: Health and Human Services
Sponsors: BROOKS, CLAXTON, CLOUTIER, CRAVEN, HYMANSON, TEPLER, LIBBY, MOORE
Amends: 22 MRSA §3174-F, 22 MRSA §3174-U

Legislative Document
No. 72
H.P. 38
House of Representatives, January 13, 2021
An Act To Improve Dental Health for Maine Children and Adults 
with Low Incomes
Received by the Clerk of the House on January 11, 2021.  Referred to the Committee on 
Health and Human Services pursuant to Joint Rule 308.2 and ordered printed pursuant to Joint 
Rule 401.
ROBERT B. HUNT
Clerk
Presented by Representative BROOKS of Lewiston.
Cosponsored by Senator CLAXTON of Androscoggin and
Representatives: CLOUTIER of Lewiston, CRAVEN of Lewiston, HYMANSON of York, 
TEPLER of Topsham, Senators: LIBBY of Androscoggin, MOORE of Washington.
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 2021-22 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 dental 
incentive payment program is measured.
C.  Beginning in fiscal year 2023-24 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, 2022, 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, 2021 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 rewarding 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.  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, 2022, 
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.