Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 295 - DENTAL SERVICES DEVELOPMENT AND SUBSIDY PROGRAMS › Section 144-295-II - THE DENTAL SERVICES DEVELOPMENT AND SUBSIDY PROGRAM

Current through 2024-29, July 17, 2024
A. The Department of Human Services will
				provide funding through this Program, to the extent allocated by the
				Legislature, to encourage the development or expansion of community-operated,
				nonprofit oral health care programs, that serve persons who are uninsured,
				underinsured, or underserved for oral health care, and that serve persons whose
				care is covered by Medicaid, in order to develop access to quality oral health
				services for such persons, and to provide oral health case management and
				community oral health education services. This Program will also provide funds
				to subsidize the provision of oral health care to persons whose gross income is
				below 200% of the nonfarm official federal poverty guidelines and who are
				without insurance for that care.
B.
				Funding Mechanism
The Department will make funds available to eligible entities
				  utilizing an RFP (Request for Proposal) process and/or its standard grants and
				  contracts procedures.
C.
				Limitations
A program may not receive funds through the Dental Services
				  Development and Subsidy Program to serve more than three (3) contiguous dental
				  care analysis areas as defined by the Department of Human Services.
D. Discrimination
Any oral health care program receiving funds under this
				  chapter may not discriminate among patients based upon payment source. That is,
				  services may not be denied to a potential patient because of the source of
				  payment available to that individual. A program may set limits for availability
				  of its sliding fee using the program's defined service area.
E. Subsidy
1. The intent of the subsidy is to assist
				qualified oral health programs in maintaining fee structures that keep services
				financially accessible to potential patients.
2. The Department will make subsidies
				available to assist qualified entities in providing oral health services to
				persons without insurance in accordance with other requirements of 22 MRSA
				§2127(2) (B). Subsidies will be subject to program compliance with a
				protocol and/or requirements outlined in the RFP or other procurement process
				issued by the Department for the allocation of funds available for this
				subsidy. The subsidy paid to the oral health program by the Department will be
				based on the difference between the payment made by the patient under the
				program's sliding fee scale arrangement and the Medicaid rate for the dental
				service(s) provided.
3. Sliding Fee
				Scale
Any RFP or other procurement process issued by the Department
				  for the allocation of funds available for the subsidy will include the
				  Department's standards for evaluating the acceptability of sliding fee scales
				  used by entities eligible to receive subsidies through the Dental Services
				  Development and Subsidy Program. Any such standards will incorporate the
				  following principles:
a. A sliding fee
				scale must be available to individuals who evidence an income below 200% of the
				poverty level as established annually by the U.S. Department of Health &
				Human Services.
b. The oral health
				care program must have an internal process to evaluate and adjust its sliding
				fee scale annually, within 90 days of the issuance of new poverty level
				guidelines as established annually by the U.S. Department of Health & Human
				Services and published in the Federal Register.
c. Persons with gross income of less that
				100% of the nonfarm official federal poverty guidelines may not be required to
				pay more than a nominal fee. For purposes of this program nominal fee has the
				same meaning as it has under Medicaid law.
d. In determining an individual's eligibility
				for its sliding fee scale, an entity receiving a subsidy funded through the
				Dental Services Development and Subsidy Program will:
1 Permit the deduction of ordinary and
				necessary business-related expenses for those who are self-employed.
2 Use current income to determine financial
				eligibility when evidence exists supporting a change in income that is the most
				accurate reflection of the family/individual's financial status.