MaineCare Notice of Agency Emergency Rule-making Adoption, MaineCare Benefits Manual, Chapter II, Section 25, Dental Services and Reimbursement Methodology

Jul 02, 2024

The Division of Policy posts all proposed and recently adopted rules on MaineCare’s Policy and Rules webpage. This website keeps the rules on file until they are finalized and until the Secretary of State website is updated to reflect the changes. The MaineCare Benefits Manual is available on-line at the Secretary of State’s website.

Below, please find a MaineCare Notice of Agency Emergency Rulemaking Adoption. You can access the complete rule at http://www.maine.gov/dhhs/oms/rules/index.shtml.

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Notice of Agency Rule-making Adoption

AGENCY:  Department of Health and Human Services, Office of MaineCare Services

CHAPTER NUMBER AND TITLE:   10-144 C.M.R., Chapter 101, MaineCare Benefits Manual, Chapter II, Section 25, Dental Services and Reimbursement Methodology

ADOPTED RULE NUMBER:

CONCISE SUMMARY:  

The Department adopts this emergency rule, which amends 10-144 CMR ch 101, MaineCare Benefits Manual (the “MBM”) Chapter II, Section 25 Dental Services and Reimbursement Methodology.

This emergency rulemaking makes the following changes:

• Section 25.06(A)(1)(Commercial Median Benchmark): This benchmark will be “assessed” rather than “updated” every two years;
• Section 25.06(A)(2)(Medicaid State Average Benchmark): This benchmark will be “assessed” rather than “updated” every two years;
• Section 25.06(B)(3)(Temporary Exceptions): These exceptions are being extended from June 30, 2024 to June 30, 2026; and
• Section 25.03 on page 18 has been corrected to: Section 25.06.

Background:

The current rule requires the Department to update the Commercial Median Benchmark and the Medicaid State Average Benchmark every two years, and the updated Benchmarks were to take effect on July 1, 2024. In accordance with 22 M.R.S. §3173-J(2), the Department provided notice of the rate determination for dental services on October 13, 2023, by posting it on the MaineCare Rate System Reform website. The Department conducted a review of data from the Maine Health Data Organization All Payer claims Database as well as utilizing data from other State’s Medicaid dental service rates. The result of this rate determination process for dental services rates was that the rebasing or updating would result in an estimated $2.2 million dollar reduction in total reimbursement to providers of MaineCare dental services. In accordance with Title 22 M.R.S. §3173-J, the Department held an online public meeting to present the results of the benchmark rebasing efforts and draft rates on April 12, 2024, and provided opportunities for stakeholder input and comment. Comments are still under review and the Department has not yet issued a written response to the comments.

Findings of Emergency:

The Department finds that immediate adoption of this rule is necessary to avoid an immediate threat to public health, safety, or general welfare. The Department’s findings with respect to the existence of an emergency are as follows:

• Dental services are critical to the physical well-being of adults and children;
• A decrease in the MaineCare dental reimbursement could lead to a loss in dental providers, which could lead to a loss in access to dental services for MaineCare members;
• Maintaining the current MaineCare reimbursement rates mitigates this emergency; and
• Extending the temporary exceptions in Section 25.06(B)(3) ensures that reimbursement rates for those excepted services will not be reduced.

Pursuant to 5 M.R.S §8054, this emergency rule may be effective for up to ninety (90) days. The Department shall proceed with routine technical rulemaking to permanently adopt these rule changes.

http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

EFFECTIVE DATE:                            06/28/2024          

AGENCY CONTACT PERSON:       Catherine Coolidge, Comprehensive Health Planner

AGENCY NAME:                              MaineCare Services

ADDRESS:                                         109 Capitol Street, 11 State House Station

                                                            Augusta, Maine 04333-0011

EMAIL:                                              catherine.coolidge@maine.gov

TELEPHONE:          (207)-624-4082 FAX: (207) 287-6106