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

Sep 25, 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 Rulemaking Adoption. You can access the complete rule at http://www.maine.gov/dhhs/oms/rules/index.shtml.

Notice of Agency Rule-making Adoption

AGENCY:  Department of Health and Human Services, MaineCare Services

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

ADOPTED RULE NUMBER:

CONCISE SUMMARY:  

The Department of Health and Human Services (“the Department”) adopts this rule to amend 10-144 CMR ch. 101, MaineCare Benefits Manual (the “MBM”) Chapter II, Section 25, Dental Services and Reimbursement Methodology.

On June 28, 2024, the Department adopted an emergency rule, pursuant to 5, M.R.S. §8054, that made 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.

The June 28, 2024 Emergency Rule expires on September 26, 2024.  This rulemaking makes permanent the three reimbursement methodology changes described above.  The changes to the two benchmarks ensure that reimbursement to Providers will not decrease. The Department conducted a review of data from the Maine Health Data Organization All Payer Claims Database as well as utilizing data from the other states’ Medicaid dental service rates. As a result, the Department concluded that updating the benchmarks would result in an estimated $2.2 million net reduction in reimbursement.  The extension for the methodology for Temporary Exceptions for services defined as extraction of an erupted or exposed root and medicament application will continue for another two years.  The Department will submit a State Plan Amendment to CMS to these changes and anticipates CMS approval of such. 

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

EFFECTIVE DATE:                      9/25/24

AGENCY CONTACT PERSON: Catherine Coolidge, Comprehensive Health Planner II

                                                     MaineCare Services

AGENCY NAME:                        Division of Policy

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

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