MaineCare Notice of Agency Rule-making Proposal, MaineCare Benefits Manual, Chapter II, Section 25, Dental Services and Reimbursement Methodology
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 Rule-making Proposal. 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 Proposal
AGENCY: Department of Health and Human Services, MaineCare Services, Division of Policy
CHAPTER NUMBER AND TITLE: 10-144 C.M.R., Chapter 101, MaineCare Benefits Manual, Chapter II, Section 25, Dental Services and Reimbursement Methodology
PROPOSED RULE NUMBER:
CONCISE SUMMARY:
The Department proposes to amend 10-144 CMR ch. 101, MaineCare Benefits Manual (the “MBM”) Chapter II, Section 25 Dental Services and Reimbursement Methodology, specifically Section 25.06 Reimbursement Methodology. On July 1, 2024, the Department enacted changes to this policy through emergency rulemaking pursuant to Title 5, M.R.S. §8054.
This proposed rulemaking seeks to make permanent the updates in the reimbursement methodology described in Section 25.06(A). In accordance with 22 M.R.S. §3173-J(2), the Department provided notice of its initiation of the process to update the benchmarked rates for dental services to the most current year of data for the payer source 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 states’ Medicaid dental service rates. The result of this process to update the benchmarked rates for dental services was that the updated benchmarks 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 updating efforts and draft rates on April 12, 2024, and provided opportunities for stakeholder input and comment.
In addition, to ensure reimbursement is not decreased, and in an effort to ensure continued access to services, this rulemaking will also amend Section 25.06(B)3 to extend the temporary exceptions for services defined as extraction of an erupted or exposed root and medicament application for an additional two years, through June 30, 2026. This change enables the Department to maintain the rates for these services in an effort to prevent further loss of enrolled dental providers and to ensure access to medically necessary services for MaineCare members.
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
STATUTORY AUTHORITY: 22 M.R.S. §§ 42, 3173, 3173-J(D)
PUBLIC HEARING:
Date and Time: 12:00 pm; Monday, August 5, 2024
Location: 109 Capitol St, Augusta, ME; Conference Room Androscoggin
The public hearing will be held both in-person and via zoom.
Zoom Meeting link: https://mainestate.zoom.us/j/81848373897?pwd=oaXkwkgaTJ8buAbdZYvbdXz3Kg1NbS.1
Meeting ID:818 4837 3897
Passcode: 65649240
Some devices may require downloading a free app from Zoom prior to joining the public hearing event. The Department requests that any individual requiring special arrangements to participate in the hearing contact the person listed for this filing 5 days in advance of the hearing.
DEADLINE FOR COMMENTS: Comments must be received by 11:59 PM on Thursday, August 15, 2024.
AGENCY CONTACT PERSON: Catherine Coolidge, Comprehensive Health Planner II
AGENCY NAME: MaineCare Services
ADDRESS: 109 Capitol Street, 11 State House Station
Augusta, Maine 04333-0011
TELEPHONE:207-624- 4082 FAX: (207) 287-1864
TTY: 711 (Deaf or Hard of Hearing)
IMPACT ON MUNICIPALITIES OR COUNTIES (if any): The Department anticipates that this rulemaking will not have any impact on municipalities or counties.
CONTACT PERSON FOR SMALL BUSINESS INFORMATION (if different): N/A
STATUTORY AUTHORITY FOR THIS RULE: 22 M.R.S. §§ 42, 3173; 22 M.R.S. 3173-J(D)
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