Section 25 Dental Services Rulemaking Update 

Jun 29, 2022

MaineCare is expanding Dental Services to include coverage for adults, investing in reimbursement rates, and updating the entire policy to make it consistent with up-to-date evidence-based procedures and practices. These changes will take effect on July 1, 2022, by emergency rulemaking. Emergency rules have a maximum effective period of 90 days. The Department will propose a routine technical rule within 7 to 14 days of the emergency rule to make these changes permanent. 

More information on the draft benefit design and fee schedule can be found on MaineCare’s Projects and Initiatives page. A final Section 25 fee schedule and billing guidance will go live on HealthPAS on July 1, 2022. 

The proposed rule and the emergency rule will have different prior authorization requirements. The emergency rule that will be effective July 1, 2022, does not include certain prior authorization requirements for which there was not clear consensus from pre-rulemaking consultation with stakeholders and Department clinical resources. The proposed rule, which will go into effect in its adopted form no more than 90 days after the emergency rule, includes the full slate of prior authorization requirements the Department initially recommended in pre-rulemaking consultation, in alignment with standard practice by state Medicaid agencies nationally. Including these new requirements in the proposed rule allows for further public comment and Department deliberation in response to these comments to determine whether to adopt these new requirements in the final rule.  

The Department conducted extensive stakeholder engagement in the development of the new dental rule, and welcomes additional input through the public comment process. 

All rulemaking documents will be posted on MaineCare’s Policy and Rules page.