Date posted:
Attachment(s):
Notice of MaineCare Reimbursement Methodology Change
AGENCY: Department of Health and Human Services, Office of MaineCare Services
SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 25 – Dental Services and Reimbursement
NATURE OF PROPOSED CHANGES: The Department plans to submit a state plan amendment (SPA) to:
- Amend the reimbursement methodology for deep sedation and general anesthesia for dental services to be equal to 67% of the commercial median benchmark;
- Continue the temporary reimbursement rate amounts for tooth extractions; and
- Continue the temporary reimbursement rate amounts for dental caries arresting medicament application.
All changes will be in effect until June 30, 2028, or until a dental rate determination is conducted and implemented, whichever is sooner.
REASON FOR PROPOSED CHANGES: All changes are pursuant to Maine Resolve 2025, Ch. 164, Resolve, to Improve Dental Care Access by Modifying the MaineCare Reimbursement Methodology for the Provision of Certain Dental Services
ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will cost $616,474 in federal fiscal year 2026 which includes $395,420 in federal funds and $221,054 in state funds and will cost $2,465,899 in federal fiscal year 2027 which includes $1,566,803 in federal funds and $899,096 in state funds.
ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926.
CONTACT INFORMATION
FOR RECEIPT OF COMMENTS: Kristin Merrill
AGENCY NAME: Office of MaineCare Services
ADDRESS: 109 Capitol Street, 11 State House Station
Augusta, Maine 04333-0011
TELEPHONE: (207) 624-4006 FAX: (207) 287-6106
TTY: 711 Maine Relay (Deaf or Hard of Hearing)
See https://www.maine.gov/dhhs/about/rulemaking for rules and related rulemaking documents.
State Plan Amendment
Office: MaineCare Services
Email: kristin.merrill@mane.gov
Comment deadline:
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