Current through 2024-38, September 18, 2024
A. The Department of Human Services will
provide funding through this Program, to the extent allocated by the
Legislature, to encourage the development or expansion of community-operated,
nonprofit oral health care programs, that serve persons who are uninsured,
underinsured, or underserved for oral health care, and that serve persons whose
care is covered by Medicaid, in order to develop access to quality oral health
services for such persons, and to provide oral health case management and
community oral health education services. This Program will also provide funds
to subsidize the provision of oral health care to persons whose gross income is
below 200% of the nonfarm official federal poverty guidelines and who are
without insurance for that care.
B.
Funding Mechanism
The Department will make funds available to eligible entities
utilizing an RFP (Request for Proposal) process and/or its standard grants and
contracts procedures.
C.
Limitations
A program may not receive funds through the Dental Services
Development and Subsidy Program to serve more than three (3) contiguous dental
care analysis areas as defined by the Department of Human Services.
D. Discrimination
Any oral health care program receiving funds under this
chapter may not discriminate among patients based upon payment source. That is,
services may not be denied to a potential patient because of the source of
payment available to that individual. A program may set limits for availability
of its sliding fee using the program's defined service area.
E. Subsidy
1. The intent of the subsidy is to assist
qualified oral health programs in maintaining fee structures that keep services
financially accessible to potential patients.
2. The Department will make subsidies
available to assist qualified entities in providing oral health services to
persons without insurance in accordance with other requirements of 22 MRSA
§2127(2) (B). Subsidies will be subject to program compliance with a
protocol and/or requirements outlined in the RFP or other procurement process
issued by the Department for the allocation of funds available for this
subsidy. The subsidy paid to the oral health program by the Department will be
based on the difference between the payment made by the patient under the
program's sliding fee scale arrangement and the Medicaid rate for the dental
service(s) provided.
3. Sliding Fee
Scale
Any RFP or other procurement process issued by the Department
for the allocation of funds available for the subsidy will include the
Department's standards for evaluating the acceptability of sliding fee scales
used by entities eligible to receive subsidies through the Dental Services
Development and Subsidy Program. Any such standards will incorporate the
following principles:
a. A sliding fee
scale must be available to individuals who evidence an income below 200% of the
poverty level as established annually by the U.S. Department of Health &
Human Services.
b. The oral health
care program must have an internal process to evaluate and adjust its sliding
fee scale annually, within 90 days of the issuance of new poverty level
guidelines as established annually by the U.S. Department of Health & Human
Services and published in the Federal Register.
c. Persons with gross income of less that
100% of the nonfarm official federal poverty guidelines may not be required to
pay more than a nominal fee. For purposes of this program nominal fee has the
same meaning as it has under Medicaid law.
d. In determining an individual's eligibility
for its sliding fee scale, an entity receiving a subsidy funded through the
Dental Services Development and Subsidy Program will:
1 Permit the deduction of ordinary and
necessary business-related expenses for those who are self-employed.
2 Use current income to determine financial
eligibility when evidence exists supporting a change in income that is the most
accurate reflection of the family/individual's financial status.
F. Vouchers
for Dental Services
An oral health program receiving a subsidy funded through the
Dental Services Development and Subsidy Program may develop and use a voucher
system to reimburse private practice dentists for dental services provided for
its patients.
1. Vouchers may be used
only when:
a. A program chooses to provide
specialized oral health services to its patients but can not provide such
services directly (that is, on-site and by its own staff);
b. The patient cannot be served by the
program with reasonable promptness, or
c. The distance to the program location or
transportation problems make access to the program difficult for the
patient.
2. A voucher
payment made to a private practice dentist may not exceed the difference
between the patient's obligation, if any, under the program's sliding fee scale
and the rate that Medicaid would reimburse a private practice dentist for that
same service, except as indicated in part 4 of this subsection.
3. If no fee has been established in the
Medicaid program for the particular service for which a voucher payment is
made, the Department shall establish a fee.
a. Fees established in this manner will be
based on the rate paid by Medicaid for similar services, using the same
method(s) utilized by Medicaid to calculate rates for dental
services.
b. Fees established in
this manner will be communicated by the Department to any/all other oral health
services programs receiving funds that can be used for voucher
payments.
4. A voucher
payment may generally only be made to a private practice dentist who is
enrolled to provide services in the Medicaid Program. Exceptions may be made as
defined by the Department of Human Services through the conditions of the
specific funding category or program award.
5. An oral health care program may place
reasonable restrictions on a voucher system it establishes if those
restrictions are consistent with the purposes of the Dental Services
Development and Subsidy Program as described in Section II-A.
G. Matching Funds
Any entity seeking support through the Dental Services
Development and Subsidy Program for the start-up or expansion of a
community-based oral health program will be required by the Department to raise
matching funds, which may include in-kind support, sufficient to demonstrate
community support.
H.
Eligible Entities
Any entity receiving funds through the Dental Services
Development and Subsidy Programs must meet the requirements as outlined in 22
MRSA §2127 for population to be served, for governance, and for the use of
the funds.
