Section 144-295-II - THE DENTAL SERVICES DEVELOPMENT AND SUBSIDY PROGRAMA. 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, orc. 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.
10- 144 C.M.R. ch. 295, § II