Resolve, Directing the Department of Health and Human Services To Implement an Oral Health Capitated Care System for Children Covered by MaineCare and the Children's Health Insurance Program

Preamble. Whereas,  there is a perennial shortage of dental services for children covered by MaineCare and the State Children's Health Insurance Program, known as SCHIP; and

Whereas,  tooth decay is the most common chronic disease of childhood, 5 times more frequent than asthma; and

Whereas,  children in lower-income homes consistently suffer more tooth decay, yet children with the greatest need have the least access to care; and

Whereas,  children in lower-income homes are predisposed to dental disease because of dietary, behavioral and socio-environmental factors that overwhelm the limited preventive interventions available to them; and

Whereas,  a major contributor to the overuse of emergency rooms is the treatment of acute and painful dental conditions in children; and

Whereas,  pain from untreated dental caries is a major contributor to poor school performance; and

Whereas,  there are few dentists willing or able to provide dental care under MaineCare on a fee-for-service basis; and

Whereas,  needy children are unable to find a nearby dental medical office from which to receive continuity of care and follow-up for acute and preventive services; and

Whereas,  the complexity of the state payment system is a factor in discouraging dentists from participating in care funded by MaineCare and SCHIP; and

Whereas,  excessive travel distances and the opportunity for only sporadic dental care contributes to missed appointments, loss of continuity in care and substantial inconvenience to cooperating dental practices; and

Whereas,  a properly structured capitated care system would relieve the system of many of its present deficiencies, expand opportunities for continuous and effective care, and reduce overuse of emergency rooms; now, therefore, be it

Sec. 1. Capitated care system. Resolved: That the Department of Health and Human Services shall establish and implement a 4-tiered capitated oral care system for children covered by MaineCare and SCHIP as described in the report entitled "Pediatric Dental Care in CHIP and Medicaid: Paying for What Kids Need; Getting Value for State Payments" published in July 1999 by the Milbank Memorial Fund; and be it further

Sec. 2. Levels of care. Resolved: That the capitated oral care system under section 1 be based on assigning each child's initial needs into one of 4 levels of care:

1. Diagnostic, preventive and disease management services;

2. Basic restorative care;

3. Advanced restorative care; and

4. Catastrophic care; and be it further

Sec. 3. Payment. Resolved: That periodic payments be established for each level of care under section 2 in order to relieve dental practices of the burden of filing fee-for-service forms; and be it further

Sec. 4. Rulemaking. Resolved: That the Department of Health and Human Services shall adopt rules to implement the provisions of this resolve. Rules adopted pursuant to this section are routine technical rules as defined by the Maine Revised Statutes, Title 5, chapter 375, subchapter 2-A.

summary

This resolve directs the Department of Health and Human Services to establish and implement a 4-tiered capitated oral care system for children covered by MaineCare and SCHIP based on assigning each child's initial needs into one of 4 levels of care: diagnostic, preventive and disease management services; basic restorative care; advanced restorative care; and catastrophic care.