ࡱ> kmjq` QbjbjqPqP 7V::0j&&&&8^ jL&Fb-g'F$,HhJ~3FQ3FF\\\d\\\\ &<d\|F0F\KdK\K\ \3F3FXF&&& 10-144 DEPARTMENT OF HUMAN SERVICES BUREAU OF HEALTH Chapter 295: DENTAL SERVICES DEVELOPMENT AND SUBSIDY PROGRAMS SUMMARY: These rules define the terms and conditions for the participation in, and receipt of funding for the Dental Services Development and Subsidy Programs as authorized and funded by 22 MRSA 2127. PURPOSE: These rules address the requirements and conditions to which applicants for funds provided through this Section must respond in order to receive the funds. I. DEFINITIONS A. Unless otherwise indicated, the following terms shall have the following meanings specific to the Dental Services Development and Subsidy Program as authorized and funded by 22 MRSA 2127. B. Defined Terms Board: A board of directors or other governing body that has responsibility for the governance and administration of the oral health care program. In the case of a public entity, an advisory or steering committee that is identified to maintain oversight of the project or initiative receiving funds through this Section, and to represent it, through reporting mechanisms or other defined relationship(s) within that entitys structure, may serve as the governing body. Community groups in initial organizational stages that do not have formal boards or governing bodies are also eligible to receive funding through this Section when a steering committee that functions as a governing body is identified. Community-operated non-profit oral health care program: an oral health services program that is governed and administered by a public or private non-profit agency or entity, and that itself provides clinical oral health services. Coverage: the hours that an oral health program providing clinical services is open to provide those services. Dental Care Analysis Area: An area as defined by the Department of Human Services for the purpose of analyzing health service patterns and areas for federal and/or state designation as having a shortage of dentists to meet the needs of the population. Dental Services Development and Subsidy Program(s): The program(s) funded as a result of Title 22 MRSA, Section 2127. Department: The fb88 Department of Human Services Full-time equivalent dentist: a dentist who actively practices at least 40 hours per week serving the targeted population. In-kind support: Support for a program or initiative that is provided without charge but for which an equivalent dollar amount can be calculated and documented. Oral health services: Oral health services include clinical dental services, and community education and oral health education and case management services.  Clinical dental services includes the full range of dental services, including without limitation preventive, pediatric, restorative, surgical, orthodontic, endodontic, and prosthodontic services.  Community education and oral health education mean education, whether targeted to the community or to individuals, that is designed to encourage good oral hygiene practices that will contribute to preventing tooth decay and other oral diseases.  Oral health case management services are case management services that facilitate the provision of oral health care services to individuals. Patient screening process: A process to determine a potential patient s eligibility for any available and applicable programs, such as but not necessarily limited to Medicaid and Cub Care (fb88s State Childrens Health Insurance Program); and which also determines eligibility for services under a sliding fee scale, and which point on that scale will apply for each patient. Sliding scale or sliding fee scale: A fee scale that adjusts the fee charged to a patient according to the patients income and family size. Underserved areas or populations: Areas or populations in the State that have been designated as underserved for clinical oral health services as determined by the Commissioner of Human Services and as defined in rules adopted by the Department of Human Services. Such a designation may be limited to a geographic area of the State or to a specific practice location at the discretion of the Commissioner of Human Services. In the absence of a determination by the Commissioner of Human Services or the adoption of rules by the Department of Human Services defining an underserved population area, underserved population area means an area of the state designated by the federal government as a dental health professional shortage area. Voucher system: A system wherein payment to another dental provider is authorized by an oral health program to purchase for a patient a specified clinical dental service which otherwise could not be provided. Voucher payment: The payment that is made by the oral health program to another dental provider in order to reimburse that dental provider for the service(s) provided. II. THE DENTAL SERVICES DEVELOPMENT AND SUBSIDY PROGRAM 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 programs 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 programs 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 Departments 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 individuals 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/individuals 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 patients obligation, if any, under the programs 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. III. ALLOCATION OF FUNDS The allocation of funds for the Dental Services Development and Subsidy Programs is legislatively determined. The Department will make every attempt to convey these funds to eligible entities annually, or through multi-year contracts as appropriate. IV. WAIVER OF RULE xzE &jw0X\LPp5Y8})ab9PCQgQQQQQQQQQQQQQQQQQQQ÷÷hQyCJaJmHnHujhLoCJUaJhLoCJaJjhLoUUhLoCJOJQJaJhLo6CJaJhLohLoCJaJhLo5CJaJC%&9:xyzE F  p@ ^ p@ `^``  p@  p@  p@ &dP $ p@ a$QQ ijV p@ ^` p@ ^ p@  p@ `^``  !p@  p@ ```VXJLnp45|}'()a  p@  !p@  p@ `^`` p@  p@ ^ p@ ^` p@ ^`ab]!^!t!u!""+","""##t$u$$$,%$$ p@ p^p`$$ p@ ^ p@ ^ p@ `^`` p@  p@ `^``,%-%''''])^)**D+E+:,;,,,`-a-#. p@ ^` p@ @ ^@ ` p@ p^p` p@ p^p` p@ ^#.$.E.F.1/2/W/X/00R0S0002222h3i34 p@ p^p` p@ @ ^@ ` p@ `^`` p@  !p@ 44:5;5-6.6A6B6n7o777d8e8f888{9|9}99 p@ 0^`0 p@ `^`` p@ ^ p@ p^p` p@ 99PPPPQ Q0QhQiQyQQQQQQQQQQ p@  p@ &dP p@ 0^`0 p@ ^ The Department may waive any requirement of this Rule, except to the extent that the requirement is mandated by legislative authority, in cases where the deviation from the rule is insubstantial and is not contrary to the purposes of the program. STATUTORY AUTHORITY: 22 MRSA 2127 EFFECTIVE DATE: December 26, 2000 (EMERGENCY - expires March 27, 2001) EFFECTIVE DATE: April 2, 2001     10-144 Chapter 295, Dental Services Development and Subsidy Program page page 6 QQQQQQQQQQ p@ h]h $&dPa$ 5 0 00 P/ =!"#$% P@P Normal'CJOJQJ^J_HkHmH sH tH uJ@J Heading 1$5CJ(OJQJ^JkH6@6 Heading 2$58@8 Heading 3a$$5DA@D Default Paragraph FontRi@R  Table Normal4 l4a (k@(No List4 @4 Footer  !4@4 Header  !DB@D Body Text p@ CJ6P@"6 Body Text 2^DR@2D Body Text Indent 2^DS@BD Body Text Indent 3^h.>@R. 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