MaineCare cannot require advance approval for dental anesthesia

The Maine Department of Health and Human Services cannot require advance approval for these dental anesthesia services. The rule covers deep sedation and general anesthesia used for dental services provided to MaineCare members. The advance-approval rule takes effect July 1, 2026.

The Maine Department of Health and Human Services must set MaineCare payments for dental anesthesia at 67% of a commercial-rate benchmark. The payment rule covers deep sedation and general anesthesia provided for dental services. The benchmark is the commercial median, meaning the middle rate in the comparison. Providers must bill these services using dental codes D9222, D9223, D9224, and D9225. The payment rule starts July 1, 2026. The minimum must remain until June 30, 2028, or rates from the required dental rate review take effect, whichever comes first.

The Maine Department of Health and Human Services must keep payments for the covered treatments at least at their temporary rates. The requirement covers tooth extractions billed under code D7140 and medicine applied to stop tooth decay billed under code D1354. The law applies retroactively to July 1, 2026. These minimums must remain until June 30, 2028, or rates from the required dental rate review take effect, whichever comes first.

The law sets aside $55,014 for the Maine Department of Health and Human Services. The money supports the dental anesthesia advance-approval rule and payments at 67% of the commercial-rate benchmark. The funding includes $17,580 from the General Fund, $31,647 from the Federal Expenditures Fund, and $5,787 from the Federal Block Grant Fund. The funding amounts apply to 2026–27; the law sets aside $0 from each listed fund for 2025–26.