An Act To Require Insurance Coverage For Covered Dental Services Provided By Licensed Dental Hygienists And To Authorize Licensed Dental Hygienists To Bill Commercial Dental Insurance

132nd Legislature (2025-2026)

Covers and reimburses dental hygienists for covered services within their scope and lets them bill commercial insurers directly, ensuring parity with dentist-provided care.

Signed by Governor

#dental #healthcarepersonnel #hygienists

Summary — LD 1361 (132nd Maine Legislature)

Title: An Act To Require Insurance Coverage For Covered Dental Services Provided By Licensed Dental Hygienists And To Authorize Licensed Dental Hygienists To Bill Commercial Dental Insurance
Bill No.: LD 1361
Introduced: March 28, 2025
Committee: Health Coverage, Insurance and Financial Services
Governor Signed: July 1, 2025
Amendment: Committee Amendment “A” (H‑536) adopted

Purpose

LD 1361 requires commercial dental (and more broadly referenced health) insurance carriers to reimburse licensed dental hygienists for covered dental services that are within the hygienist’s scope of practice when those same services would otherwise be reimbursed if provided by a dentist. The bill also authorizes licensed dental hygienists to bill commercial dental insurance directly.

Key provisions

Requires insurance carriers to reimburse licensed dental hygienists for covered services within their statutory scope when the same services would be reimbursed if provided by a dentist.

Authorizes licensed dental hygienists to submit claims directly to commercial dental insurers for such covered services.

Applies to coverage and reimbursement parity (i.e., insurers must cover equivalent services performed by hygienists that they would cover if performed by dentists).

Note: The enacted text as amended (H‑536) was passed and sent for concurrence; the fiscal notes reflect the bill as both introduced and as engrossed with amendment.

Who is affected

Licensed dental hygienists: gain explicit authority to bill commercial dental insurers and to be reimbursed for covered services within their scope.

Commercial dental insurance carriers and possibly other health insurers: required to accept and reimburse claims submitted by hygienists under the parity rule.

Patients/enrollees: may have expanded access to receiving covered preventive and routine dental services from hygienists and may experience changes in provider choice or out‑of‑pocket cost depending on plan terms.

Dentists: could see shifts in service mix if more care is provided directly by hygienists.

Fiscal and budgetary impact

Fiscal notes (approved 5/31/25 and 6/9/25) indicate potential current biennium increases or savings to All Funds but conclude a precise fiscal estimate cannot be determined.

The uncertainty stems from whether new claims will represent previously unmet utilization (increasing costs) or substitution for services previously billed by dentists (potentially reducing costs if hygienist-provided services are reimbursed at lower amounts).

No specific dollar amounts or effective date details are provided in the fiscal notes.

Notes/Uncertainties

The bill establishes coverage and billing parity but does not specify reimbursement rates, billing procedures, or administrative implementation details — those will be determined through existing insurer processes and possibly subsequent rulemaking or guidance.

The net effect on premiums, state health expenditures, or enrollee costs remains indeterminate per the fiscal notes.

Bill