HF 1518

as introduced - 89th Legislature (2015 - 2016) Posted on 03/16/2015 04:32pm

A bill for an act
relating to human services; changing provisions governing critical access dental
providers; amending Minnesota Statutes 2014, section 256B.76, subdivision 4.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2014, section 256B.76, subdivision 4, is amended to read:

Subd. 4.

Critical access dental providers.

(a) Effective for dental services
rendered on or after January 1, 2002, the commissioner shall increase reimbursements
to dentists and dental clinics deemed by the commissioner to be critical access dental
providers. For dental services rendered on or after July 1, 2007, the commissioner shall
increase reimbursement by 35 percent above the reimbursement rate that would otherwise
be paid to the critical access dental provider. The commissioner shall pay the managed
care plans and county-based purchasing plans in amounts sufficient to reflect increased
reimbursements to critical access dental providers as approved by the commissioner.

(b) The commissioner shall designate the following dentists and dental clinics as
critical access dental providers:

(1) nonprofit community clinics that:

(i) have nonprofit status in accordance with chapter 317A;

(ii) have tax exempt status in accordance with the Internal Revenue Code, section
501(c)(3);

(iii) are established to provide oral health services to patients who are low income,
uninsured, have special needs, and are underserved;

(iv) have professional staff familiar with the cultural background of the clinic's
patients;

(v) charge for services on a sliding fee scale designed to provide assistance to
low-income patients based on current poverty income guidelines and family size;

(vi) do not restrict access or services because of a patient's financial limitations
or public assistance status; deleted text begin and
deleted text end

(vii) have free care available as needed; new text begin and
new text end

new text begin (viii) have more than 50 percent of the clinic's patient encounters per year with
patients who are uninsured or covered by medical assistance or MinnesotaCare;
new text end

(2) federally qualified health centers, rural health clinics, and public health clinics;

(3) deleted text begin city or county deleted text end new text begin hospital-based dental clinics new text end owned and operated deleted text begin hospital-based
dental clinics deleted text end new text begin by a city, county, or former state hospital as defined in section 62Q.19,
subdivision 1, paragraph (a), clause (4) new text end ;

(4) a dental clinic or dental group owned and operated by a deleted text begin nonprofit corporation in
accordance with chapter 317A deleted text end new text begin health system, group dental practice, or health plan company
new text end with more than deleted text begin 10,000 deleted text end new text begin 50 percent of the clinic or dental group's new text end patient encounters per
year with patients who are uninsured or covered by medical assistance or MinnesotaCare;

(5) a dental clinic owned and operated by the University of Minnesota or the
Minnesota State Colleges and Universities system; and

(6) private practicing dentists if:

(i) the dentist's office is located deleted text begin within a health professional shortage area as defined
under Code of Federal Regulations, title 42, part 5, and United States Code, title 42,
section 254E;
deleted text end

deleted text begin (ii) deleted text end new text begin within the seven-county metropolitan area and new text end more than 50 percent of the
dentist's patient encounters per year are with patients who are uninsured or covered by
medical assistance or MinnesotaCare; new text begin or
new text end

deleted text begin (iii) the dentist does not restrict access or services because of a patient's financial
limitations or public assistance status; and
deleted text end

deleted text begin (iv) the level of service provided by the dentist is critical to maintaining adequate
levels of patient access within the service area in which the dentist operates.
deleted text end

new text begin (ii) the dentist's office is located outside the seven-county metropolitan area and
more than 30 percent of the dentist's patient encounters per year are with patients who are
uninsured or covered by medical assistance or MinnesotaCare.
new text end

(c) A new text begin dentist or dental clinic new text end designated new text begin as a new text end critical access deleted text begin clinic deleted text end new text begin dental provider under
paragraph (b) new text end shall receive the reimbursement rate specified in paragraph (a) for dental
services provided off site at a private dental office if the following requirements are met:

(1) the designated critical access dental clinic is located deleted text begin within a health professional
shortage area as defined under Code of Federal Regulations, title 42, part 5, and United
States Code, title 42, section 254E, and is located deleted text end outside the seven-county metropolitan
area;

(2) the designated critical access dental clinic is not able to provide the service
and refers the patient to the off-site dentist;

(3) the service, if provided at the critical access dental clinic, would be reimbursed
at the critical access reimbursement rate;

(4) the dentist and allied dental professionals providing the services off site are
licensed and in good standing under chapter 150A;

(5) the dentist providing the services is enrolled as a medical assistance provider;

(6) the critical access dental clinic submits the claim for services provided off site
and receives the payment for the services; and

(7) the critical access dental clinic maintains dental records for each claim submitted
under this paragraph, including the name of the dentist, the off-site location, and the
license number of the dentist and allied dental professionals providing the services.