HF 1349

as introduced - 90th Legislature (2017 - 2018) Posted on 03/09/2017 10:54am

A bill for an act
relating to human services; establishing a pilot project to provide urgent dental
care services; modifying critical access dental provider payments; amending
Minnesota Statutes 2016, section 256B.76, subdivision 4; proposing coding for
new law in Minnesota Statutes, chapter 256.

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

Section 1.

new text begin [256.9641] DENTAL CARE PILOT PROJECT.
new text end

new text begin The commissioner shall authorize a pilot project to reduce the total cost to the state for
dental services provided to enrollees of the state public health care programs by reducing
hospital emergency room costs for preventable or nonemergency dental services. As part
of the project, a community dental clinic or dental provider, in collaboration with a hospital
emergency room, shall provide urgent care dental services as an alternative to the hospital
emergency room for nonemergency dental care. Project participants shall establish a process
to divert a patient presenting at the emergency room for nonemergency dental care to the
dental community clinic or to an appropriate dental provider. The commissioner may
establish special payment rates for urgent care services provided and may change or waive
existing payment policies to adequately reimburse providers for providing cost-effective
alternative services in an outpatient or urgent care setting. The commissioner may establish
the project in conjunction with the initiative authorized under section 256.963.
new text end

Sec. 2.

Minnesota Statutes 2016, section 256B.76, subdivision 4, is amended to read:

Subd. 4.

Critical access dental providers.

(a) 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, 2016, the
commissioner shall increase reimbursement by 37.5 percent above the reimbursement rate
that would otherwise be paid to the critical access dental provider, except as specified under
paragraph (b). 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) For dental services rendered on or after July 1, 2016, by a dental clinic or dental
group that meets the critical access dental provider designation under paragraph (d), clause
(4), and is owned and operated by a health maintenance organization licensed under chapter
62D, the commissioner shall increase reimbursement by 35 percent above the reimbursement
rate that would otherwise be paid to the critical access provider.

(c) Critical access dental payments made under paragraph (a) or (b) for dental services
provided by a critical access dental provider to an enrollee of a managed care plan or
county-based purchasing plan must not reflect any capitated payments or cost-based payments
from the managed care plan or county-based purchasing plan. The managed care plan or
county-based purchasing plan must base the additional critical access dental payment on
the amount that would have been paid for that service had the dental provider been paid
according to the managed care plan or county-based purchasing plan's fee schedule that
applies to dental providers that are not paid under a capitated payment or cost-based payment.

(d) 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; and

(vii) have free care available as needed;

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

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

(4) a dental clinic or dental group owned and operated by a nonprofit corporation in
accordance with chapter 317A with more than 10,000 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 within the seven-county metropolitan area and 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; or

(ii) the dentist's office is located outside the seven-county metropolitan area and more
than 25 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 (e) A designated critical access clinic 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:
new text end

new text begin (1) the designated critical access dental clinic is not able to provide the services and
refers the patient to the off-site dentist;
new text end

new text begin (2) the services, if provided at the critical access dental clinic, would be reimbursed at
the critical access reimbursement rate;
new text end

new text begin (3) the dentists and allied dental professionals providing the services off site are licensed
and in good standing under chapter 150A;
new text end

new text begin (4) the critical access dental clinic submits the claim for services provided off site and
receives the payment for the services;
new text end

new text begin (5) 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 providing the services; and
new text end

new text begin (6) the commissioner makes available to the public on the agency's Web site the physical
addresses of the off-site private dental offices and contact information for the critical access
dental clinic, and the critical access dental clinic serves as the point of contact for services
provided under this subdivision through the off-site private dental offices.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2017.
new text end