HF 3269

1st Engrossment - 86th Legislature (2009 - 2010) Posted on 03/08/2010 01:21pm

A bill for an act
relating to human services; modifying medical assistance dental coverage;
modifying covered services under the critical access dental program; setting
criteria for designating and terminating critical access dental providers;
appropriating money; amending Minnesota Statutes 2008, section 256B.76,
subdivision 4, by adding a subdivision; Minnesota Statutes 2009 Supplement,
section 256B.0625, subdivision 9.

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

Section 1.

Minnesota Statutes 2009 Supplement, section 256B.0625, subdivision 9,
is amended to read:

Subd. 9.

Dental services.

(a) Medical assistance covers dental services.

(b) Medical assistance dental coverage for nonpregnant adults is limited to the
following services:

(1) comprehensive exams, limited to once every five years;

(2) periodic exams, limited to one per year;

(3) limited exams;

(4) bitewing x-rays, limited to one per year;

(5) periapical x-rays;

(6) panoramic x-rays new text begin or full-mouth radiographs new text end , limited to one every five years,
and only if provided in conjunction with a posterior extraction or scheduled outpatient
facility procedure, or as medically necessary for the diagnosis and follow-up of oral and
maxillofacial pathology and trauma. Panoramic x-rays may be taken once every two years
for patients who cannot cooperate for intraoral film due to a developmental disability or
medical condition that does not allow for intraoral film placement;

(7) prophylaxis, limited to one per year;

(8) application of fluoride varnish, limited to one per year;

(9) posterior fillings, all at the amalgam rate;

(10) anterior fillings;

(11) endodontics, limited to root canals on the anterior and premolars only new text begin , and
molar root canal therapy as deemed medically necessary for patients that are at high risk
of osteonecrosis from molar extractions new text end ;

(12) removable prostheses, each dental arch limited to one every six years deleted text begin ; deleted text end new text begin including:
new text end

new text begin (i) relines of full dentures once every six years;
new text end

new text begin (ii) repair of acrylic bases of full dentures and acrylic partial dentures, limited to one
per year; and
new text end

new text begin (iii) adding a maximum of two denture teeth and two wrought wire clasps per year
to partial dentures;
new text end

(13) oral surgery, limited to extractions, biopsies, and incision and drainage of
abscesses;

(14) palliative treatment and sedative fillings for relief of pain; deleted text begin and
deleted text end

(15) full-mouth deleted text begin debridement deleted text end new text begin periodontal scaling and root planing new text end , limited to one
every five years new text begin ; and
new text end

new text begin (16) sedation, limited to when provided by a board-certified or board-eligible oral
maxillofacial surgeon when medically necessary to allow the surgical management of
acute oral and maxillofacial pathology which cannot be accomplished safely with local
anesthesia alone and would otherwise require operating room services new text end .

(c) In addition to the services specified in paragraph (b), medical assistance
covers the following services for adults, if provided in an outpatient hospital setting or
freestanding ambulatory surgical center as part of outpatient dental surgery:

(1) periodontics, limited to periodontal scaling and root planing once every two
years;

(2) general anesthesia; and

(3) full-mouth survey once every deleted text begin five deleted text end new text begin two new text end years.

(d) Medical assistance covers dental services for children that are medically
necessary. The following guidelines apply:

(1) posterior fillings are paid at the amalgam rate;

(2) application of sealants once every five years per permanent molar; and

(3) application of fluoride varnish once every six months.

Sec. 2.

Minnesota Statutes 2008, section 256B.76, subdivision 4, is amended to read:

Subd. 4.

Critical access dental providers.

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 30 percent above the reimbursement rate that would otherwise be paid to
the critical access dental provider. The commissioner shall pay the health plan companies
in amounts sufficient to reflect increased reimbursements to critical access dental providers
as approved by the commissioner. In determining which dentists and dental clinics shall
be deemed critical access dental providers, the commissioner shall review:

(1) the utilization rate in the service area in which the dentist or dental clinic operates
for dental services to patients covered by medical assistance, general assistance medical
care, or MinnesotaCare as their primary source of coverage;

(2) the level of services provided by the dentist or dental clinic to patients covered
by medical assistance, general assistance medical care, or MinnesotaCare as their primary
source of coverage deleted text begin ; and deleted text end new text begin . The commissioner shall pay critical access dental provider
payments to a dentist or dental clinic that meets any one of the following criteria: new text end

new text begin (i) at least 40 percent of patient encounters are with patients who are uninsured or
covered by medical assistance, general assistance medical care, or MinnesotaCare;
new text end

new text begin (ii) the dental clinic or dental group is owned and operated by a nonprofit operation
under chapter 317A with more than 10,000 patient encounters per year with patients
who are uninsured or covered by medical assistance, general assistance medical care, or
MinnesotaCare; or
new text end

new text begin (iii) the dental clinic is associated with an oral health or dental education program
operated by the University of Minnesota or an institution within the Minnesota State
Colleges and Universities system; and
new text end

(3) whether the level of services provided by the dentist or dental clinic is critical to
maintaining adequate levels of patient access within deleted text begin the deleted text end new text begin a geographic new text end service area new text begin , and
to ensure that the maximum travel distance or travel time is the lesser of 60 miles or 60
minutes new text end .

In the absence of a critical access dental provider in a service area, the commissioner may
designate a dentist or dental clinic as a critical access dental provider if the dentist or
dental clinic is willing to provide care to patients covered by medical assistance, general
assistance medical care, or MinnesotaCare at a level which significantly increases access
to dental care in the service area.

Sec. 3.

Minnesota Statutes 2008, section 256B.76, is amended by adding a subdivision
to read:

new text begin Subd. 4a. new text end

new text begin Designation and termination of critical access dental providers. new text end

new text begin (a)
Notwithstanding the provisions in subdivision 4, the commissioner shall not designate
an individual dentist as a critical access dental provider under subdivision 4 or section
256L.11, subdivision 7, when the dentist:
new text end

new text begin (1) has been subject to a corrective or disciplinary action by the Minnesota Board of
Dentistry related to fraud, a pattern of three or more infractions within the past two years
that have not been resolved within a time period as prescribed by the commissioner, or
egregious practice as determined by the commissioner. Designation shall not be made
until the provider is no longer subject to a corrective or disciplinary action;
new text end

new text begin (2) has been subject, within the past three years, to a postinvestigation action by the
commissioner of human services or issuance of a warning as specified in Minnesota Rules,
parts 9505.2160 to 9505.2245;
new text end

new text begin (3) has not completed the application for critical access dental provider designation,
has submitted the application after the due date, provided incorrect information, or has
knowingly and willfully submitted a fraudulent designation form;
new text end

new text begin (4) does not meet the quality and continuity of care criteria that have been
recommended by the Dental Services Advisory Committee and adopted by the department;
or
new text end

new text begin (5) does not serve people in all Minnesota health care programs.
new text end

new text begin (b) The commissioner shall terminate a critical access designation of an individual
dentist if the dentist:
new text end

new text begin (1) becomes subject to a disciplinary or corrective action by the Minnesota Board
of Dentistry related to fraud, a pattern of three or more infractions within the past two
years that have not been resolved within a time period as prescribed by the commissioner,
or egregious practice as determined by the commissioner. The provider shall not be
considered for critical access designation until the January following the year in which
the action has ended;
new text end

new text begin (2) becomes subject to a postinvestigation action by the commissioner of human
services or issuance of a warning as specified in Minnesota Rules, parts 9505.2160
to 9505.2245;
new text end

new text begin (3) does not meet the quality and continuity of care criteria that have been
recommended by the Dental Services Advisory Committee and adopted by the department;
or
new text end

new text begin (4) does not serve people in all Minnesota public health care programs.
new text end

new text begin (c) Any termination is retroactive to the date of the:
new text end

new text begin (1) postinvestigative action;
new text end

new text begin (2) disciplinary or corrective action by the Minnesota Board of Dentistry; or
new text end

new text begin (3) determination of not meeting quality and continuity of care criteria.
new text end

new text begin (d) A provider who has been terminated or not designated under this section may
appeal only through the contested hearing process as defined in section 14.02, subdivision
3, by filing with the commissioner a written request of appeal. The appeal request must
be received by the commissioner no later than 30 days after notification of termination
or nondesignation.
new text end

new text begin (e) The commissioner may make an exception to paragraphs (a) and (b) if an action
taken by the Board of Dentistry, commissioner, or health plan under contract to provide
services to Minnesota health care programs is the result of a onetime event not directly
related to patient care or that will not affect direct patient care to Minnesota health care
program enrollees.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 4. new text begin APPROPRIATION.
new text end

new text begin $3,000,000 is appropriated from the general fund for the fiscal year beginning July
1, 2010, to the commissioner of human services for medical assistance payments to
critical access dental providers.
new text end