HF 961

1st Engrossment - 86th Legislature (2009 - 2010) Posted on 02/09/2010 01:43am

A bill for an act
relating to human services; providing for urgent dental care pilot projects;
clarifying medical assistance coverage of dental services; amending critical
access dental care provisions; amending Minnesota Statutes 2008, sections
256.963, by adding a subdivision; 256B.0625, subdivision 9; 256B.76,
subdivision 4; 256L.11, subdivision 7.

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

Section 1.

Minnesota Statutes 2008, section 256.963, is amended by adding a
subdivision to read:

new text begin Subd. 3. new text end

new text begin Urgent dental care services. new text end

new text begin The commissioner of human services shall
authorize pilot projects to reduce the total costs to the state for dental services provided
to persons enrolled in Minnesota health care programs by reducing hospital emergency
room costs for preventable and nonemergency dental services. The commissioner may
provide start-up funding and establish special payment rates for urgent dental care services
provided as an alternative to emergency room services and may change or waive existing
payment policies in order to adequately reimburse providers for providing cost-effective
alternative services in outpatient or urgent care settings. The commissioner may establish
a project in conjunction with the initiative authorized under subdivisions 1 and 2, or
establish new initiatives, or may implement both approaches.
new text end

Sec. 2.

Minnesota Statutes 2008, section 256B.0625, subdivision 9, is amended to read:

Subd. 9.

Dental services.

new text begin (a) new text end Medical assistance covers dental services. deleted text begin Dental
services include, with prior authorization, fixed bridges that are cost-effective for persons
who cannot use removable dentures because of their medical condition.
deleted text end

new text begin (b) Medical assistance dental coverage for adults is limited to the following services:
new text end

new text begin (1) comprehensive exams, limited to enrollees who are eligible for the program on
the basis of being elderly, blind, or disabled;
new text end

new text begin (2) periodic exams, limited to one per year;
new text end

new text begin (3) bitewing x-rays, limited to one per year;
new text end

new text begin (4) periapical x-rays;
new text end

new text begin (5) panoramic x-rays, limited to one every five years, and only if provided in
conjunction with a posterior extraction or scheduled outpatient facility procedure;
new text end

new text begin (6) prophylaxis, limited to one per year;
new text end

new text begin (7) application of fluoride varnish, limited to one per year;
new text end

new text begin (8) posterior restorations, all at the amalgams rate;
new text end

new text begin (9) endodontics, limited to root canals on the anterior and premolars only;
new text end

new text begin (10) dentures or partial dentures, limited to one every ten years;
new text end

new text begin (11) oral surgery, limited to extractions only; and
new text end

new text begin (12) urgent or emergency care for pain.
new text end

new text begin (c) In addition to the services specified in paragraph (b), medical assistance covers
the following services for adults, if provided in the outpatient hospital setting as part of
outpatient dental surgery:
new text end

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

new text begin (2) general anesthesia.
new text end

new text begin (d) The following limitations apply to medical assistance coverage of dental services
for children:
new text end

new text begin (1) application of sealants are limited to once every five years per permanent tooth;
new text end

new text begin (2) oral hygiene instructions are not a separately reimbursed service;
new text end

new text begin (3) application of fluoride varnish is limited to once every six months; and
new text end

new text begin (4) posterior restorations are all at the amalgams rate.
new text end

Sec. 3.

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, deleted text begin 2007 deleted text end new text begin 2009 new text end , the commissioner shall increase
reimbursement by deleted text begin 30 deleted text end new text begin ....... new text end 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; and

(3) whether the level of services provided by the dentist or dental clinic is critical to
maintaining adequate levels of patient access within the service area.

new text begin Effective July 1, 2009, the commissioner shall require that ....... percent or more of a
provider's patient base consist of medical assistance, general assistance medical care, or
MinnesotaCare enrollees, in order for that provider to be deemed a critical access dental
provider. For purposes of this requirement, a provider's patient base is the unduplicated
number of patients who have dental coverage through a private sector health plan,
medical assistance, general assistance medical care, or MinnesotaCare. 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. 4.

Minnesota Statutes 2008, section 256L.11, subdivision 7, is amended to read:

Subd. 7.

Critical access dental providers.

Effective for dental services provided
to MinnesotaCare enrollees on or after January 1, deleted text begin 2007 deleted text end new text begin 2010 new text end , the commissioner shall
increase payment rates to dentists and dental clinics deemed by the commissioner to be
critical access providers under section 256B.76, subdivision 4, by deleted text begin 50 deleted text end new text begin ....... new text end percent above
the payment rate that would otherwise be paid to the provider. The commissioner shall
pay the prepaid health plans under contract with the commissioner amounts sufficient to
reflect this rate increase. The prepaid health plan must pass this rate increase to providers
who have been identified by the commissioner as critical access dental providers under
section 256B.76, subdivision 4.