HF 3035

as introduced - 88th Legislature (2013 - 2014) Posted on 03/13/2014 02:43pm

A bill for an act
relating to human services; establishing a single administrator to administer the
provision of dental services to medical assistance and MinnesotaCare enrollees;
proposing coding for new law in Minnesota Statutes, chapter 256B.

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

Section 1.

new text begin [256B.54] PROVISION OF DENTAL SERVICES.
new text end

new text begin Subdivision 1. new text end

new text begin Single dental administrator. new text end

new text begin Effective for dental services rendered
on or after January 1, 2016, the commissioner shall contract with a single dental plan or
dental plan administrative entity to administer the delivery of dental services to medical
assistance and MinnesotaCare enrollees. The contract for the single administrator shall be
awarded through competitive bidding. The entity shall administer all state dental program
services, including those provided through the current fee-for-service system and those
provided through the prepaid medical assistance program.
new text end

new text begin Subd. 2. new text end

new text begin Contract provisions. new text end

new text begin The contract with the dental administrator shall:
new text end

new text begin (1) include the provision of all dental services authorized under section 256B.0625;
new text end

new text begin (2) ensure adequate numbers of dentists and dental clinics to provide accessible
care to program enrollees;
new text end

new text begin (3) establish a centralized dental referral system, including a toll-free telephone
number, to identify available dentists and dental clinics and to schedule appointments for
program enrollees who need assistance in locating dental care;
new text end

new text begin (4) include nonprofit clinics, federally qualified health centers, the University of
Minnesota School of Dentistry and its affiliated clinics, publicly owned and operated
hospital-based dental clinics, dental clinics within state-operated services, and private
practicing dentists in its dental provider network;
new text end

new text begin (5) encourage private practicing dentists to participate and provide services to public
program enrollees through flexible scheduling and coordination of referrals;
new text end

new text begin (6) develop a program to reduce hospital emergency room visits for dental care
treatment;
new text end

new text begin (7) streamline information systems to provide information on patient eligibility and
state program restrictions on dental benefits, including prior authorization requirements
for dental care treatments;
new text end

new text begin (8) clearly communicate authorization criteria and benefit changes to dental
providers participating in the dental provider network; and
new text end

new text begin (9) measure access to dental services for program enrollees and report access and
encounter data annually to the commissioner.
new text end

new text begin Subd. 3. new text end

new text begin Advisory committee. new text end

new text begin The administrator shall establish an advisory
committee of participating providers from community and public clinics and private
practices to assist in the development and maintenance of the program.
new text end

new text begin Subd. 4. new text end

new text begin Appeals. new text end

new text begin All recipients of dental services provided under contract by the
administrator shall have the right to appeal to the commissioner under section 256.045.
new text end

new text begin Subd. 5. new text end

new text begin Data privacy. new text end

new text begin The contract between the commissioner and the
administrator must specify that the administrator is the agent of the state and shall have
access to patient data on program enrollees to the extent necessary to carry out the
administrator's responsibilities under the contract. The administrator shall comply with
the relevant provisions of chapter 13.
new text end

new text begin Subd. 6. new text end

new text begin Prepaid medical assistance dental services. new text end

new text begin Effective January 1, 2016,
all dental services must be removed from prepaid medical assistance program contracts
with managed care organizations and county-based purchasing plans. All dental services
must be included in the services provided under contract from the dental administrator.
Each managed care organization and county-based purchasing plan providing dental care
to program enrollees either directly or through contract with a dental plan administrator
must provide the commissioner with dental encounter data and aggregate reimbursement
data for dental care provided through the prepaid medical assistance program for calendar
year 2014.
new text end

new text begin Subd. 7. new text end

new text begin Exclusions. new text end

new text begin The commissioner may exclude from this section dental
programs administered through county-based purchasing plans if the commissioner
determines that a single administrator already exists and that the dental services currently
provided are adequate to meet the needs of public program enrollees within the area
served by the county-based purchasing plan.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2015, and is applicable to all
Department of Human Services contracts providing dental services on or after that date.
new text end