1.1                          A bill for an act 
  1.2             relating to health; increasing the medical assistance 
  1.3             reimbursement rate for certain dentists; requiring a 
  1.4             study; establishing a grant program for community 
  1.5             clinics providing dental services; appropriating 
  1.6             money; amending Minnesota Statutes 2000, section 
  1.7             256B.76; proposing coding for new law in Minnesota 
  1.8             Statutes, chapter 144. 
  1.9   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.10     Section 1.  [144.1499] [DENTAL SERVICE EXPANSION GRANT 
  1.11  PROGRAM.] 
  1.12     (a) The commissioner of health shall establish a grant 
  1.13  program to award grants to the academic health center at the 
  1.14  University of Minnesota to establish or expand the operations of 
  1.15  nonprofit community clinics that provide dental services on a 
  1.16  sliding fee scale basis and that do not restrict access to 
  1.17  services because of a client's financial limitations. 
  1.18     (b) Grant funds must be used for capital needs expenses or 
  1.19  for the expansion of dental services in the community. 
  1.20     Sec. 2.  Minnesota Statutes 2000, section 256B.76, is 
  1.21  amended to read: 
  1.22     256B.76 [PHYSICIAN AND DENTAL REIMBURSEMENT.] 
  1.23     (a) Effective for services rendered on or after October 1, 
  1.24  1992, the commissioner shall make payments for physician 
  1.25  services as follows: 
  1.26     (1) payment for level one Health Care Finance 
  1.27  Administration's common procedural coding system (HCPCS) codes 
  2.1   titled "office and other outpatient services," "preventive 
  2.2   medicine new and established patient," "delivery, antepartum, 
  2.3   and postpartum care," "critical care," Caesarean delivery and 
  2.4   pharmacologic management provided to psychiatric patients, and 
  2.5   HCPCS level three codes for enhanced services for prenatal high 
  2.6   risk, shall be paid at the lower of (i) submitted charges, or 
  2.7   (ii) 25 percent above the rate in effect on June 30, 1992.  If 
  2.8   the rate on any procedure code within these categories is 
  2.9   different than the rate that would have been paid under the 
  2.10  methodology in section 256B.74, subdivision 2, then the larger 
  2.11  rate shall be paid; 
  2.12     (2) payments for all other services shall be paid at the 
  2.13  lower of (i) submitted charges, or (ii) 15.4 percent above the 
  2.14  rate in effect on June 30, 1992; 
  2.15     (3) all physician rates shall be converted from the 50th 
  2.16  percentile of 1982 to the 50th percentile of 1989, less the 
  2.17  percent in aggregate necessary to equal the above increases 
  2.18  except that payment rates for home health agency services shall 
  2.19  be the rates in effect on September 30, 1992; 
  2.20     (4) effective for services rendered on or after January 1, 
  2.21  2000, payment rates for physician and professional services 
  2.22  shall be increased by three percent over the rates in effect on 
  2.23  December 31, 1999, except for home health agency and family 
  2.24  planning agency services; and 
  2.25     (5) the increases in clause (4) shall be implemented 
  2.26  January 1, 2000, for managed care. 
  2.27     (b) Effective for services rendered on or after October 1, 
  2.28  1992, the commissioner shall make payments for dental services 
  2.29  as follows: 
  2.30     (1) dental services shall be paid at the lower of (i) 
  2.31  submitted charges, or (ii) 25 percent above the rate in effect 
  2.32  on June 30, 1992; 
  2.33     (2) dental rates shall be converted from the 50th 
  2.34  percentile of 1982 to the 50th percentile of 1989, less the 
  2.35  percent in aggregate necessary to equal the above increases; 
  2.36     (3) effective for services rendered on or after January 1, 
  3.1   2000, payment rates for dental services shall be increased by 
  3.2   three percent over the rates in effect on December 31, 1999; 
  3.3      (4) the commissioner shall award grants to community 
  3.4   clinics or other nonprofit community organizations, political 
  3.5   subdivisions, professional associations, or other organizations 
  3.6   that demonstrate the ability to provide dental services 
  3.7   effectively to public program recipients.  Grants may be used to 
  3.8   fund the costs related to coordinating access for recipients, 
  3.9   developing and implementing patient care criteria, upgrading or 
  3.10  establishing new facilities, acquiring furnishings or equipment, 
  3.11  recruiting new providers, or other development costs that will 
  3.12  improve access to dental care in a region.  In awarding grants, 
  3.13  the commissioner shall give priority to applicants that plan to 
  3.14  serve areas of the state in which the number of dental providers 
  3.15  is not currently sufficient to meet the needs of recipients of 
  3.16  public programs or uninsured individuals.  The commissioner 
  3.17  shall consider the following in awarding the grants:  (i) 
  3.18  potential to successfully increase access to an underserved 
  3.19  population; (ii) the ability to raise matching funds; (iii) the 
  3.20  long-term viability of the project to improve access beyond the 
  3.21  period of initial funding; (iv) the efficiency in the use of the 
  3.22  funding; and (v) the experience of the proposers in providing 
  3.23  services to the target population. 
  3.24     The commissioner shall monitor the grants and may terminate 
  3.25  a grant if the grantee does not increase dental access for 
  3.26  public program recipients.  The commissioner shall consider 
  3.27  grants for the following: 
  3.28     (i) implementation of new programs or continued expansion 
  3.29  of current access programs that have demonstrated success in 
  3.30  providing dental services in underserved areas; 
  3.31     (ii) a pilot program for utilizing hygienists outside of a 
  3.32  traditional dental office to provide dental hygiene services; 
  3.33  and 
  3.34     (iii) a program that organizes a network of volunteer 
  3.35  dentists, establishes a system to refer eligible individuals to 
  3.36  volunteer dentists, and through that network provides donated 
  4.1   dental care services to public program recipients or uninsured 
  4.2   individuals. 
  4.3      (5) beginning October 1, 1999, the payment for tooth 
  4.4   sealants and fluoride treatments shall be the lower of (i) 
  4.5   submitted charge, or (ii) 80 percent of median 1997 charges; and 
  4.6      (6) the increases listed in clauses (3) and (5) shall be 
  4.7   implemented January 1, 2000, for managed care. 
  4.8      (c) Effective for dental services rendered on or after July 
  4.9   1, 2001, the commissioner may increase reimbursements to 
  4.10  dentists and dental clinics deemed by the commissioner to be 
  4.11  critical access dental providers.  Reimbursement to a critical 
  4.12  access dental provider may be increased by not more than 50 
  4.13  percent above the reimbursement rate that would otherwise be 
  4.14  paid to the provider.  Payments to health plan companies shall 
  4.15  be adjusted to reflect increased reimbursements to critical 
  4.16  access dental providers as approved by the commissioner.  In 
  4.17  determining which dentists and dental clinics shall be deemed 
  4.18  critical access dental providers, the commissioner shall review: 
  4.19     (1) the utilization rate in the service area in which the 
  4.20  dentist or dental clinic operates for dental services to 
  4.21  patients covered by medical assistance, general assistance 
  4.22  medical care, or MinnesotaCare as their primary source of 
  4.23  coverage; 
  4.24     (2) the level of services provided by the dentist or dental 
  4.25  clinic to patients covered by medical assistance, general 
  4.26  assistance medical care, or MinnesotaCare as their primary 
  4.27  source of coverage; and 
  4.28     (3) whether the level of services provided by the dentist 
  4.29  or dental clinic is critical to maintaining adequate levels of 
  4.30  patient access within the service area. 
  4.31  In the absence of a critical access dental provider in a service 
  4.32  area, the commissioner may designate a dentist or dental clinic 
  4.33  as a critical access dental provider if the dentist or dental 
  4.34  clinic is willing to provide care to patients covered by medical 
  4.35  assistance, general assistance medical care, or MinnesotaCare at 
  4.36  a level which significantly increases access to dental care in 
  5.1   the service area. 
  5.2      (d) An entity that operates both a Medicare certified 
  5.3   comprehensive outpatient rehabilitation facility and a facility 
  5.4   which was certified prior to January 1, 1993, that is licensed 
  5.5   under Minnesota Rules, parts 9570.2000 to 9570.3600, and for 
  5.6   whom at least 33 percent of the clients receiving rehabilitation 
  5.7   services in the most recent calendar year are medical assistance 
  5.8   recipients, shall be reimbursed by the commissioner for 
  5.9   rehabilitation services at rates that are 38 percent greater 
  5.10  than the maximum reimbursement rate allowed under paragraph (a), 
  5.11  clause (2), when those services are (1) provided within the 
  5.12  comprehensive outpatient rehabilitation facility and (2) 
  5.13  provided to residents of nursing facilities owned by the entity. 
  5.14     Sec. 3.  [STUDY; DENTAL CARE ACCESS.] 
  5.15     The commissioner of human services, in consultation with 
  5.16  the commissioner of health, the board of dentistry, and other 
  5.17  stakeholders shall study and report on how dental hygienists, 
  5.18  dental assistants, and other health care professionals may be 
  5.19  utilized in new ways to improve access to dental care.  The 
  5.20  report must address the training, scope of practice, licensing, 
  5.21  and supervision changes that are necessary to accomplish the 
  5.22  goal of increased access; must identify the effect these changes 
  5.23  will have on the existing supply of providers of dental 
  5.24  services; and must address the impact of these changes on 
  5.25  patient safety, efficacy and cost of treatment, and quality of 
  5.26  care.  The commissioner shall submit a report to the legislature 
  5.27  by January 15, 2002. 
  5.28     Sec. 4.  [APPROPRIATIONS.] 
  5.29     $....... is appropriated for the biennium ending June 30, 
  5.30  2003, from the general fund to the commissioner of human 
  5.31  services for the reimbursement rate increases described in 
  5.32  Minnesota Statutes, section 256B.76, paragraph (c). 
  5.33     $....... is appropriated for the biennium ending June 30, 
  5.34  2003, from the general fund to the commissioner of health for 
  5.35  the grants described in Minnesota Statutes, section 144.1499. 
  5.36     Sec. 5.  [EFFECTIVE DATE.] 
  6.1      Section 2 is effective the day following final enactment.