1.1                          A bill for an act 
  1.2             relating to health; creating a dentists loan 
  1.3             forgiveness program; creating a retired dentist 
  1.4             program; modifying reimbursement provisions for dental 
  1.5             care; creating a demonstration project; appropriating 
  1.6             money; amending Minnesota Statutes 2000, sections 
  1.7             256B.69, by adding a subdivision; 256B.76; proposing 
  1.8             coding for new law in Minnesota Statutes, chapters 
  1.9             144; 256; repealing Minnesota Statutes 2000, section 
  1.10            256B.037, subdivision 5. 
  1.11  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.12     Section 1.  [144.1498] [DENTIST LOAN FORGIVENESS.] 
  1.13     Subdivision 1.  [DEFINITIONS.] For the purposes of this 
  1.14  section, "qualified educational loan" means a government, 
  1.15  commercial, or foundation loan for the actual costs paid for 
  1.16  tuition, reasonable education expenses, and reasonable living 
  1.17  expenses related to graduate or undergraduate education of a 
  1.18  dentist.  
  1.19     Subd. 2.  [CREATION OF ACCOUNT.] A dental education account 
  1.20  is established in the general fund.  The commissioner shall use 
  1.21  money from the account to establish a loan forgiveness program 
  1.22  for dentists agreeing to provide services for a substantial 
  1.23  number of state public assistance program participants and other 
  1.24  low- to moderate-income uninsured patients, as defined by the 
  1.25  commissioner of health.  
  1.26     Subd. 3.  [ELIGIBILITY.] To be eligible to participate in 
  1.27  the program, a dental student must submit an application to the 
  1.28  commissioner of health while attending a program of study 
  2.1   designed to prepare the student to become a licensed dentist.  
  2.2   To be eligible to participate in the program, a licensed dentist 
  2.3   must submit an application to the commissioner of health within 
  2.4   three years of graduation from a dental school or completion of 
  2.5   a graduate dental program.  An applicant who is accepted must 
  2.6   sign a contract to agree to serve:  (1) a minimum three-year 
  2.7   service obligation during which at least 15 percent of the 
  2.8   dentist's yearly patient encounters are provided to public 
  2.9   assistance program enrollees or patients receiving sliding fee 
  2.10  schedule discounts through a formal sliding fee schedule that 
  2.11  meets the standards established in Code of Federal Regulations, 
  2.12  title 42, section 51c.303; or (2) a minimum three-year service 
  2.13  obligation in a designated rural area, as defined by the 
  2.14  commissioner under section 144.1494.  The service obligation for 
  2.15  applicants who are dental students shall begin no later than 
  2.16  March 31 of the first year following completion of training.  
  2.17  The service obligation for applicants who are licensed dentists 
  2.18  shall begin no later than 12 months following the date on which 
  2.19  an application is submitted. 
  2.20     Subd. 4.  [LOAN FORGIVENESS.] The commissioner of health 
  2.21  may accept up to 14 applicants per year for participation in the 
  2.22  loan forgiveness program.  Applicants are responsible for 
  2.23  securing their own qualified educational loan.  Applicants 
  2.24  chosen to participate in the loan forgiveness program may 
  2.25  designate, for each year of dentistry study up to a maximum of 
  2.26  four years, an agreed amount, not to exceed $10,000, as a 
  2.27  qualified educational loan.  For each year that a participant 
  2.28  meets the service obligation required under subdivision 3, up to 
  2.29  a maximum of four years, the commissioner shall make annual 
  2.30  disbursements directly to the participant in an amount equal to 
  2.31  $10,000 per year of service, not to exceed $40,000 or the 
  2.32  balance of the qualified educational loan, whichever is less.  
  2.33  The total amount of all disbursements must not exceed the 
  2.34  principal and accrued interest of the qualified educational 
  2.35  loan.  Before receiving loan repayment disbursements, the 
  2.36  participant must complete and return to the commissioner an 
  3.1   affidavit of practice form provided by the commissioner 
  3.2   verifying that the participant's practice meets the requirements 
  3.3   described in subdivision 3.  After each disbursement, the 
  3.4   participant must provide the commissioner with verification that 
  3.5   the full amount of a loan repayment disbursement received by the 
  3.6   participant has been applied toward the qualified educational 
  3.7   loan before the next loan repayment disbursement is made.  
  3.8   Participants who move their practice remain eligible for loan 
  3.9   repayment if the requirements of subdivision 3 continue to be 
  3.10  met.  
  3.11     Subd. 5.  [PENALTY FOR NONFULFILLMENT.] If a participant 
  3.12  does not fulfill the service commitment as required under 
  3.13  subdivision 3, the commissioner of health shall collect from the 
  3.14  participant 100 percent of any payments made for the qualified 
  3.15  educational loan and interest at a rate established under 
  3.16  section 270.75.  The commissioner shall deposit the money 
  3.17  collected in the dental education account established under 
  3.18  subdivision 2.  
  3.19     Subd. 6.  [SUSPENSION OR WAIVER OF OBLIGATION.] Payment or 
  3.20  service obligations cancel in the event of a participant's 
  3.21  death.  The commissioner of health may waive or suspend payment 
  3.22  or service obligations in cases of total and permanent 
  3.23  disability or long-term temporary disability lasting for more 
  3.24  than two years.  The commissioner shall evaluate all other 
  3.25  requests for suspension or waivers on a case-by-case basis and 
  3.26  may grant a waiver of all or part of the money owed as a result 
  3.27  of a nonfulfillment penalty if emergency circumstances prevented 
  3.28  fulfillment of the required service commitment. 
  3.29     Sec. 2.  [256.958] [RETIRED DENTIST PROGRAM.] 
  3.30     Subdivision 1.  [PROGRAM.] The commissioner of human 
  3.31  services shall establish a program to reimburse a retired 
  3.32  dentist for the dentist's license fee and for the cost of 
  3.33  malpractice insurance in exchange for the dentist providing ... 
  3.34  hours of dental services on a volunteer basis within a six-month 
  3.35  period at a community dental clinic or a dental training clinic 
  3.36  located at a Minnesota state college or university.  
  4.1      Subd. 2.  [DOCUMENTATION.] Upon completion of the required 
  4.2   hours, the retired dentist shall submit to the commissioner the 
  4.3   following: 
  4.4      (1) documentation of service provided; 
  4.5      (2) the cost of malpractice insurance for the six-month 
  4.6   period; and 
  4.7      (3) the cost of the license.  
  4.8      Subd. 3.  [REIMBURSEMENT.] Upon receipt of the information 
  4.9   described in subdivision 2, the commissioner shall provide 
  4.10  reimbursement to the retired dentist for the cost of malpractice 
  4.11  insurance for the previous six-month period and the cost of the 
  4.12  license. 
  4.13     Sec. 3.  Minnesota Statutes 2000, section 256B.69, is 
  4.14  amended by adding a subdivision to read: 
  4.15     Subd. 6c.  [DENTAL SERVICES DEMONSTRATION PROJECT.] The 
  4.16  commissioner shall establish a dental services demonstration 
  4.17  project in Crow Wing, Todd, Morrison, Wadena, and Cass counties 
  4.18  for provision of dental services to medical assistance, general 
  4.19  assistance medical care, and MinnesotaCare recipients.  The 
  4.20  commissioner may contract on a prospective per capita payment 
  4.21  basis for these dental services with an organization licensed 
  4.22  under chapter 62C, 62D, or 62N in accordance with section 
  4.23  256B.037 or may establish and administer a fee-for-service 
  4.24  system for the reimbursement of dental services.  
  4.25     Sec. 4.  Minnesota Statutes 2000, section 256B.76, is 
  4.26  amended to read: 
  4.27     256B.76 [PHYSICIAN AND DENTAL REIMBURSEMENT.] 
  4.28     (a) Effective for services rendered on or after October 1, 
  4.29  1992, the commissioner shall make payments for physician 
  4.30  services as follows: 
  4.31     (1) payment for level one Health Care Finance 
  4.32  Administration's common procedural coding system (HCPCS) codes 
  4.33  titled "office and other outpatient services," "preventive 
  4.34  medicine new and established patient," "delivery, antepartum, 
  4.35  and postpartum care," "critical care," Caesarean cesarean 
  4.36  delivery and pharmacologic management provided to psychiatric 
  5.1   patients, and HCPCS level three codes for enhanced services for 
  5.2   prenatal high risk, shall be paid at the lower of (i) submitted 
  5.3   charges, or (ii) 25 percent above the rate in effect on June 30, 
  5.4   1992.  If the rate on any procedure code within these categories 
  5.5   is different than the rate that would have been paid under the 
  5.6   methodology in section 256B.74, subdivision 2, then the larger 
  5.7   rate shall be paid; 
  5.8      (2) payments for all other services shall be paid at the 
  5.9   lower of (i) submitted charges, or (ii) 15.4 percent above the 
  5.10  rate in effect on June 30, 1992; 
  5.11     (3) all physician rates shall be converted from the 50th 
  5.12  percentile of 1982 to the 50th percentile of 1989, less the 
  5.13  percent in aggregate necessary to equal the above increases 
  5.14  except that payment rates for home health agency services shall 
  5.15  be the rates in effect on September 30, 1992; 
  5.16     (4) effective for services rendered on or after January 1, 
  5.17  2000, payment rates for physician and professional services 
  5.18  shall be increased by three percent over the rates in effect on 
  5.19  December 31, 1999, except for home health agency and family 
  5.20  planning agency services; and 
  5.21     (5) the increases in clause (4) shall be implemented 
  5.22  January 1, 2000, for managed care. 
  5.23     (b) Effective for services rendered on or after October 1, 
  5.24  1992, the commissioner shall make payments for dental services 
  5.25  as follows: 
  5.26     (1) dental services shall be paid at the lower of (i) 
  5.27  submitted charges, or (ii) 25 percent above the rate in effect 
  5.28  on June 30, 1992; 
  5.29     (2) dental rates shall be converted from the 50th 
  5.30  percentile of 1982 to the 50th percentile of 1989, less the 
  5.31  percent in aggregate necessary to equal the above increases; 
  5.32     (3) effective for services rendered on or after January 1, 
  5.33  2000, payment rates for dental services shall be increased by 
  5.34  three percent over the rates in effect on December 31, 1999; 
  5.35     (4) the commissioner shall award grants to community 
  5.36  clinics or other nonprofit community organizations, political 
  6.1   subdivisions, professional associations, or other organizations 
  6.2   that demonstrate the ability to provide dental services 
  6.3   effectively to public program recipients.  Grants may be used to 
  6.4   fund the costs related to coordinating access for recipients, 
  6.5   developing and implementing patient care criteria, upgrading or 
  6.6   establishing new facilities, acquiring furnishings or equipment, 
  6.7   recruiting new providers, or other development costs that will 
  6.8   improve access to dental care in a region.  In awarding grants, 
  6.9   the commissioner shall give priority to applicants that plan to 
  6.10  serve areas of the state in which the number of dental providers 
  6.11  is not currently sufficient to meet the needs of recipients of 
  6.12  public programs or uninsured individuals.  The commissioner 
  6.13  shall consider the following in awarding the grants:  (i) 
  6.14  potential to successfully increase access to an underserved 
  6.15  population; (ii) the ability to raise matching funds; (iii) the 
  6.16  long-term viability of the project to improve access beyond the 
  6.17  period of initial funding; (iv) the efficiency in the use of the 
  6.18  funding; and (v) the experience of the proposers in providing 
  6.19  services to the target population. 
  6.20     The commissioner shall monitor the grants and may terminate 
  6.21  a grant if the grantee does not increase dental access for 
  6.22  public program recipients.  The commissioner shall consider 
  6.23  grants for the following: 
  6.24     (i) implementation of new programs or continued expansion 
  6.25  of current access programs that have demonstrated success in 
  6.26  providing dental services in underserved areas; 
  6.27     (ii) a pilot program for utilizing hygienists outside of a 
  6.28  traditional dental office to provide dental hygiene services; 
  6.29  and 
  6.30     (iii) a program that organizes a network of volunteer 
  6.31  dentists, establishes a system to refer eligible individuals to 
  6.32  volunteer dentists, and through that network provides donated 
  6.33  dental care services to public program recipients or uninsured 
  6.34  individuals. 
  6.35     (5) beginning October 1, 1999, the payment for tooth 
  6.36  sealants and fluoride treatments shall be the lower of (i) 
  7.1   submitted charge, or (ii) 80 percent of median 1997 charges; and 
  7.2      (6) the increases listed in clauses (3) and (5) shall be 
  7.3   implemented January 1, 2000, for managed care; and 
  7.4      (7) effective for services provided on or after October 1, 
  7.5   2001, payment for diagnostic examinations and dental x-rays 
  7.6   provided to children under age 21 shall be the lower of (i) the 
  7.7   submitted charge, or (ii) 85 percent of median 1999 charges.  
  7.8      (c) An entity that operates both a Medicare certified 
  7.9   comprehensive outpatient rehabilitation facility and a facility 
  7.10  which was certified prior to January 1, 1993, that is licensed 
  7.11  under Minnesota Rules, parts 9570.2000 to 9570.3600, and for 
  7.12  whom at least 33 percent of the clients receiving rehabilitation 
  7.13  services in the most recent calendar year are medical assistance 
  7.14  recipients, shall be reimbursed by the commissioner for 
  7.15  rehabilitation services at rates that are 38 percent greater 
  7.16  than the maximum reimbursement rate allowed under paragraph (a), 
  7.17  clause (2), when those services are (1) provided within the 
  7.18  comprehensive outpatient rehabilitation facility and (2) 
  7.19  provided to residents of nursing facilities owned by the entity. 
  7.20     (d) Effective for dental services provided on or after July 
  7.21  1, 2001, the commissioner may increase reimbursement to dentists 
  7.22  or dental clinics classified by the commissioner as critical 
  7.23  access providers.  The commissioner may increase reimbursement 
  7.24  to a critical access provider by up to 50 percent more than 
  7.25  would otherwise be paid to that provider.  In determining 
  7.26  critical access provider status, the commissioner shall review: 
  7.27     (1) the utilization rate for dental services by Minnesota 
  7.28  health care program patients in the service area; 
  7.29     (2) the level of service provided to Minnesota health care 
  7.30  program patients by the dentist or dental clinic; and 
  7.31     (3) whether the level of services provided by the dentist 
  7.32  or clinic is critical to maintaining an adequate level of access 
  7.33  for patients in the service area. 
  7.34  If no provider in a service area is designated a critical access 
  7.35  provider upon review, the commissioner may designate a dentist 
  7.36  or dental clinic as a critical access provider if the dentist or 
  8.1   clinic is willing to provide care to Minnesota health care 
  8.2   program patients at a level that significantly increases access 
  8.3   to dental care within the service area.  The commissioner shall 
  8.4   adjust payments to prepaid health plans to reflect increased 
  8.5   reimbursement to critical access providers under this paragraph. 
  8.6      Sec. 5.  [APPROPRIATION.] 
  8.7      (a) $560,000 is appropriated for each year in the biennium 
  8.8   beginning July 1, 2001, from the general fund to the 
  8.9   commissioner of health for the dentist loan forgiveness program 
  8.10  created under Minnesota Statutes, section 144.1498. 
  8.11     (b) $....... is appropriated for the biennium beginning 
  8.12  July 1, 2001, from the general fund to the commissioner of human 
  8.13  services for the retired dentist program under Minnesota 
  8.14  Statutes, section 256.958. 
  8.15     (c) $....... is appropriated from the general fund to the 
  8.16  commissioner of human services for the biennium beginning July 
  8.17  1, 2001, for the increases in dental rates provided in Minnesota 
  8.18  Statutes, section 256B.76. 
  8.19     Sec. 6.  [REPEALER.] 
  8.20     Minnesota Statutes 2000, section 256B.037, subdivision 5, 
  8.21  is repealed. 
  8.22     Sec. 7.  [EFFECTIVE DATES.] 
  8.23     Sections 3 and 6 are effective January 1, 2002.