1.1                          A bill for an act 
  1.2             relating to health care; permitting dental hygienists 
  1.3             to practice certain services; establishing a retired 
  1.4             dentist program; creating a dental practice donation 
  1.5             program; requiring a plan to expand dental auxiliary 
  1.6             personnel; appropriating money; amending Minnesota 
  1.7             Statutes 2000, sections 150A.10, by adding a 
  1.8             subdivision; and 256B.76; proposing coding for new law 
  1.9             in Minnesota Statutes, chapter 256.  
  1.10  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.11     Section 1.  Minnesota Statutes 2000, section 150A.10, is 
  1.12  amended by adding a subdivision to read: 
  1.13     Subd. 1a.  [LIMITED AUTHORIZATION FOR DENTAL 
  1.14  HYGIENISTS.] (a) Notwithstanding subdivision 1, a dental 
  1.15  hygienist licensed under this chapter may be employed or 
  1.16  retained by a health care facility to perform dental hygienist 
  1.17  services described under paragraph (b) under general supervision 
  1.18  of a licensed dentist if the dental hygienist: 
  1.19     (1) has two years practical clinical experience with a 
  1.20  licensed dentist within the preceding five years; and 
  1.21     (2) has entered into a collaborative agreement with a 
  1.22  licensed dentist that designates authorization for the services 
  1.23  provided by the dental hygienist. 
  1.24     (b) The dental hygiene services authorized to be performed 
  1.25  by a dental hygienist under this subdivision are limited to 
  1.26  removal of deposits and stains from the surfaces of the teeth, 
  1.27  application of topical preventive or prophylactic agents, 
  2.1   polishing and smoothing restorations, and performance of root 
  2.2   planning and soft-tissue curettage.  The dental hygienist shall 
  2.3   not perform injections of anesthetic agents or the 
  2.4   administration of nitrous oxide, unless under the indirect 
  2.5   supervision of a licensed dentist.  The performance of dental 
  2.6   hygiene services in a health care facility is limited to 
  2.7   patients, students, and residents of the facility.  A dental 
  2.8   hygienist must refer patients to a licensed dentist for dental 
  2.9   diagnosis planning and dental treatment.  
  2.10     (c) A supervising dentist must be licensed under this 
  2.11  chapter and may enter into a collaborative agreement with more 
  2.12  than one dental hygienist.  The collaborative agreement must be 
  2.13  maintained by the dentist and the dental hygienist and must be 
  2.14  made available to the board upon request.  
  2.15     (d) For the purposes of this subdivision, a "health care 
  2.16  facility" is limited to a hospital; nursing home; home health 
  2.17  agency; group home serving the elderly, disabled, or juveniles; 
  2.18  state-operated facility licensed by the commissioner of human 
  2.19  services or the commissioner of corrections; and federal, state, 
  2.20  or local public health facility, community clinic, or tribal 
  2.21  clinic.  
  2.22     (e) For purposes of this subdivision, "general supervision" 
  2.23  means authorizing and accepting responsibility for the services 
  2.24  performed by the dental hygienist.  The services authorized 
  2.25  under this subdivision and the collaborative agreement may be 
  2.26  performed without the presence of the supervising dentist and 
  2.27  may be performed at a location other than the usual place of 
  2.28  practice of the dentist or dental hygienist.  
  2.29     Sec. 2.  [256.958] [RETIRED DENTIST PROGRAM.] 
  2.30     Subdivision 1.  [PROGRAM.] The commissioner of human 
  2.31  services shall establish a program to reimburse a retired 
  2.32  dentist for the dentist's license fee and for the reasonable 
  2.33  cost of malpractice insurance compared to other dentists in the 
  2.34  community in exchange for the dentist providing 100 hours of 
  2.35  dental services on a volunteer basis within a 12-month period at 
  2.36  a community dental clinic or a dental training clinic located at 
  3.1   a Minnesota state college or university.  
  3.2      Subd. 2.  [DOCUMENTATION.] Upon completion of the required 
  3.3   hours, the retired dentist shall submit to the commissioner the 
  3.4   following: 
  3.5      (1) documentation of service provided; 
  3.6      (2) the cost of malpractice insurance for the 12-month 
  3.7   period; and 
  3.8      (3) the cost of the license.  
  3.9      Subd. 3.  [REIMBURSEMENT.] Upon receipt of the information 
  3.10  described in subdivision 2, the commissioner shall provide 
  3.11  reimbursement to the retired dentist for the cost of malpractice 
  3.12  insurance for the previous six-month period and the cost of the 
  3.13  license.  
  3.14     Sec. 3.  [256.959] [DENTAL PRACTICE DONATION PROGRAM.] 
  3.15     Subdivision 1.  [ESTABLISHMENT.] The commissioner of human 
  3.16  services shall establish a dental practice donation program that 
  3.17  coordinates the donation of a qualifying dental practice to a 
  3.18  qualified charitable organization and a dentist licensed under 
  3.19  chapter 150A who wishes to maintain the dental practice.  
  3.20     Subd. 2.  [QUALIFYING DENTAL PRACTICE.] To qualify for the 
  3.21  dental practice donation program, a dental practice must meet 
  3.22  the following requirements: 
  3.23     (1) the dental practice must be owned by the donating 
  3.24  dentist; 
  3.25     (2) the dental practice must be located in a designated 
  3.26  underserved area of the state as defined by the commissioner; 
  3.27  and 
  3.28     (3) the practice must be equipped with the basic dental 
  3.29  equipment necessary to maintain a dental practice as determined 
  3.30  by the commissioner.  
  3.31     Subd. 3.  [COORDINATION.] The commissioner shall establish 
  3.32  a procedure for dentists to donate their dental practices to a 
  3.33  qualified charitable organization.  The commissioner shall 
  3.34  authorize a practice for donation only if it meets the 
  3.35  requirements of subdivision 2 and there is a licensed dentist 
  3.36  who is interested in entering into an agreement as described in 
  4.1   subdivision 4.  Upon donation of the practice, the commissioner 
  4.2   shall provide the donating dentist with a statement verifying 
  4.3   that a donation of the practice was made to a qualifying 
  4.4   charitable organization for purposes of state and federal income 
  4.5   tax returns.  
  4.6      Subd. 4.  [DONATED DENTAL PRACTICE AGREEMENT.] (a) A 
  4.7   dentist accepting the donated practice must enter into an 
  4.8   agreement with the qualified charitable organization to maintain 
  4.9   the dental practice for a minimum of five years at the donated 
  4.10  practice site and to provide services to underserved populations 
  4.11  up to a preagreed percentage of patients served.  
  4.12     (b) The agreement must include the terms for the recovery 
  4.13  of the donated dental practice if the dentist accepting the 
  4.14  practice does not fulfill the service commitment required under 
  4.15  this subdivision.  
  4.16     (c) Any costs associated with operating the dental practice 
  4.17  during the service commitment time period are the financial 
  4.18  responsibility of the dentist accepting the practice. 
  4.19     Sec. 4.  Minnesota Statutes 2000, section 256B.76, is 
  4.20  amended to read: 
  4.21     256B.76 [PHYSICIAN AND DENTAL REIMBURSEMENT.] 
  4.22     (a) Effective for services rendered on or after October 1, 
  4.23  1992, the commissioner shall make payments for physician 
  4.24  services as follows: 
  4.25     (1) payment for level one Health Care Finance 
  4.26  Administration's common procedural coding system (HCPCS) codes 
  4.27  titled "office and other outpatient services," "preventive 
  4.28  medicine new and established patient," "delivery, antepartum, 
  4.29  and postpartum care," "critical care," Caesarean cesarean 
  4.30  delivery and pharmacologic management provided to psychiatric 
  4.31  patients, and HCPCS level three codes for enhanced services for 
  4.32  prenatal high risk, shall be paid at the lower of (i) submitted 
  4.33  charges, or (ii) 25 percent above the rate in effect on June 30, 
  4.34  1992.  If the rate on any procedure code within these categories 
  4.35  is different than the rate that would have been paid under the 
  4.36  methodology in section 256B.74, subdivision 2, then the larger 
  5.1   rate shall be paid; 
  5.2      (2) payments for all other services shall be paid at the 
  5.3   lower of (i) submitted charges, or (ii) 15.4 percent above the 
  5.4   rate in effect on June 30, 1992; 
  5.5      (3) all physician rates shall be converted from the 50th 
  5.6   percentile of 1982 to the 50th percentile of 1989, less the 
  5.7   percent in aggregate necessary to equal the above increases 
  5.8   except that payment rates for home health agency services shall 
  5.9   be the rates in effect on September 30, 1992; 
  5.10     (4) effective for services rendered on or after January 1, 
  5.11  2000, payment rates for physician and professional services 
  5.12  shall be increased by three percent over the rates in effect on 
  5.13  December 31, 1999, except for home health agency and family 
  5.14  planning agency services; and 
  5.15     (5) the increases in clause (4) shall be implemented 
  5.16  January 1, 2000, for managed care. 
  5.17     (b) Effective for services rendered on or after October 1, 
  5.18  1992, the commissioner shall make payments for dental services 
  5.19  as follows: 
  5.20     (1) dental services shall be paid at the lower of (i) 
  5.21  submitted charges, or (ii) 25 percent above the rate in effect 
  5.22  on June 30, 1992; 
  5.23     (2) dental rates shall be converted from the 50th 
  5.24  percentile of 1982 to the 50th percentile of 1989, less the 
  5.25  percent in aggregate necessary to equal the above increases; 
  5.26     (3) effective for services rendered on or after January 1, 
  5.27  2000, payment rates for dental services shall be increased by 
  5.28  three percent over the rates in effect on December 31, 1999; 
  5.29     (4) the commissioner shall award grants to community 
  5.30  clinics or other nonprofit community organizations, political 
  5.31  subdivisions, professional associations, or other organizations 
  5.32  that demonstrate the ability to provide dental services 
  5.33  effectively to public program recipients.  Grants may be used to 
  5.34  fund the costs related to coordinating access for recipients, 
  5.35  developing and implementing patient care criteria, upgrading or 
  5.36  establishing new facilities, acquiring furnishings or equipment, 
  6.1   recruiting new providers, or other development costs that will 
  6.2   improve access to dental care in a region.  In awarding grants, 
  6.3   the commissioner shall give priority to applicants that plan to 
  6.4   serve areas of the state in which the number of dental providers 
  6.5   is not currently sufficient to meet the needs of recipients of 
  6.6   public programs or uninsured individuals.  The commissioner 
  6.7   shall consider the following in awarding the grants:  (i) 
  6.8   potential to successfully increase access to an underserved 
  6.9   population; (ii) the ability to raise matching funds; (iii) the 
  6.10  long-term viability of the project to improve access beyond the 
  6.11  period of initial funding; (iv) the efficiency in the use of the 
  6.12  funding; and (v) the experience of the proposers in providing 
  6.13  services to the target population. 
  6.14     The commissioner shall monitor the grants and may terminate 
  6.15  a grant if the grantee does not increase dental access for 
  6.16  public program recipients.  The commissioner shall consider 
  6.17  grants for the following: 
  6.18     (i) implementation of new programs or continued expansion 
  6.19  of current access programs that have demonstrated success in 
  6.20  providing dental services in underserved areas; 
  6.21     (ii) a pilot program for utilizing hygienists outside of a 
  6.22  traditional dental office to provide dental hygiene services; 
  6.23  and 
  6.24     (iii) a program that organizes a network of volunteer 
  6.25  dentists, establishes a system to refer eligible individuals to 
  6.26  volunteer dentists, and through that network provides donated 
  6.27  dental care services to public program recipients or uninsured 
  6.28  individuals. 
  6.29     (5) beginning October 1, 1999, the payment for tooth 
  6.30  sealants and fluoride treatments shall be the lower of (i) 
  6.31  submitted charge, or (ii) 80 percent of median 1997 charges; and 
  6.32     (6) the increases listed in clauses (3) and (5) shall be 
  6.33  implemented January 1, 2000, for managed care; and 
  6.34     (7) beginning July 1, 2001, a dental provider shall be 
  6.35  reimbursed for the dental services actually provided to a 
  6.36  patient when the dental work scheduled requires more than one 
  7.1   appointment and the patient fails to keep the subsequent 
  7.2   appointment or appointments.  
  7.3      (c) An entity that operates both a Medicare certified 
  7.4   comprehensive outpatient rehabilitation facility and a facility 
  7.5   which was certified prior to January 1, 1993, that is licensed 
  7.6   under Minnesota Rules, parts 9570.2000 to 9570.3600, and for 
  7.7   whom at least 33 percent of the clients receiving rehabilitation 
  7.8   services in the most recent calendar year are medical assistance 
  7.9   recipients, shall be reimbursed by the commissioner for 
  7.10  rehabilitation services at rates that are 38 percent greater 
  7.11  than the maximum reimbursement rate allowed under paragraph (a), 
  7.12  clause (2), when those services are (1) provided within the 
  7.13  comprehensive outpatient rehabilitation facility and (2) 
  7.14  provided to residents of nursing facilities owned by the entity. 
  7.15     Sec. 5.  [DENTAL RESTORATIVE PRACTITIONER; FOREIGN-TRAINED 
  7.16  DENTISTS; DENTAL CLINICS.] 
  7.17     Subdivision 1.  [DEVELOPMENT.] (a) The board of dentistry, 
  7.18  in consultation with the University of Minnesota school of 
  7.19  dentistry, the Minnesota state colleges and universities that 
  7.20  offer a dental auxiliary training program, the commissioner of 
  7.21  health, and licensed dentists and dental hygienists practicing 
  7.22  in private practice and at community clinics, shall develop a 
  7.23  new dental auxiliary category entitled "dental restorative 
  7.24  practitioner."  The dental restorative practitioner shall work 
  7.25  in collaboration with a licensed dentist to provide cavity 
  7.26  preparations and restorations and any other selected technical 
  7.27  skills the board deems appropriate.  The board shall establish a 
  7.28  standard of practice and necessary educational qualifications 
  7.29  for a dental restorative practitioner. 
  7.30     (b) The board shall make recommendations to amend Minnesota 
  7.31  Statutes, chapter 150A, to permit foreign-trained dentists to 
  7.32  practice as a dental hygienist or as a dental restorative 
  7.33  practitioner.  
  7.34     (c) The board shall submit the proposed changes to 
  7.35  Minnesota Statutes, chapter 150A, to the legislature by January 
  7.36  15, 2002.  
  8.1      Subd. 2.  [TRAINING CURRICULUM.] The Minnesota state 
  8.2   colleges and universities, in consultation with the board of 
  8.3   dentistry, shall develop a training curriculum for the dental 
  8.4   restorative practitioner to meet the educational requirements 
  8.5   set by the board under subdivision 1.  
  8.6      Subd. 3.  [DENTAL CLINICS.] The commissioner of health, in 
  8.7   consultation with the Minnesota state colleges and universities, 
  8.8   shall determine the capital improvements needed to establish 
  8.9   community-based dental clinics at state colleges and 
  8.10  universities to be used as training sites and as public 
  8.11  community-based dental clinics for public program recipients 
  8.12  during times when the school is not in session and the clinic is 
  8.13  not in use.  The commissioner shall submit the necessary capital 
  8.14  improvement costs for start-up equipment and necessary 
  8.15  infrastructure as part of the 2002 legislative capital budget 
  8.16  requests. 
  8.17     Sec. 6.  [APPROPRIATION.] 
  8.18     $....... is appropriated for the biennium beginning July 1, 
  8.19  2001, from the general fund to the commissioner of human 
  8.20  services for the retired dentist program under section 2.