1.1                          A bill for an act 
  1.2             relating to health; modifying dental practice 
  1.3             provisions; amending Minnesota Statutes 2002, sections 
  1.4             144.1502, subdivisions 3, 4; 150A.06, by adding a 
  1.5             subdivision; 150A.10, subdivision 1a; 256B.037, by 
  1.6             adding a subdivision; 256B.76; proposing coding for 
  1.7             new law in Minnesota Statutes, chapters 150A; 256B. 
  1.8   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.9      Section 1.  Minnesota Statutes 2002, section 144.1502, 
  1.10  subdivision 3, is amended to read: 
  1.11     Subd. 3.  [ELIGIBILITY.] To be eligible to participate in 
  1.12  the loan forgiveness program, a dental student must submit an 
  1.13  application to the commissioner of health while attending a 
  1.14  program of study designed to prepare the individual to become a 
  1.15  licensed dentist.  For fiscal year 2002, applicants may have 
  1.16  graduated from a dentistry program in calendar year 2001.  A 
  1.17  dental student who is accepted into the loan forgiveness program 
  1.18  must sign a contract to agree to serve a minimum three-year 
  1.19  service obligation during which at least 25 20 percent of the 
  1.20  dentist's yearly patient encounters are delivered to state 
  1.21  public program enrollees or patients receiving sliding fee 
  1.22  schedule discounts through a formal sliding fee schedule meeting 
  1.23  the standards established by the United States Department of 
  1.24  Health and Human Services under Code of Federal Regulations, 
  1.25  title 42, section 51, chapter 303.  The service obligation shall 
  1.26  begin no later than March 31 of the first year following 
  2.1   completion of training.  If fewer applications are submitted by 
  2.2   dental students than there are participant slots available, the 
  2.3   commissioner may consider applications submitted by dental 
  2.4   program graduates who are licensed dentists.  Dentists selected 
  2.5   for loan forgiveness must comply with all terms and conditions 
  2.6   of this section.  
  2.7      Sec. 2.  Minnesota Statutes 2002, section 144.1502, 
  2.8   subdivision 4, is amended to read: 
  2.9      Subd. 4.  [LOAN FORGIVENESS.] The commissioner of health 
  2.10  may accept up to 14 seven applicants per year for participation 
  2.11  in the loan forgiveness program.  Applicants are responsible for 
  2.12  securing their own loans.  The commissioner shall select 
  2.13  participants based on their suitability for practice serving 
  2.14  public program patients, as indicated by experience or 
  2.15  training.  In selecting participants, the commissioner shall 
  2.16  first consider potential practice locations in geographic areas 
  2.17  of the state with the greatest need for dental care services to 
  2.18  medical assistance, general assistance medical care, and 
  2.19  MinnesotaCare program recipients.  The commissioner shall give 
  2.20  preference to applicants who have attended a Minnesota dentistry 
  2.21  educational institution and to applicants closest to completing 
  2.22  their training.  For each year that a participant meets the 
  2.23  service obligation required under subdivision 3, up to a maximum 
  2.24  of four years, the commissioner shall make annual disbursements 
  2.25  directly to the participant equivalent to $10,000 $20,000 per 
  2.26  year of service, not to exceed $40,000 $80,000 or the balance of 
  2.27  the qualifying educational loans, whichever is less.  Before 
  2.28  receiving loan repayment disbursements and as requested, the 
  2.29  participant must complete and return to the commissioner an 
  2.30  affidavit of practice form provided by the commissioner 
  2.31  verifying that the participant is practicing as required under 
  2.32  subdivision 3.  The participant must provide the commissioner 
  2.33  with verification that the full amount of loan repayment 
  2.34  disbursement received by the participant has been applied toward 
  2.35  the designated loans.  After each disbursement, verification 
  2.36  must be received by the commissioner and approved before the 
  3.1   next loan repayment disbursement is made.  Participants who move 
  3.2   their practice remain eligible for loan repayment as long as 
  3.3   they practice as required under subdivision 3. 
  3.4      Sec. 3.  Minnesota Statutes 2002, section 150A.06, is 
  3.5   amended by adding a subdivision to read: 
  3.6      Subd. 2d.  [VOLUNTEER AND RETIRED DENTISTS.] The board 
  3.7   shall grant an exemption to the continuing education 
  3.8   requirements under this chapter for a dentist who documents to 
  3.9   the satisfaction of the board that the dentist has retired from 
  3.10  active practice in the state and limits the provision of dental 
  3.11  services to those offered without reimbursement in a public 
  3.12  health, community or tribal clinic or a nonprofit organization 
  3.13  that provides services to the indigent or to recipients of the 
  3.14  medical assistance, general assistance medical care, or 
  3.15  MinnesotaCare programs.  The board may require written 
  3.16  documentation from the volunteer retired dentist prior to 
  3.17  granting this exemption. 
  3.18     Sec. 4.  Minnesota Statutes 2002, section 150A.10, 
  3.19  subdivision 1a, is amended to read: 
  3.20     Subd. 1a.  [LIMITED AUTHORIZATION FOR DENTAL HYGIENISTS.] 
  3.21  (a) Notwithstanding subdivision 1, a dental hygienist licensed 
  3.22  under this chapter may be employed or retained by a health care 
  3.23  facility, program, or organization to perform dental hygiene 
  3.24  services described under paragraph (b) without the patient first 
  3.25  being examined by a licensed dentist if the dental hygienist: 
  3.26     (1) has two years practical clinical experience with a 
  3.27  licensed dentist within the preceding five years been engaged in 
  3.28  the active practice of clinical dental hygiene for not less than 
  3.29  2,400 hours in the past 18 months or a total of 3,000 hours in 
  3.30  active practice with a minimum of 200 hours of clinical practice 
  3.31  in two of the past three years; and 
  3.32     (2) has entered into a collaborative agreement with a 
  3.33  licensed dentist that designates authorization for the services 
  3.34  provided by the dental hygienist; 
  3.35     (3) has documented participation in courses in infection 
  3.36  control and medical emergencies within the hygienist's current 
  4.1   continuing education cycle; and 
  4.2      (4) has completed within the past two years an advanced or 
  4.3   basic cardiac life support course recognized by the American 
  4.4   Heart Association, the American Red Cross, or another agency 
  4.5   whose courses are equivalent to the American Health Association 
  4.6   or American Red Cross courses. 
  4.7      (b) The dental hygiene services authorized to be performed 
  4.8   by a dental hygienist under this subdivision are limited to oral 
  4.9   health promotion and disease prevention education, removal of 
  4.10  deposits and stains from the surfaces of the teeth, application 
  4.11  of topical preventive or prophylactic agents, including fluoride 
  4.12  varnishes and pit and fissure sealants, polishing and smoothing 
  4.13  restorations, removal of marginal overhangs, performance of 
  4.14  preliminary charting, taking of radiographs, and performance of 
  4.15  root planing and soft-tissue curettage.  The dental hygienist 
  4.16  shall not place pit and fissure sealants, unless the patient has 
  4.17  been recently examined and the treatment planned by a licensed 
  4.18  dentist.  The dental hygienist shall not perform injections of 
  4.19  anesthetic agents or the administration of nitrous oxide unless 
  4.20  under the indirect supervision of a licensed dentist.  Dental 
  4.21  hygienists working under a collaborative agreement with a 
  4.22  licensed dentist may work with dental assistants who may perform 
  4.23  duties for which registration is not required.  The performance 
  4.24  of dental hygiene services in a health care facility is limited 
  4.25  to patients, students, and residents of the facility. 
  4.26     (c) A collaborating dentist must be licensed under this 
  4.27  chapter and may enter into a collaborative agreement with no 
  4.28  more than four dental hygienists.  The collaborative agreement 
  4.29  must include: 
  4.30     (1) consideration for medically compromised patients and 
  4.31  medical conditions for which a dental evaluation and treatment 
  4.32  plan must occur prior to the provision of dental hygiene 
  4.33  services; and 
  4.34     (2) age and procedure-specific standard collaborative 
  4.35  practice protocols, including recommended intervals for the 
  4.36  performance of dental hygiene services, and a period of time in 
  5.1   which an examination by a dentist should occur; and 
  5.2      (3) copies of consents to treatment forms, which must 
  5.3   include a statement advising that dental hygiene services do not 
  5.4   substitute for a complete dental examination by a dentist. 
  5.5   The collaborative agreement must be maintained by the dentist 
  5.6   and, the dental hygienist, and the facility, program, or 
  5.7   organization; must be reviewed and updated annually; and must be 
  5.8   made available to the board upon request.  
  5.9      (d) For the purposes of this subdivision, a "health care 
  5.10  facility, program, or organization" is limited to a hospital; 
  5.11  nursing home; home health agency; group home serving the 
  5.12  elderly, disabled, or juveniles; state-operated facility 
  5.13  licensed by the commissioner of human services or the 
  5.14  commissioner of corrections; and federal, state, or local public 
  5.15  health facility, community clinic, or tribal clinic, school 
  5.16  district, Head Start program, or nonprofit organization that 
  5.17  serves recipients of the medical assistance, general assistance 
  5.18  medical care, or MinnesotaCare programs.  
  5.19     (e) For purposes of this subdivision, a "collaborative 
  5.20  agreement" means a written agreement with a licensed dentist who 
  5.21  authorizes and accepts responsibility for the services performed 
  5.22  by the dental hygienist.  The services authorized under this 
  5.23  subdivision and the collaborative agreement may be performed 
  5.24  without the presence of a licensed dentist and may be performed 
  5.25  at a location other than the usual place of practice of the 
  5.26  dentist or dental hygienist and without a dentist's diagnosis 
  5.27  and treatment plan, unless specified in the collaborative 
  5.28  agreement. 
  5.29     Sec. 5.  [150A.23] [DONATED DENTAL SERVICES.] 
  5.30     (a) The commissioner of health shall contract with the 
  5.31  Minnesota Dental Association, the National Foundation of 
  5.32  Dentistry for the Handicapped, or another appropriate and 
  5.33  qualified organization to develop and operate a donated dental 
  5.34  services program to provide dental care to public program 
  5.35  recipients and the uninsured dentists who volunteer their 
  5.36  services without compensation.  As part of the contract, the 
  6.1   commissioner shall include specific performance and outcome 
  6.2   measures that the contracting organization must meet.  The 
  6.3   donated dental services program must: 
  6.4      (1) establish a network of volunteer dentists, including 
  6.5   dental specialties, to donate dental services to eligible 
  6.6   individuals; 
  6.7      (2) establish a system to refer eligible individuals to the 
  6.8   appropriate volunteer dentists; and 
  6.9      (3) develop and implement a public awareness campaign to 
  6.10  educate eligible individuals about the availability of the 
  6.11  program. 
  6.12     (b) Funding for the program may be used for administrative 
  6.13  or technical support.  The organization contracting with the 
  6.14  commissioner shall provide an annual report that accounts for 
  6.15  funding appropriated to the program by the state, documents the 
  6.16  number of individuals served by the program and the number of 
  6.17  dentists participating as program providers, and provides data 
  6.18  on meeting the specific performance and outcome measures 
  6.19  identified by the board. 
  6.20     Sec. 6.  Minnesota Statutes 2002, section 256B.037, is 
  6.21  amended by adding a subdivision to read: 
  6.22     Subd. 1d.  [SINGLE DENTAL BENEFIT ADMINISTRATOR.] Beginning 
  6.23  with dental care services provided after July 1, 2005, the 
  6.24  commissioner shall contract for the provision of dental services 
  6.25  with a single entity in each county or group of counties 
  6.26  providing dental care to recipients of the medical assistance, 
  6.27  general assistance medical care, and MinnesotaCare programs.  
  6.28  The commissioner may elect to have the department act as the 
  6.29  dental plan administrator in counties where a sole plan 
  6.30  administrator is not available or feasible.  The commissioner 
  6.31  shall seek any federal waivers or approvals necessary to 
  6.32  implement this section from the secretary of health and human 
  6.33  services. 
  6.34     Sec. 7.  [256B.555] [URGENT CARE DENTAL CLINIC.] 
  6.35     The commissioner shall research and develop a proposal for 
  6.36  the construction and operation of an urgent care dental clinic 
  7.1   within the Twin Cities metropolitan area.  The commissioner 
  7.2   shall also study the feasibility of one or more urgent care 
  7.3   dental clinics outside the Twin Cities metropolitan area.  The 
  7.4   primary purpose of an urgent care dental clinic is to provide 
  7.5   recipients of medical assistance, general assistance medical 
  7.6   care, and MinnesotaCare with an alternative to receiving dental 
  7.7   care services in hospital emergency rooms.  The commissioner 
  7.8   shall determine if savings from the reduction in dental care 
  7.9   provided in emergency rooms would warrant the construction of 
  7.10  urgent care facilities.  The commissioner may seek funding for 
  7.11  the construction and operation of a dental urgent care clinic 
  7.12  from the federal government as authorized by Congress under the 
  7.13  dental health improvement provisions of the Health Care Safety 
  7.14  Net Improvement Act of 2002. 
  7.15     Sec. 8.  Minnesota Statutes 2002, section 256B.76, is 
  7.16  amended to read: 
  7.17     256B.76 [PHYSICIAN AND DENTAL REIMBURSEMENT.] 
  7.18     (a) Effective for services rendered on or after October 1, 
  7.19  1992, the commissioner shall make payments for physician 
  7.20  services as follows: 
  7.21     (1) payment for level one Centers for Medicare and Medicaid 
  7.22  Services' common procedural coding system codes titled "office 
  7.23  and other outpatient services," "preventive medicine new and 
  7.24  established patient," "delivery, antepartum, and postpartum 
  7.25  care," "critical care," cesarean delivery and pharmacologic 
  7.26  management provided to psychiatric patients, and level three 
  7.27  codes for enhanced services for prenatal high risk, shall be 
  7.28  paid at the lower of (i) submitted charges, or (ii) 25 percent 
  7.29  above the rate in effect on June 30, 1992.  If the rate on any 
  7.30  procedure code within these categories is different than the 
  7.31  rate that would have been paid under the methodology in section 
  7.32  256B.74, subdivision 2, then the larger rate shall be paid; 
  7.33     (2) payments for all other services shall be paid at the 
  7.34  lower of (i) submitted charges, or (ii) 15.4 percent above the 
  7.35  rate in effect on June 30, 1992; 
  7.36     (3) all physician rates shall be converted from the 50th 
  8.1   percentile of 1982 to the 50th percentile of 1989, less the 
  8.2   percent in aggregate necessary to equal the above increases 
  8.3   except that payment rates for home health agency services shall 
  8.4   be the rates in effect on September 30, 1992; 
  8.5      (4) effective for services rendered on or after January 1, 
  8.6   2000, payment rates for physician and professional services 
  8.7   shall be increased by three percent over the rates in effect on 
  8.8   December 31, 1999, except for home health agency and family 
  8.9   planning agency services; and 
  8.10     (5) the increases in clause (4) shall be implemented 
  8.11  January 1, 2000, for managed care. 
  8.12     (b) Effective for services rendered on or after October 1, 
  8.13  1992, the commissioner shall make payments for dental services 
  8.14  as follows: 
  8.15     (1) dental services shall be paid at the lower of (i) 
  8.16  submitted charges, or (ii) 25 percent above the rate in effect 
  8.17  on June 30, 1992; 
  8.18     (2) dental rates shall be converted from the 50th 
  8.19  percentile of 1982 to the 50th percentile of 1989, less the 
  8.20  percent in aggregate necessary to equal the above increases; 
  8.21     (3) effective for services rendered on or after January 1, 
  8.22  2000, payment rates for dental services shall be increased by 
  8.23  three percent over the rates in effect on December 31, 1999; 
  8.24     (4) the commissioner shall award grants to community 
  8.25  clinics or other nonprofit community organizations, political 
  8.26  subdivisions, professional associations, or other organizations 
  8.27  that demonstrate the ability to provide dental services 
  8.28  effectively to public program recipients.  Grants may be used to 
  8.29  fund the costs related to coordinating access for recipients, 
  8.30  developing and implementing patient care criteria, upgrading or 
  8.31  establishing new facilities, acquiring furnishings or equipment, 
  8.32  recruiting new providers, or other development costs that will 
  8.33  improve access to dental care in a region.  In awarding grants, 
  8.34  the commissioner shall give priority to applicants that plan to 
  8.35  serve areas of the state in which the number of dental providers 
  8.36  is not currently sufficient to meet the needs of recipients of 
  9.1   public programs or uninsured individuals.  The commissioner 
  9.2   shall consider the following in awarding the grants: 
  9.3      (i) potential to successfully increase access to an 
  9.4   underserved population; 
  9.5      (ii) the ability to raise matching funds; 
  9.6      (iii) the long-term viability of the project to improve 
  9.7   access beyond the period of initial funding; 
  9.8      (iv) the efficiency in the use of the funding; and 
  9.9      (v) the experience of the proposers in providing services 
  9.10  to the target population. 
  9.11     The commissioner shall monitor the grants and may terminate 
  9.12  a grant if the grantee does not increase dental access for 
  9.13  public program recipients.  The commissioner shall consider 
  9.14  grants for the following: 
  9.15     (i) implementation of new programs or continued expansion 
  9.16  of current access programs that have demonstrated success in 
  9.17  providing dental services in underserved areas; 
  9.18     (ii) a pilot program for utilizing hygienists outside of a 
  9.19  traditional dental office to provide dental hygiene services; 
  9.20  and 
  9.21     (iii) a program that organizes a network of volunteer 
  9.22  dentists, establishes a system to refer eligible individuals to 
  9.23  volunteer dentists, and through that network provides donated 
  9.24  dental care services to public program recipients or uninsured 
  9.25  individuals; 
  9.26     (5) beginning October 1, 1999, the payment for tooth 
  9.27  sealants and fluoride treatments shall be the lower of (i) 
  9.28  submitted charge, or (ii) 80 percent of median 1997 charges; 
  9.29     (6) the increases listed in clauses (3) and (5) shall be 
  9.30  implemented January 1, 2000, for managed care; and 
  9.31     (7) effective for services provided on or after January 1, 
  9.32  2002, payment for diagnostic examinations and dental x-rays 
  9.33  provided to children under age 21 shall be the lower of (i) the 
  9.34  submitted charge, or (ii) 85 percent of median 1999 charges.  
  9.35     (c) Effective for dental services rendered on or after 
  9.36  January 1, 2002, the commissioner may, within the limits of 
 10.1   available appropriation, increase reimbursements to dentists and 
 10.2   dental clinics deemed by the commissioner to be critical access 
 10.3   dental providers.  Reimbursement to a critical access dental 
 10.4   provider may be increased by not more than 50 percent above the 
 10.5   reimbursement rate that would otherwise be paid to the 
 10.6   provider.  Payments to health plan companies shall be adjusted 
 10.7   to reflect increased reimbursements to critical access dental 
 10.8   providers as approved by the commissioner.  In determining which 
 10.9   dentists and dental clinics shall be deemed critical access 
 10.10  dental providers, the commissioner shall review: 
 10.11     (1) the utilization rate in the service area in which the 
 10.12  dentist or dental clinic operates for dental services to 
 10.13  patients covered by medical assistance, general assistance 
 10.14  medical care, or MinnesotaCare as their primary source of 
 10.15  coverage; 
 10.16     (2) the level of services provided by the dentist or dental 
 10.17  clinic to patients covered by medical assistance, general 
 10.18  assistance medical care, or MinnesotaCare as their primary 
 10.19  source of coverage; and 
 10.20     (3) whether the level of services provided by the dentist 
 10.21  or dental clinic is critical to maintaining adequate levels of 
 10.22  patient access within the service area. 
 10.23  In the absence of a critical access dental provider in a service 
 10.24  area, the commissioner may designate a dentist or dental clinic 
 10.25  as a critical access dental provider if the dentist or dental 
 10.26  clinic is willing to provide care to patients covered by medical 
 10.27  assistance, general assistance medical care, or MinnesotaCare at 
 10.28  a level which significantly increases access to dental care in 
 10.29  the service area.  In awarding critical access determinations 
 10.30  within available appropriations, the commissioner shall first 
 10.31  consider geographic areas of the state with the greatest need 
 10.32  for dental care services to medical assistance, general 
 10.33  assistance medical care, and MinnesotaCare recipients. 
 10.34     (d) Effective July 1, 2001, the medical assistance rates 
 10.35  for outpatient mental health services provided by an entity that 
 10.36  operates: 
 11.1      (1) a Medicare-certified comprehensive outpatient 
 11.2   rehabilitation facility; and 
 11.3      (2) a facility that was certified prior to January 1, 1993, 
 11.4   with at least 33 percent of the clients receiving rehabilitation 
 11.5   services in the most recent calendar year who are medical 
 11.6   assistance recipients, will be increased by 38 percent, when 
 11.7   those services are provided within the comprehensive outpatient 
 11.8   rehabilitation facility and provided to residents of nursing 
 11.9   facilities owned by the entity. 
 11.10     (e) An entity that operates both a Medicare certified 
 11.11  comprehensive outpatient rehabilitation facility and a facility 
 11.12  which was certified prior to January 1, 1993, that is licensed 
 11.13  under Minnesota Rules, parts 9570.2000 to 9570.3600, and for 
 11.14  whom at least 33 percent of the clients receiving rehabilitation 
 11.15  services in the most recent calendar year are medical assistance 
 11.16  recipients, shall be reimbursed by the commissioner for 
 11.17  rehabilitation services at rates that are 38 percent greater 
 11.18  than the maximum reimbursement rate allowed under paragraph (a), 
 11.19  clause (2), when those services are (1) provided within the 
 11.20  comprehensive outpatient rehabilitation facility and (2) 
 11.21  provided to residents of nursing facilities owned by the entity.