1.1 	A bill for an act
1.2 	relating to health; modifying medical assistance to cover pediatric zirconia crowns;
1.3 	amending Minnesota Statutes 2022, section 256B.0625, subdivision 9.
1.4 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.5 	Section 1. Minnesota Statutes 2022, section 256B.0625, subdivision 9, is amended to read:
1.6 		Subd. 9.Dental services. (a) Medical assistance covers dental services.
1.7 	(b) Medical assistance dental coverage for nonpregnant adults is limited to the following 
1.8 	services:
1.9 	(1) comprehensive exams, limited to once every five years;
1.10 	(2) periodic exams, limited to one per year;
1.11 	(3) limited exams;
1.12 	(4) bitewing x-rays, limited to one per year;
1.13 	(5) periapical x-rays;
1.14 	(6) panoramic x-rays, limited to one every five years except (1) when medically necessary 
1.15 	for the diagnosis and follow-up of oral and maxillofacial pathology and trauma or (2) once 
1.16 	every two years for patients who cannot cooperate for intraoral film due to a developmental 
1.17 	disability or medical condition that does not allow for intraoral film placement;
1.18 	(7) prophylaxis, limited to one per year;
1.19 	(8) application of fluoride varnish, limited to one per year;
1.20 	(9) posterior fillings, all at the amalgam rate;
2.1 	(10) anterior fillings;
2.2 	(11) endodontics, limited to root canals on the anterior and premolars only;
2.3 	(12) removable prostheses, each dental arch limited to one every six years;
2.4 	(13) oral surgery, limited to extractions, biopsies, and incision and drainage of abscesses;
2.5 	(14) palliative treatment and sedative fillings for relief of pain;
2.6 	(15) full-mouth debridement, limited to one every five years; and
2.7 	(16) nonsurgical treatment for periodontal disease, including scaling and root planing 
2.8 	once every two years for each quadrant, and routine periodontal maintenance procedures.
2.9 	(c) In addition to the services specified in paragraph (b), medical assistance covers the 
2.10 	following services for adults, if provided in an outpatient hospital setting or freestanding 
2.11 	ambulatory surgical center as part of outpatient dental surgery:
2.12 	(1) periodontics, limited to periodontal scaling and root planing once every two years;
2.13 	(2) general anesthesia; and
2.14 	(3) full-mouth survey once every five years.
2.15 	(d) Medical assistance covers medically necessary dental services for children and 
2.16 	pregnant women. The following guidelines apply:
2.17 	(1) posterior fillings are paid at the amalgam rate;
2.18 	(2) application of sealants are covered once every five years per permanent molar for 
2.19 	children only;
2.20 	(3) application of fluoride varnish is covered once every six months; and
2.21 	(4) orthodontia is eligible for coverage for children only.
2.22 	(e) In addition to the services specified in paragraphs (b) and (c), medical assistance 
2.23 	covers the following services for adults:
2.24 	(1) house calls or extended care facility calls for on-site delivery of covered services;
2.25 	(2) behavioral management when additional staff time is required to accommodate 
2.26 	behavioral challenges and sedation is not used;
2.27 	(3) oral or IV sedation, if the covered dental service cannot be performed safely without 
2.28 	it or would otherwise require the service to be performed under general anesthesia in a 
2.29 	hospital or surgical center; and
3.1 	(4) prophylaxis, in accordance with an appropriate individualized treatment plan, but 
3.2 	no more than four times per year.
3.3 	(f) In addition to the services specified in paragraph (d), medical assistance covers 
3.4 	pediatric zirconia crowns for children.
3.5 	(f) (g) The commissioner shall not require prior authorization for the services included 
3.6 	in paragraph (e), clauses (1) to (3), and shall prohibit managed care and county-based 
3.7 	purchasing plans from requiring prior authorization for the services included in paragraph 
3.8 	(e), clauses (1) to (3), when provided under sections 256B.69, 256B.692, and 256L.12.