HF 2690

Introduction - 94th Legislature (2025 - 2026)

Posted on 03/24/2025 03:03 p.m.

A bill for an act
relating to health care; modifying medical assistance dental provisions; amending
Minnesota Statutes 2024, sections 256B.0371, subdivision 3; 256B.0625,
subdivision 3c.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2024, section 256B.0371, subdivision 3, is amended to read:

Subd. 3.

Contingent contract with dental administrator.

(a) The commissioner shall
determine the extent to which managed care and county-based purchasing plans in the
aggregate meet the performance benchmark specified in subdivision 1 for coverage year
2024. If managed care and county-based purchasing plans in the aggregate fail to meet the
performance benchmark, the commissioner, after issuing a request for information followed
by a request for proposals, shall contract with a dental administrator to administer dental
services beginning January 1, 2026, for all recipients of medical assistance and
MinnesotaCare, including persons served under fee-for-service and persons receiving
services through managed care and county-based purchasing plans.

(b) The dental administrator must provide administrative services, including but not
limited to:

(1) provider recruitment, contracting, and assistance;

(2) recipient outreach and assistance;

(3) utilization management and reviews of medical necessity for dental services;

(4) dental claims processing;

(5) coordination of dental care with other services;

(6) management of fraud and abuse;

(7) monitoring access to dental services;

(8) performance measurement;

(9) quality improvement and evaluation; and

(10) management of third-party liability requirements.

(c) Dental administrator payments to contracted dental providers must be at deleted text begin the deleted text end rates
deleted text begin established under sections 256B.76 and 256L.11 deleted text end new text begin at least equal to the average rates paid by
managed care plans and county-based purchasing plans for coverage year 2024 new text end .

(d) Recipients must be given a choice of dental provider, including any provider who
agrees to provider participation requirements and payment rates established by the
commissioner and dental administrator. The dental administrator must comply with the
network adequacy and geographic access requirements that apply to managed care and
county-based purchasing plans for dental services under section 62K.14.

(e) The contract with the dental administrator must include a provision that states that
if the dental administrator fails to meet, by calendar year 2029, a performance benchmark
under which at least 55 percent of children and adults who were continuously enrolled for
at least 11 months in either medical assistance or MinnesotaCare received at least one dental
visit during the calendar year, the contract must be terminated and the commissioner must
enter into a contract with a new dental administrator as soon as practicable.

(f) The commissioner shall implement this subdivision in consultation with representatives
of providers who provide dental services to patients enrolled in medical assistance or
MinnesotaCare, including but not limited to providers serving primarily low-income and
socioeconomically complex populations, and with representatives of managed care plans
and county-based purchasing plans.

Sec. 2.

Minnesota Statutes 2024, section 256B.0625, subdivision 3c, is amended to read:

Subd. 3c.

Health Services Advisory Council.

(a) The commissioner, after receiving
recommendations from professional physician associations, professional associations
representing licensed nonphysician health care professionals, and consumer groups, shall
establish a 14-member Health Services Advisory Council, which consists of 13 voting
members and one nonvoting member. The Health Services Advisory Council shall advise
the commissioner regarding (1) health services pertaining to the administration of health
care benefits covered under Minnesota health care programs (MHCP); and (2) evidence-based
decision-making and health care benefit and coverage policies for MHCP. The Health
Services Advisory Council shall consider available evidence regarding quality, safety, and
cost-effectiveness when advising the commissioner. The Health Services Advisory Council
shall meet at least quarterly. The Health Services Advisory Council shall annually select a
chair from among its members who shall work directly with the commissioner's medical
director to establish the agenda for each meeting. The Health Services Advisory Council
may recommend criteria for verifying centers of excellence for specific aspects of medical
care where a specific set of combined services, a volume of patients necessary to maintain
a high level of competency, or a specific level of technical capacity is associated with
improved health outcomes.

(b) The commissioner shall establish a dental subcouncil to operate under the Health
Services Advisory Council. The dental subcouncil consists of general dentists, dental
specialists, safety net providers, dental hygienists, deleted text begin health plan company and deleted text end county and
public health representatives, health researchers, consumers, and a designee of the
commissioner of health. The dental subcouncil shall advise the commissioner regarding:

(1) the critical access dental program under section 256B.76, subdivision 4, including
but not limited to criteria for designating and terminating critical access dental providers;

(2) any changes to the critical access dental provider program necessary to comply with
program expenditure limits;

(3) dental coverage policy based on evidence, quality, continuity of care, and best
practices;

(4) the development of dental delivery models; deleted text begin and
deleted text end

(5) dental services to be added or eliminated from subdivision 9 deleted text begin . deleted text end new text begin ; and
new text end

new text begin (6) the availability of dental services under MHCP and policies to improve MHCP
recipients' access to the services.
new text end

(c) The Health Services Advisory Council may monitor and track the practice patterns
of health care providers who serve MHCP recipients under fee-for-service, managed care,
and county-based purchasing. The monitoring and tracking shall focus on services or
specialties for which there is a high variation in utilization or quality across providers, or
which are associated with high medical costs. The commissioner, based upon the findings
of the Health Services Advisory Council, may notify providers whose practice patterns
indicate below average quality or higher than average utilization or costs. Managed care
and county-based purchasing plans shall provide the commissioner with utilization and cost
data necessary to implement this paragraph, and the commissioner shall make these data
available to the Health Services Advisory Council.

Sec. 3. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES; PAYMENTS
FOR DENTAL SERVICES.
new text end

new text begin Upon implementation of a dental administrator administering dental services for all
recipients of medical assistance and MinnesotaCare, the commissioner of human services
must ensure the portion of the capitation rate paid to managed care organizations and
county-based purchasing plans under medical assistance and MinnesotaCare attributable to
the provision of dental services is directed toward the rates the dental administrator must
pay dental providers under Minnesota Statutes, section 256B.0371, subdivision 3, paragraph
(c).
new text end