SF 4553
Introduction - 94th Legislature (2025 - 2026)
Posted on 03/19/2026 09:04 a.m.
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A bill for an act
relating to human services; modifying medical assistance reimbursement rates for
dental services and critical access dental providers; amending Minnesota Statutes
2024, section 256B.76, subdivisions 2, 4.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1.
Minnesota Statutes 2024, section 256B.76, subdivision 2, is amended to read:
Subd. 2.
Dental reimbursement.
(a) Effective for services rendered on or after October
1, 1992, the commissioner shall make payments for dental services as follows:
(1) dental services shall be paid at the lower of (i) submitted charges, or (ii) 25 percent
above the rate in effect on June 30, 1992; and
(2) dental rates shall be converted from the 50th percentile of 1982 to the 50th percentile
of 1989, less the percent in aggregate necessary to equal the above increases.
(b) Beginning October 1, 1999, the payment for tooth sealants and fluoride treatments
shall be the lower of (1) submitted charge, or (2) 80 percent of median 1997 charges.
(c) Effective for services rendered on or after January 1, 2000, payment rates for dental
services shall be increased by three percent over the rates in effect on December 31, 1999.
(d) Effective for services provided on or after January 1, 2002, payment for diagnostic
examinations and dental x-rays provided to children under age 21 shall be the lower of (1)
the submitted charge, or (2) 85 percent of median 1999 charges.
(e) The increases listed in paragraphs (b) and (c) shall be implemented January 1, 2000,
for managed care.
(f) Effective for dental services rendered on or after October 1, 2010, by a state-operated
dental clinic, payment shall be paid on a reasonable cost basis that is based on the Medicare
principles of reimbursement. This payment shall be effective for services rendered on or
after January 1, 2011, to recipients enrolled in managed care plans or county-based
purchasing plans.
(g) Beginning in fiscal year 2011, if the payments to state-operated dental clinics in
paragraph (f), including state and federal shares, are less than $1,850,000 per fiscal year, a
supplemental state payment equal to the difference between the total payments in paragraph
(f) and $1,850,000 shall be paid from the general fund to state-operated services for the
operation of the dental clinics.
(h) Effective for services rendered on or after January 1, 2014, through December 31,
2021, payment rates for dental services shall be increased by five percent from the rates in
effect on December 31, 2013. This increase does not apply to state-operated dental clinics
in paragraph (f), federally qualified health centers, rural health centers, and Indian health
services. Effective January 1, 2014, payments made to managed care plans and county-based
purchasing plans under sections 256B.69, 256B.692, and 256L.12 shall reflect the payment
increase described in this paragraph.
(i) Effective for services provided on or after January 1, 2017, through December 31,
2021, the commissioner shall increase payment rates by 9.65 percent for dental services
provided outside of the seven-county metropolitan area. This increase does not apply to
state-operated dental clinics in paragraph (f), federally qualified health centers, rural health
centers, or Indian health services. Effective January 1, 2017, payments to managed care
plans and county-based purchasing plans under sections 256B.69 and 256B.692 shall reflect
the payment increase described in this paragraph.
(j) Effective for services provided on or after July 1, 2017, through December 31, 2021,
the commissioner shall increase payment rates by 23.8 percent for dental services provided
to enrollees under the age of 21. This rate increase does not apply to state-operated dental
clinics in paragraph (f), federally qualified health centers, rural health centers, or Indian
health centers. This rate increase does not apply to managed care plans and county-based
purchasing plans.
(k) Effective for services provided on or after January 1, 2022, the commissioner shall
exclude from medical assistance and MinnesotaCare payments for dental services to public
health and community health clinics the 20 percent increase authorized under Laws 1989,
chapter 327, section 5, subdivision 2, paragraph (b).
(l) Effective for services provided on or after January 1, 2022, the commissioner shall
increase payment rates by 98 percent for all dental services. This rate increase does not
apply to state-operated dental clinics, federally qualified health centers, rural health centers,
or Indian health services.
new text begin
(m) Effective for services provided on or after January 1, 2028, or on or after federal
approval, whichever is later, payment rates for dental services shall be ....... percent of the
....... percentile of the median charges for coverage year 2024. This rate increase does not
apply to state-operated dental clinics, federally qualified health centers, rural health centers,
or Indian health services.
new text end
deleted text begin (m)deleted text end new text begin (n)new text end Managed care plans and county-based purchasing plans shall reimburse providers
at a level that is at least equal to the rate paid under fee-for-service for dental services. If,
for any coverage year, federal approval is not received for this paragraph, the commissioner
must adjust the capitation rates paid to managed care plans and county-based purchasing
plans for that contract year to reflect the removal of this provision. Contracts between
managed care plans and county-based purchasing plans and providers to whom this paragraph
applies must allow recovery of payments from those providers if capitation rates are adjusted
in accordance with this paragraph. Payment recoveries must not exceed an amount equal
to any increase in rates that results from this provision. If, for any coverage year, federal
approval is not received for this paragraph, the commissioner shall not implement this
paragraph for subsequent coverage years.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
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Sec. 2.
Minnesota Statutes 2024, section 256B.76, subdivision 4, is amended to read:
Subd. 4.
Critical access dental providers.
(a) The commissioner shall increase
reimbursements to dentists and dental clinics deemed by the commissioner to be critical
access dental providers. For dental services rendered on or after July 1, 2016, through
December 31, 2021, the commissioner shall increase reimbursement by 37.5 percent above
the reimbursement rate that would otherwise be paid to the critical access dental provider,
except as specified under paragraph (b). The commissioner shall pay the managed care
plans and county-based purchasing plans in amounts sufficient to reflect increased
reimbursements to critical access dental providers as approved by the commissioner.
(b) For dental services rendered on or after July 1, 2016, through December 31, 2021,
by a dental clinic or dental group that meets the critical access dental provider designation
under paragraph (f), clause (4), and is owned and operated by a health maintenance
organization licensed under chapter 62D, the commissioner shall increase reimbursement
by 35 percent above the reimbursement rate that would otherwise be paid to the critical
access provider.
(c) The commissioner shall increase reimbursement to dentists and dental clinics deemed
by the commissioner to be critical access dental providers. For dental services provided on
or after January 1, 2022, by a dental provider deemed to be a critical access dental provider
under paragraph (f), the commissioner shall increase reimbursement by 20 percent above
the reimbursement rate that would otherwise be paid to the critical access dental provider.new text begin
For dental services provided on or after January 1, 2028, or on or after federal approval,
whichever is later, by a dental provider deemed to be a critical access dental provider under
paragraph (f), the commissioner shall increase reimbursement by ....... percent above the
reimbursement rate that would otherwise be paid to the critical access dental provider.new text end This
paragraph does not apply to federally qualified health centers, rural health centers,
state-operated dental clinics, or Indian health centers.
(d) Managed care plans and county-based purchasing plans shall increase reimbursement
to critical access dental providers by at least the amount specified in paragraph (c). If, for
any coverage year, federal approval is not received for this paragraph, the commissioner
must adjust the capitation rates paid to managed care plans and county-based purchasing
plans for that contract year to reflect the removal of this provision. Contracts between
managed care plans and county-based purchasing plans and providers to whom this paragraph
applies must allow recovery of payments from those providers if capitation rates are adjusted
in accordance with this paragraph. Payment recoveries must not exceed an amount equal
to any increase in rates that results from this provision. If, for any coverage year, federal
approval is not received for this paragraph, the commissioner shall not implement this
paragraph for subsequent coverage years.
(e) Critical access dental payments made under this subdivision for dental services
provided by a critical access dental provider to an enrollee of a managed care plan or
county-based purchasing plan must not reflect any capitated payments or cost-based payments
from the managed care plan or county-based purchasing plan. The managed care plan or
county-based purchasing plan must base the additional critical access dental payment on
the amount that would have been paid for that service had the dental provider been paid
according to the managed care plan or county-based purchasing plan's fee schedule that
applies to dental providers that are not paid under a capitated payment or cost-based payment.
(f) The commissioner shall designate the following dentists and dental clinics as critical
access dental providers:
(1) nonprofit community clinics that:
(i) have nonprofit status in accordance with chapter 317A;
(ii) have tax exempt status in accordance with the Internal Revenue Code, section
501(c)(3);
(iii) are established to provide oral health services to patients who are low income,
uninsured, have special needs, and are underserved;
(iv) have professional staff familiar with the cultural background of the clinic's patients;
(v) charge for services on a sliding fee scale designed to provide assistance to low-income
patients based on current poverty income guidelines and family size;
(vi) do not restrict access or services because of a patient's financial limitations or public
assistance status; and
(vii) have free care available as needed;
(2) federally qualified health centers, rural health clinics, and public health clinics;
(3) hospital-based dental clinics owned and operated by a city, county, or former state
hospital as defined in section 62Q.19, subdivision 1, paragraph (a), clause (4);
(4) a dental clinic or dental group owned and operated by a nonprofit corporation in
accordance with chapter 317A with more than 10,000 patient encounters per year with
patients who are uninsured or covered by medical assistance or MinnesotaCare;
(5) a dental clinic owned and operated by the University of Minnesota or the Minnesota
State Colleges and Universities system; and
(6) private practicing dentists if:
(i) the dentist's office is located within the seven-county metropolitan area and more
than 50 percent of the dentist's patient encounters per year are with patients who are uninsured
or covered by medical assistance or MinnesotaCare; or
(ii) the dentist's office is located outside the seven-county metropolitan area and more
than 25 percent of the dentist's patient encounters per year are with patients who are uninsured
or covered by medical assistance or MinnesotaCare.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
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