SF 5230

Introduction - 94th Legislature (2025 - 2026)

Posted on 04/24/2026 12:22 p.m.

A bill for an act
relating to human services; delaying implementation of the single dental
administrator for the medical assistance program; amending Minnesota Statutes
2024, section 256B.0371, subdivision 4; Minnesota Statutes 2025 Supplement,
section 256B.0371, subdivision 3.

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

Section 1.

Minnesota Statutes 2025 Supplement, 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, deleted text begin 2028 deleted text end new text begin 2030 new text end , for recipients of medical assistance and
MinnesotaCare who are served under fee-for-service and persons receiving services through
managed care 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 statewide;

(8) performance measurement;

(9) quality improvement and evaluation;

(10) management of third-party liability requirements; and

(11) establishment of grievance and appeals processes for providers and enrollees that
the commissioner can monitor.

(c) Dental administrator payments to contracted dental providers must be based on rates
recommended by the dental access working group. If the recommended rates are not
established in law prior to July 1, deleted text begin 2027 deleted text end new text begin 2029 new text end , dental administrator payments to contracted
dental providers must be at the rates established under sections 256B.76 and 256L.11.

(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 plans
for dental services under section 62K.14.

(e) The contract with the dental administrator must include performance benchmarks,
accountability measures, and progress rewards based on the recommendations from the
dental access working group.

(f) Notwithstanding the contract term limits under section 16C.06, subdivision 3b, the
commissioner may extend the implementation contract for the single dental administrator
under paragraph (a) up to three years from the date of execution and may contract with the
same contractor as the single dental administrator for up to five years, beginning in deleted text begin 2028 deleted text end new text begin
2030 new text end .

Sec. 2.

Minnesota Statutes 2024, section 256B.0371, subdivision 4, is amended to read:

Subd. 4.

Dental utilization report.

(a) The commissioner shall submit an annual report
beginning March 15, 2022, and ending March 15, deleted text begin 2026 deleted text end new text begin 2028 new text end , to the chairs and ranking
minority members of the legislative committees with jurisdiction over health and human
services policy and finance that includes the percentage for adults and children one through
20 years of age for the most recent complete calendar year receiving at least one dental visit
for both fee-for-service and the prepaid medical assistance program. The report must include:

(1) statewide utilization for both fee-for-service and for the prepaid medical assistance
program;

(2) utilization by county;

(3) utilization by children receiving dental services through fee-for-service and through
a managed care plan or county-based purchasing plan; and

(4) utilization by adults receiving dental services through fee-for-service and through a
managed care plan or county-based purchasing plan.

(b) The report must also include a description of any corrective action plans required to
be submitted under subdivision 2.

(c) The initial report due on March 15, 2022, must include the utilization metrics described
in paragraph (a) for each of the following calendar years: 2017, 2018, 2019, and 2020.

(d) In the annual report due on March 15, 2023, and in each report due thereafter, the
commissioner shall include the following:

(1) the number of dentists enrolled with the commissioner as a medical assistance dental
provider and the congressional district or districts in which the dentist provides services;

(2) the number of enrolled dentists who provided fee-for-service dental services to
medical assistance or MinnesotaCare patients within the previous calendar year in the
following increments: one to nine patients, ten to 100 patients, and over 100 patients;

(3) the number of enrolled dentists who provided dental services to medical assistance
or MinnesotaCare patients through a managed care plan or county-based purchasing plan
within the previous calendar year in the following increments: one to nine patients, ten to
100 patients, and over 100 patients; and

(4) the number of dentists who provided dental services to a new patient who was enrolled
in medical assistance or MinnesotaCare within the previous calendar year.

(e) The report due on March 15, 2023, must include the metrics described in paragraph
(d) for each of the following years: 2017, 2018, 2019, 2020, and 2021.