HF 277

as introduced - 89th Legislature (2015 - 2016) Posted on 03/02/2015 04:46pm

A bill for an act
relating to human services; establishing a single administrator to administer the
provision of dental services to medical assistance and MinnesotaCare enrollees;
increasing payment rates for dental services; amending Minnesota Statutes 2014,
sections 256B.69, by adding a subdivision; 256B.76, subdivision 2; 256L.12,
subdivision 7; proposing coding for new law in Minnesota Statutes, chapter 256B.

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

Section 1.

new text begin [256B.54] PROVISION OF DENTAL SERVICES.
new text end

new text begin Subdivision 1. new text end

new text begin Single dental administrator. new text end

new text begin Effective for dental services provided
on or after January 1, 2017, the commissioner shall contract with a single dental plan or
dental plan administrative entity to administer the delivery of dental services to medical
assistance and MinnesotaCare enrollees. The contract for the single administrator shall be
awarded through competitive bidding. The entity shall administer all state dental program
services, including those provided through the current fee-for-service system and those
provided through the prepaid medical assistance program and MinnesotaCare.
new text end

new text begin Subd. 2. new text end

new text begin Contract provisions. new text end

new text begin The contract with the dental administrator shall:
new text end

new text begin (1) include the provision of all dental services authorized under section 256B.0625;
new text end

new text begin (2) ensure adequate numbers of dentists and dental clinics to provide accessible
care to program enrollees;
new text end

new text begin (3) establish a centralized dental referral system, including a toll-free telephone
number, to identify available dentists and dental clinics and to schedule appointments for
program enrollees who need assistance in locating dental care;
new text end

new text begin (4) include in its dental provider network nonprofit clinics, federally qualified health
centers, the University of Minnesota School of Dentistry and its affiliated clinics, publicly
owned and operated hospital-based dental clinics, dental clinics within state-operated
services, and private practicing dentists;
new text end

new text begin (5) encourage private practicing dentists to participate and provide services to public
program enrollees through flexible scheduling and coordination of referrals;
new text end

new text begin (6) develop a program to reduce hospital emergency room visits for dental care
treatment;
new text end

new text begin (7) streamline information systems to provide information on patient eligibility and
state program restrictions on dental benefits, including prior authorization requirements
for dental care treatments;
new text end

new text begin (8) clearly communicate authorization criteria and benefit changes to dental
providers participating in the dental provider network; and
new text end

new text begin (9) measure access to dental services for program enrollees and report access and
encounter data annually to the commissioner.
new text end

new text begin Subd. 3. new text end

new text begin Advisory committee. new text end

new text begin The administrator shall establish an advisory
committee of participating providers from community and public clinics and private
practices to assist in the development and maintenance of the program.
new text end

new text begin Subd. 4. new text end

new text begin Appeals. new text end

new text begin All recipients of dental services provided under contract by the
administrator shall have the right to appeal to the commissioner under section 256.045.
new text end

new text begin Subd. 5. new text end

new text begin Data privacy. new text end

new text begin The contract between the commissioner and the
administrator must specify that the administrator is the agent of the state and shall have
access to patient data on program enrollees to the extent necessary to carry out the
administrator's responsibilities under the contract. The administrator shall comply with
the relevant provisions of chapter 13.
new text end

new text begin Subd. 6. new text end

new text begin Prepaid dental services. new text end

new text begin Effective January 1, 2017, all dental services
must be removed from prepaid medical assistance program and MinnesotaCare contracts
with managed care organizations and county-based purchasing plans. All dental services
must be included in the services provided under contract from the dental administrator.
Each managed care organization and county-based purchasing plan providing dental care
to program enrollees either directly or through contract with a dental plan administrator
must provide the commissioner with dental encounter data and aggregate reimbursement
data for dental care provided through the prepaid medical assistance program for calendar
year 2015.
new text end

new text begin Subd. 7. new text end

new text begin Exclusions. new text end

new text begin (a) The commissioner shall exclude from this section dental
programs administered through county-based purchasing plans if the commissioner
determines that a single administrator already exists and that the dental services currently
provided are adequate to meet the needs of public program enrollees within the area
served by the county-based purchasing plan.
new text end

new text begin (b) The commissioner shall exclude from this section dental services provided
as part of a child and teen checkup or episodic care visit under section 256B.0625,
subdivisions 14, paragraph (d), and 58.
new text end

Sec. 2.

Minnesota Statutes 2014, section 256B.69, is amended by adding a subdivision
to read:

new text begin Subd. 6e. new text end

new text begin Dental services. new text end

new text begin Effective January 1, 2017, dental services shall be
provided as specified in section 256B.54.
new text end

Sec. 3.

Minnesota Statutes 2014, 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) If the cost-based payment system for state-operated dental clinics described in
paragraph (f) does not receive federal approval, then state-operated dental clinics shall be
designated as critical access dental providers under subdivision 4, paragraph (b), and shall
receive the critical access dental reimbursement rate as described under subdivision 4,
paragraph (a).

(i) Effective for services rendered on or after September 1, 2011, through June 30,
2013, payment rates for dental services shall be reduced by three percent. This reduction
does not apply to state-operated dental clinics in paragraph (f).

(j) Effective for services rendered on or after January 1, 2014, 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.

new text begin (k) Effective for services rendered on or after January 1, 2017, payment rates for
dental services shall be increased by ... percent from the rates in effect on December
31, 2016. 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, 2017, payments to the single dental administrator under section
256B.54, and county-based purchasing plans if dental services provided by the plans
are excluded under section 256B.54, subdivision 7, shall reflect the payment increase
described in this paragraph.
new text end

Sec. 4.

Minnesota Statutes 2014, section 256L.12, subdivision 7, is amended to read:

Subd. 7.

Managed care plan vendor requirements.

The following requirements
apply to all counties or vendors who contract with the Department of Human Services to
serve MinnesotaCare recipients. Managed care plan contractors:

(1) shall authorize and arrange for the provision of the full range of services listed in
section 256L.03 in order to ensure appropriate health care is delivered to enrollees new text begin , with
dental services being provided as specified in section 256B.54, effective January 1, 2017 new text end ;

(2) shall accept the prospective, per capita payment or other contractually defined
payment from the commissioner in return for the provision and coordination of covered
health care services for eligible individuals enrolled in the program;

(3) may contract with other health care and social service practitioners to provide
services to enrollees;

(4) shall provide for an enrollee grievance process as required by the commissioner
and set forth in the contract with the department;

(5) shall retain all revenue from enrollee co-payments;

(6) shall accept all eligible MinnesotaCare enrollees, without regard to health status
or previous utilization of health services;

(7) shall demonstrate capacity to accept financial risk according to requirements
specified in the contract with the department. A health maintenance organization licensed
under chapter 62D, or a nonprofit health plan licensed under chapter 62C, is not required
to demonstrate financial risk capacity, beyond that which is required to comply with
chapters 62C and 62D; and

(8) shall submit information as required by the commissioner, including data
required for assessing enrollee satisfaction, quality of care, cost, and utilization of services.