HF 754

as introduced - 87th Legislature (2011 - 2012) Posted on 02/28/2011 10:18am

A bill for an act
relating to human services; modifying medical assistance dental coverage;
establishing dental services program for the aged, blind, or disabled; amending
Minnesota Statutes 2010, section 256B.0625, subdivision 9; proposing coding
for new law in Minnesota Statutes, chapter 256B.

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

Section 1.

Minnesota Statutes 2010, section 256B.0625, subdivision 9, is amended to
read:

Subd. 9.

Dental services.

(a) Medical assistance covers dental services.

new text begin (b) Medical assistance dental services coverage for aged, blind, or disabled
individuals is covered under section 256B.7611.
new text end

deleted text begin (b) deleted text end new text begin (c) new text end Medical assistance dental coverage for nonpregnant adults new text begin not covered under
paragraph (b) new text end is limited to the following services:

(1) comprehensive exams, limited to once every five years;

(2) periodic exams, limited to one per year;

(3) limited exams;

(4) bitewing x-rays, limited to one per year;

(5) periapical x-rays;

(6) panoramic x-rays, limited to one every five years except (1) when medically
necessary for the diagnosis and follow-up of oral and maxillofacial pathology and trauma
or (2) once every two years for patients who cannot cooperate for intraoral film due to
a developmental disability or medical condition that does not allow for intraoral film
placement;

(7) prophylaxis, limited to one per year;

(8) application of fluoride varnish, limited to one per year;

(9) posterior fillings, all at the amalgam rate;

(10) anterior fillings;

(11) endodontics, limited to root canals on the anterior and premolars only;

(12) removable prostheses, each dental arch limited to one every six years;

(13) oral surgery, limited to extractions, biopsies, and incision and drainage of
abscesses;

(14) palliative treatment and sedative fillings for relief of pain; and

(15) full-mouth debridement, limited to one every five years.

(c) In addition to the services specified in paragraph (b), medical assistance
covers the following services for adults, if provided in an outpatient hospital setting or
freestanding ambulatory surgical center as part of outpatient dental surgery:

(1) periodontics, limited to periodontal scaling and root planing once every two
years;

(2) general anesthesia; and

(3) full-mouth survey once every five years.

(d) Medical assistance covers medically necessary dental services for children and
pregnant women. The following guidelines apply:

(1) posterior fillings are paid at the amalgam rate;

(2) application of sealants are covered once every five years per permanent molar for
children only;

(3) application of fluoride varnish is covered once every six months; and

(4) orthodontia is eligible for coverage for children only.

Sec. 2.

new text begin [256B.7611] DENTAL SERVICES PROGRAM FOR AGED, BLIND,
OR DISABLED.
new text end

new text begin Subdivision 1. new text end

new text begin Dental services; aged, blind, or disabled. new text end

new text begin Medical assistance
covers dental services for aged, blind, or disabled individuals through the dental services
program established in this section. The covered services provided under this section
must be at least equivalent to the covered services provided to children under medical
assistance, including population-appropriate services. Dental services must be provided
at intervals meeting reasonable dental standards and at all other intervals as medically
necessary to determine the existence of illness.
new text end

new text begin Subd. 2. new text end

new text begin Definitions. new text end

new text begin For the purposes of this section, the following definitions
apply.
new text end

new text begin (a) "Behavior management" means techniques or therapies used to alter or control
the actions of a patient who is receiving dental examination or treatment.
new text end

new text begin (b) "House call" means the delivery of dental services in a long-term care facility
as defined under section 256.9741, intermediate care facilities, group homes, and adult
foster care homes. House calls may also be made to eligible individuals with traumatic
brain injuries or developmental disabilities in their homes.
new text end

new text begin Subd. 3. new text end

new text begin Eligibility. new text end

new text begin An individual is considered aged, blind, or disabled under this
section if the individual:
new text end

new text begin (1) is eligible for medical assistance or is receiving assistance under Medicare title I,
X, XIV, or XVI; and
new text end

new text begin (2) is considered an aged, blind, or disabled individual under Medicare title XVI
regardless of whether the individual satisfies the income and resource requirements for
receiving Supplemental Security Income benefits under Medicare title XVI.
new text end

new text begin Subd. 4. new text end

new text begin Covered services. new text end

new text begin The dental services program under this section covers
the following services:
new text end

new text begin (1) relief of pain and infections in the mouth;
new text end

new text begin (2) restoration or replacement of teeth;
new text end

new text begin (3) all periodontal treatment;
new text end

new text begin (4) dental health preventive services, including adult fluoride application;
new text end

new text begin (5) inpatient and outpatient dental surgical, evaluation, and examination services;
new text end

new text begin (6) dentures or partial denture care consistent with frequency limits under section
256B.0625, subdivision 9;
new text end

new text begin (7) patient house call and long-term care facility visits;
new text end

new text begin (8) sedation and general anesthesia; and
new text end

new text begin (9) behavior management services.
new text end

new text begin Subd. 5. new text end

new text begin Duties of the commissioner. new text end

new text begin The commissioner of human services shall:
new text end

new text begin (1) inform all eligible individuals in the state of the availability of dental services
under this section; and
new text end

new text begin (2) arrange for, directly or through referral to appropriate agencies, organizations, or
individuals, treatment for services covered under subdivision 4.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2012.
new text end