HF 898

as introduced - 93rd Legislature (2023 - 2024) Posted on 02/09/2023 09:00pm

A bill for an act
relating to human services; expanding medical assistance coverage for adult dental
services; amending Minnesota Statutes 2022 Supplement, section 256B.0625,
subdivision 9, as amended.

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

Section 1.

Minnesota Statutes 2022, section 256B.0625, subdivision 9, is amended to read:

Subd. 9.

Dental services.

(a) Medical assistance covers new text begin medically necessary new text end dental
services.

deleted text begin (b) Medical assistance dental coverage for nonpregnant adults is limited to the following
services:
deleted text end

deleted text begin (1) comprehensive exams, limited to once every five years;
deleted text end

deleted text begin (2) periodic exams, limited to one per year;
deleted text end

deleted text begin (3) limited exams;
deleted text end

deleted text begin (4) bitewing x-rays, limited to one per year;
deleted text end

deleted text begin (5) periapical x-rays;
deleted text end

deleted text begin (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;
deleted text end

deleted text begin (7) prophylaxis, limited to one per year;
deleted text end

deleted text begin (8) application of fluoride varnish, limited to one per year;
deleted text end

deleted text begin (9) posterior fillings, all at the amalgam rate;
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deleted text begin (10) anterior fillings;
deleted text end

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

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

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

deleted text begin (14) palliative treatment and sedative fillings for relief of pain;
deleted text end

deleted text begin (15) full-mouth debridement, limited to one every five years; and
deleted text end

deleted text begin (16) nonsurgical treatment for periodontal disease, including scaling and root planing
once every two years for each quadrant, and routine periodontal maintenance procedures.
deleted text end

deleted text begin (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:
deleted text end

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

deleted text begin (2) general anesthesia; and
deleted text end

deleted text begin (3) full-mouth survey once every five years.
deleted text end

deleted text begin (d) Medical assistance covers medically necessary dental services for children and
pregnant women. deleted text end 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 deleted text begin for
children only deleted text end ;

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

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

deleted text begin (e) deleted text end new text begin (b) new text end In addition to the services specified in deleted text begin paragraphs (b) and (c) deleted text end new text begin paragraph (a) new text end ,
medical assistance covers the following services for adults:

(1) house calls or extended care facility calls for on-site delivery of covered services;

(2) behavioral management when additional staff time is required to accommodate
behavioral challenges and sedation is not used;

(3) oral or IV sedation, if the covered dental service cannot be performed safely without
it or would otherwise require the service to be performed under general anesthesia in a
hospital or surgical center; and

(4) prophylaxis, in accordance with an appropriate individualized treatment plan, but
no more than four times per year.

deleted text begin (f) deleted text end new text begin (c) new text end The commissioner shall not require prior authorization for the services included
in paragraph deleted text begin (e) deleted text end new text begin (b) new text end , clauses (1) to (3), and shall prohibit managed care and county-based
purchasing plans from requiring prior authorization for the services included in paragraph
deleted text begin (e) deleted text end new text begin (b) new text end , clauses (1) to (3), when provided under sections 256B.69, 256B.692, and 256L.12.