HF 1030

as introduced - 86th Legislature (2009 - 2010) Posted on 02/09/2010 01:43am

A bill for an act
relating to human services; establishing a single dental administrator to
administer dental services for the recipients of the state health care programs;
amending Minnesota Statutes 2008, sections 13.461, subdivision 23; 256B.69,
subdivision 6; proposing coding for new law in Minnesota Statutes, chapter
256B; repealing Minnesota Statutes 2008, sections 256B.037; 256B.69,
subdivision 6c.

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

Section 1.

Minnesota Statutes 2008, section 13.461, subdivision 23, is amended to read:

Subd. 23.

Medical assistance dental plans.

Access to welfare data by dental
plans contracted to provide services under the medical assistance program is governed
by section deleted text begin 256B.037 deleted text end new text begin 256B.0375 new text end .

Sec. 2.

new text begin [256B.0375] 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 January 1, 2010, the
commissioner shall either implement a fee-for-service system for the delivery of dental
services or contract with a single entity to administer the delivery of dental services to
medical assistance, general assistance medical care, and MinnesotaCare recipients. If
the commissioner decides to contract with a single entity to administer these services, a
request for proposal must be developed by September 1, 2009. The request for proposal
must include:
new text end

new text begin (1) the capacity to establish a statewide dental referral system or regional centers
to identify available dentists and dental clinics and to schedule appointments with an
appropriate dentist or clinic;
new text end

new text begin (2) the use of collaborative practice dental hygienists to provide assessment,
prevention, and education to state health care program recipients and to provide triage and
referrals for children as necessary;
new text end

new text begin (3) ways to encourage private practice dentists to treat more public program patients,
including the flexibility to determine the number and type of patients they agree to serve;
new text end

new text begin (4) the capacity to establish and implement dental homes for patients with chronic
dental disease that would include the coordination of care with other health care
professionals;
new text end

new text begin (5) establishing an advisory committee of participating dentists from both community
clinics and private settings to assist in the development and maintenance of the program;
new text end

new text begin (6) the use of electronic claims processing with uniform claims forms; and
new text end

new text begin (7) identifying the administrative costs in implementing the program as the sole
dental administrator.
new text end

new text begin Subd. 2. new text end

new text begin Appeals. new text end

new text begin All recipients of dental services under this section have the right
to appeal to the commissioner under section 256.045.
new text end

new text begin Subd. 3. new text end

new text begin Information required by commissioner. new text end

new text begin A contractor shall submit
encounter-specific information as required by the commissioner, including, but not limited
to, information required for assessing client satisfaction, quality of care, and cost and
utilization of services. Participating providers must provide the commissioner access to
recipient dental records to monitor compliance with this section.
new text end

new text begin Subd. 4. new text end

new text begin Other contracts permitted. new text end

new text begin Nothing in this section prohibits the
commissioner from contracting with an organization for comprehensive health services,
excluding dental services, under section 256B.031; 256B.035; 256B.69; 256D.03,
subdivision 4; or 256L.12.
new text end

new text begin Subd. 5. new text end

new text begin Recipient costs. new text end

new text begin A contractor and its participating providers or
nonparticipating providers who provide emergency services or services authorized by the
contractor shall not charge recipients for any costs for covered services.
new text end

new text begin Subd. 6. new text end

new text begin Financial accountability. new text end

new text begin A contractor is accountable to the commissioner
for the fiscal management of covered dental care services. The state of Minnesota and
recipients shall be held harmless for the payment of obligations incurred by the contractor
if the contractor or a participating provider becomes insolvent and the department has
made the payments due to the contractor or participating provider under the contract.
new text end

new text begin Subd. 7. new text end

new text begin Quality improvement. new text end

new text begin The contractor shall permit the commissioner or
the commissioner's agents to evaluate the quality, appropriateness, and timeliness of
covered dental care services through inspections, site visits, and review of dental records.
new text end

new text begin Subd. 8. new text end

new text begin Third-party liability. new text end

new text begin To the extent required under section 62A.046 and
Minnesota Rules, part 9506.0080, the contractor shall coordinate benefits for or recover
the cost of dental care services provided recipients who have other dental care coverage.
Coordination of benefits includes the contractor paying applicable co-payments or
deductibles on behalf of a recipient.
new text end

new text begin Subd. 9. new text end

new text begin Data privacy. new text end

new text begin The contract between the commissioner and the contractor
must specify that the contractor is an agent of the welfare system and shall have access
to welfare data on recipients to the extent necessary to carry out the contractor's
responsibilities under the contract. The contractor shall comply with chapter 13, the
Minnesota Government Data Practices Act.
new text end

Sec. 3.

Minnesota Statutes 2008, section 256B.69, subdivision 6, is amended to read:

Subd. 6.

Service delivery.

(a) new text begin Except as provided in paragraph (c), new text end each
demonstration provider shall be responsible for the health care coordination for eligible
individuals. Demonstration providers:

(1) shall authorize and arrange for the provision of all needed health services
including but not limited to the full range of services listed in sections 256B.02,
subdivision 8, and 256B.0625 in order to ensure appropriate health care is delivered to
enrollees. Notwithstanding section 256B.0621, demonstration providers that provide
nursing home and community-based services under this section shall provide relocation
service coordination to enrolled persons age 65 and over;

(2) shall accept the prospective, per capita payment from the commissioner in return
for the provision of comprehensive and coordinated 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; and

(4) shall institute recipient grievance procedures according to the method established
by the project, utilizing applicable requirements of chapter 62D. Disputes not resolved
through this process shall be appealable to the commissioner as provided in subdivision 11.

(b) Demonstration providers must comply with the standards for claims settlement
under section 72A.201, subdivisions 4, 5, 7, and 8, when contracting with other health
care and social service practitioners to provide services to enrollees. A demonstration
provider must pay a clean claim, as defined in Code of Federal Regulations, title 42,
section 447.45(b), within 30 business days of the date of acceptance of the claim.

new text begin (c) A demonstration provider shall not authorize or arrange dental services listed
under section 256B.0625; 256D.03, subdivision 4; or 256L.03 as part of the comprehensive
health care services that are required to be provided by the demonstration provider under
this section. Dental services shall be provided according to section 256B.0375.
new text end

Sec. 4. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2008, sections 256B.037; and 256B.69, subdivision 6c, new text end new text begin are
repealed.
new text end