HF 1057

as introduced - 87th Legislature (2011 - 2012) Posted on 03/14/2011 10:08am

A bill for an act
relating to human services; expanding medical assistance dental coverage for
adults; amending Minnesota Statutes 2010, section 256B.0625, subdivision 9.

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 new text begin appropriate and necessary
new text end dental services.

(b) Medical assistance dental coverage for nonpregnant adults 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) new text begin full-mouth survey, limited to once every five years;
new text end

new text begin (7) new text end panoramic x-rays, limited to one every five years except deleted text begin (1) deleted text end new text begin (i) new text end when medically
necessary for the diagnosis and follow-up of oral and maxillofacial pathology and trauma
or deleted text begin (2) deleted text end new text begin (ii) new text end 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 begin (7) deleted text end new text begin (8) new text end prophylaxis, limited to one per year deleted text begin ; deleted text end new text begin , except for patients with a major medical
or dental risk factor, who are limited to a maximum of four per year based upon the
severity of their medical or dental risk factors, such as:
new text end

new text begin (i) diabetes;
new text end

new text begin (ii) heart disease; and
new text end

new text begin (iii) other similar oral and systemic conditions designated by the commissioner;
new text end

new text begin (9) periodontal scaling and root planing, limited to a maximum of four quadrants
per year;
new text end

deleted text begin (8) deleted text end new text begin (10) new text end application of fluoride varnish, limited to one per year;

deleted text begin (9) deleted text end new text begin (11) new text end posterior fillings, all at the amalgam rate;

deleted text begin (10) deleted text end new text begin (12) new text end anterior fillings;

deleted text begin (11) deleted text end new text begin (13) new text end endodontics, limited to root canals on the anterior and premolars only;

deleted text begin (12) deleted text end new text begin (14) new text end removable prostheses, each dental arch limited to one every six years;

deleted text begin (13) deleted text end new text begin (15) new text end oral surgery, limited to extractions, biopsies, and incision and drainage
of abscesses;

deleted text begin (14) deleted text end new text begin (16) new text end palliative treatment and sedative fillings for relief of pain; and

deleted text begin (15) deleted text end new text begin (17) new text end 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; deleted text begin and
deleted text end

(4) new text begin pediatric prophylaxis, limited to one per year for patients without a major
medical or dental risk factor, paid at 50 percent of the applicable medical assistance
payment rate in effect on June 30, 2011; and
new text end

new text begin (5) new text end orthodontia is eligible for coverage for children only.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2011.
new text end