HF 1058

as introduced - 87th Legislature (2011 - 2012) Posted on 03/14/2011 10:09am

A bill for an act
relating to human services; modifying criteria and payment methods for critical
access dental providers; prohibiting rulemaking for the critical access dental
program; amending Minnesota Statutes 2010, section 256B.76, subdivision 4.

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

Section 1.

Minnesota Statutes 2010, section 256B.76, subdivision 4, is amended to read:

Subd. 4.

Critical access dental providers.

(a) Effective for dental services
rendered on or after January 1, 2002, the commissioner shall increase reimbursements
to dentists and dental clinics deemed by the commissioner to be critical access dental
providers. For dental services rendered on or after July 1, 2007, the commissioner shall
increase reimbursement by 30 percent above the reimbursement rate that would otherwise
be paid to the critical access dental provider. deleted text begin The commissioner shall pay the managed
care plans and county-based purchasing plans in amounts sufficient to reflect increased
reimbursements to critical access dental providers as approved by the commissioner.
deleted text end

(b) The commissioner shall designate the following dentists and dental clinics as
critical access dental providers:

deleted text begin (1) nonprofit community clinics that:
deleted text end

deleted text begin (i) have nonprofit status in accordance with chapter 317A;
deleted text end

deleted text begin (ii) have tax exempt status in accordance with the Internal Revenue Code, section
501(c)(3);
deleted text end

deleted text begin (iii) are established to provide oral health services to patients who are low income,
uninsured, have special needs, and are underserved;
deleted text end

deleted text begin (iv) have professional staff familiar with the cultural background of the clinic's
patients;
deleted text end

deleted text begin (v) charge for services on a sliding fee scale designed to provide assistance to
low-income patients based on current poverty income guidelines and family size;
deleted text end

deleted text begin (vi) do not restrict access or services because of a patient's financial limitations
or public assistance status; and
deleted text end

deleted text begin (vii) have free care available as needed;
deleted text end

new text begin (1) dentists and dental clinics that participate as providers in the medical assistance
and MinnesotaCare programs, and for which medical assistance and MinnesotaCare
enrollees constitute at least 30 percent of total annual patient encounters;
new text end

(2) federally qualified health centers, rural health clinics, and public health clinics new text begin ,
that serve as the primary source of dental care for medical assistance and MinnesotaCare
enrollees new text end ;

(3) deleted text begin county owned and operated hospital-based dental clinics; deleted text end new text begin a dental clinic owned
by a county or a hospital-based dental clinic, where the level of services provided by the
clinic is critical to maintaining adequate levels of patient access within the service area; and
new text end

deleted text begin (4) a dental clinic or dental group owned and operated by a nonprofit corporation in
accordance with chapter 317A with more than 10,000 patient encounters per year with
patients who are uninsured or covered by medical assistance, general assistance medical
care, or MinnesotaCare; and
deleted text end

deleted text begin (5) deleted text end new text begin (4) new text end a dental clinic associated with an oral health or dental education program
operated by the University of Minnesota or an institution within the Minnesota State
Colleges and Universities system.

(c) new text begin In the absence of adequate access to dental services in a service area, new text end the
commissioner may designate a dentist or dental clinic as a critical access dental provider
if the dentist or dental clinic is willing to provide care to patients covered by medical
assistance, general assistance medical care, or MinnesotaCare at a level which significantly
increases access to dental care in the service area.

(d) Notwithstanding paragraph (a), critical access payments must not be made for
dental services provided from April 1, 2010, through June 30, 2010.

new text begin (e) Notwithstanding any law or provider contract provision to the contrary, effective
July 1, 2011, critical access dental providers shall be allowed to provide services to all
medical assistance and MinnesotaCare program enrollees, regardless of which managed
care plan or county-based purchasing plan the patient is enrolled in, and regardless of
whether the patient receives services through a managed care or county-based purchasing
plan or through fee-for-service. Payment of critical access dental providers for services
provided to enrollees shall be made directly by the commissioner to the critical access
dental provider. The critical access dental provider add-on payment shall be paid at the
same time as the base payment for the service provided. The commissioner shall recoup
from the managed care or county-based purchasing plan the amount of any base payments
plus estimated administrative costs and contributions to surplus paid by the commissioner
to critical access dental providers for services provided to enrollees of the plan. Estimated
administrative costs and contributions to surplus are to be based upon each managed care
or county-based purchasing plan's prior year reported average administrative costs and
overall contributions to surplus.
new text end

new text begin (f) Notwithstanding section 256B.04, subdivision 2, the commissioner of human
services shall not adopt rules governing this section or section 256L.11, subdivision 7.
new text end

new text begin EFFECTIVE DATE. new text end

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