HF 2171

as introduced - 88th Legislature (2013 - 2014) Posted on 02/25/2014 12:50pm

A bill for an act
relating to oral health; adding dental therapists and advanced dental therapists to
the health professional education loan forgiveness program; covering basic dental
screenings performed by dental therapists or dental hygienists in collaborative
practices; covering oral health services provided by telehealth; amending
Minnesota Statutes 2012, sections 144.1501, subdivisions 1, 2, 3; 256B.0625,
subdivision 14, by adding a subdivision.

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

Section 1.

Minnesota Statutes 2012, section 144.1501, subdivision 1, is amended to read:

Subdivision 1.

Definitions.

(a) For purposes of this section, the following definitions
apply.

(b) "Dentist" means an individual who is licensed to practice dentistry.

(c) "Designated rural area" means an area defined as a small rural area or isolated rural
area according to the four category classifications of the Rural Urban Commuting Area
system developed for the United States Health Resources and Services Administration.

(d) "Emergency circumstances" means those conditions that make it impossible for
the participant to fulfill the service commitment, including death, total and permanent
disability, or temporary disability lasting more than two years.

(e) "Medical resident" means an individual participating in a medical residency in
family practice, internal medicine, obstetrics and gynecology, pediatrics, or psychiatry.

(f) "Midlevel practitioner" means a nurse practitioner, nurse-midwife, nurse
anesthetist, advanced clinical nurse specialist, or physician assistant.

(g) "Nurse" means an individual who has completed training and received all
licensing or certification necessary to perform duties as a licensed practical nurse or
registered nurse.

(h) "Nurse-midwife" means a registered nurse who has graduated from a program of
study designed to prepare registered nurses for advanced practice as nurse-midwives.

(i) "Nurse practitioner" means a registered nurse who has graduated from a program
of study designed to prepare registered nurses for advanced practice as nurse practitioners.

(j) "Pharmacist" means an individual with a valid license issued under chapter 151.

(k) "Physician" means an individual who is licensed to practice medicine in the areas
of family practice, internal medicine, obstetrics and gynecology, pediatrics, or psychiatry.

(l) "Physician assistant" means a person licensed under chapter 147A.

(m) "Qualified educational loan" means a government, commercial, or foundation
loan for actual costs paid for tuition, reasonable education expenses, and reasonable living
expenses related to the graduate or undergraduate education of a health care professional.

(n) "Underserved urban community" means a Minnesota urban area or population
included in the list of designated primary medical care health professional shortage areas
(HPSAs), medically underserved areas (MUAs), or medically underserved populations
(MUPs) maintained and updated by the United States Department of Health and Human
Services.

new text begin (o) "Dental therapist" means a dental therapist licensed under section 150A.105.
new text end

new text begin (p) "Advanced dental therapist" means an advanced dental therapist certified under
section 150A.106.
new text end

Sec. 2.

Minnesota Statutes 2012, section 144.1501, subdivision 2, is amended to read:

Subd. 2.

Creation of account.

(a) A health professional education loan forgiveness
program account is established. The commissioner of health shall use money from the
account to establish a loan forgiveness program:

(1) for medical residents agreeing to practice in designated rural areas or underserved
urban communities or specializing in the area of pediatric psychiatry;

(2) for midlevel practitioners agreeing to practice in designated rural areas or to
teach at least 12 credit hours, or 720 hours per year in the nursing field in a postsecondary
program at the undergraduate level or the equivalent at the graduate level;

(3) for nurses who agree to practice in a Minnesota nursing home or intermediate
care facility for persons with developmental disability or to teach at least 12 credit hours,
or 720 hours per year in the nursing field in a postsecondary program at the undergraduate
level or the equivalent at the graduate level;

(4) for other health care technicians agreeing to teach at least 12 credit hours, or 720
hours per year in their designated field in a postsecondary program at the undergraduate
level or the equivalent at the graduate level. The commissioner, in consultation with
the Healthcare Education-Industry Partnership, shall determine the health care fields
where the need is the greatest, including, but not limited to, respiratory therapy, clinical
laboratory technology, radiologic technology, and surgical technology;

(5) for pharmacists who agree to practice in designated rural areas; deleted text begin and
deleted text end

(6) for dentists agreeing to deliver at least 25 percent of the dentist's yearly patient
encounters to state public program enrollees or patients receiving sliding fee schedule
discounts through a formal sliding fee schedule meeting the standards established by
the United States Department of Health and Human Services under Code of Federal
Regulations, title 42, section 51, chapter 303 new text begin ; and
new text end

new text begin (7) for dental therapists or advanced dental therapists new text end .

(b) Appropriations made to the account do not cancel and are available until
expended, except that at the end of each biennium, any remaining balance in the account
that is not committed by contract and not needed to fulfill existing commitments shall
cancel to the fund.

Sec. 3.

Minnesota Statutes 2012, section 144.1501, subdivision 3, is amended to read:

Subd. 3.

Eligibility.

(a) To be eligible to participate in the loan forgiveness program,
an individual must:

(1) be a medical or dental resident, a licensed pharmacist or be enrolled in a dentist,
new text begin dental therapist, advanced dental therapist, new text end midlevel practitioner, registered nurse, or a
licensed practical nurse training program; and

(2) submit an application to the commissioner of health. If fewer applications are
submitted by dental students or residents than there are dentist participant slots available,
the commissioner may consider applications submitted by dental program graduates
who are licensed dentists.

(b) An applicant selected to participate must sign a contract to agree to serve a
minimum three-year full-time service obligation according to subdivision 2, which shall
begin no later than March 31 following completion of required training.

Sec. 4.

Minnesota Statutes 2012, section 256B.0625, subdivision 14, is amended to read:

Subd. 14.

Diagnostic, screening, and preventive services.

(a) Medical assistance
covers diagnostic, screening, and preventive services.

(b) "Preventive services" include services related to pregnancy, including:

(1) services for those conditions which may complicate a pregnancy and which may
be available to a pregnant woman determined to be at risk of poor pregnancy outcome;

(2) prenatal HIV risk assessment, education, counseling, and testing; and

(3) alcohol abuse assessment, education, and counseling on the effects of alcohol
usage while pregnant. Preventive services available to a woman at risk of poor pregnancy
outcome may differ in an amount, duration, or scope from those available to other
individuals eligible for medical assistance.

(c) "Screening services" include, but are not limited to deleted text begin , deleted text end new text begin :
new text end

new text begin (1) new text end blood lead tests deleted text begin . deleted text end new text begin ; and
new text end

new text begin (2) oral health screenings conducted by a licensed dental provider in collaborative
practice under section 150A.10, subdivision 1a, or 150A.106, to determine an enrollee's
need to be seen by a dentist for diagnosis and assessment to identify possible signs
of oral or systemic disease, malformation, or injury, and the potential need for referral
for diagnosis and treatment. This clause includes oral health screenings conducted by a
licensed dental provider as part of a state or federally mandated screening.
new text end

(d) The commissioner shall encourage, at the time of the child and teen checkup or
at an episodic care visit, the primary care health care provider to perform primary caries
preventive services. Primary caries preventive services include, at a minimum:

(1) a general visual examination of the child's mouth without using probes or other
dental equipment or taking radiographs;

(2) a risk assessment using the factors established by the American Academies
of Pediatrics and Pediatric Dentistry; and

(3) the application of a fluoride varnish beginning at age one to those children
assessed by the provider as being high risk in accordance with best practices as defined by
the Department of Human Services. The provider must obtain parental or legal guardian
consent before a fluoride varnish is applied to a minor child's teeth.

At each checkup, if primary caries preventive services are provided, the provider must
provide to the child's parent or legal guardian: information on caries etiology and
prevention; and information on the importance of finding a dental home for their child
by the age of one. The provider must also advise the parent or legal guardian to contact
the child's managed care plan or the Department of Human Services in order to secure a
dental appointment with a dentist. The provider must indicate in the child's medical record
that the parent or legal guardian was provided with this information and document any
primary caries prevention services provided to the child.

Sec. 5.

Minnesota Statutes 2012, section 256B.0625, is amended by adding a
subdivision to read:

new text begin Subd. 64. new text end

new text begin Oral health telehealth. new text end

new text begin Medical assistance covers dental and oral health
services that are otherwise covered by medical assistance as direct face-to-face services
provided via telecommunications equipment, including, but not limited to, store and
forward technology. Reimbursement is at the same rates and under the same requirements
that would otherwise apply to the service.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2015, or upon federal
approval, whichever is later, and applies to services provided after the effective date.
new text end