HF 2275

as introduced - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am

A bill for an act
relating to human services; modifying reimbursement for critical access dental
providers; requiring additional staff to be hired to administer the critical access
dental program; amending Minnesota Statutes 2006, sections 256B.76; 256L.11,
subdivision 7.

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

Section 1.

Minnesota Statutes 2006, section 256B.76, is amended to read:

256B.76 PHYSICIAN AND DENTAL REIMBURSEMENT.

(a) Effective for services rendered on or after October 1, 1992, the commissioner
shall make payments for physician services as follows:

(1) payment for level one Centers for Medicare and Medicaid Services' common
procedural coding system codes titled "office and other outpatient services," "preventive
medicine new and established patient," "delivery, antepartum, and postpartum care,"
"critical care," cesarean delivery and pharmacologic management provided to psychiatric
patients, and level three codes for enhanced services for prenatal high risk, shall be paid
at the lower of (i) submitted charges, or (ii) 25 percent above the rate in effect on June
30, 1992. If the rate on any procedure code within these categories is different than the
rate that would have been paid under the methodology in section 256B.74, subdivision 2,
then the larger rate shall be paid;

(2) payments for all other services shall be paid at the lower of (i) submitted charges,
or (ii) 15.4 percent above the rate in effect on June 30, 1992;

(3) all physician rates shall be converted from the 50th percentile of 1982 to the 50th
percentile of 1989, less the percent in aggregate necessary to equal the above increases
except that payment rates for home health agency services shall be the rates in effect
on September 30, 1992;

(4) effective for services rendered on or after January 1, 2000, payment rates for
physician and professional services shall be increased by three percent over the rates in
effect on December 31, 1999, except for home health agency and family planning agency
services; and

(5) the increases in clause (4) shall be implemented January 1, 2000, for managed
care.

(b) Effective for services rendered on or after October 1, 1992, the commissioner
shall make payments for dental services as follows:

(1) dental services shall be paid at the lower of (i) submitted charges, or (ii) 25
percent above the rate in effect on June 30, 1992;

(2) dental rates shall be converted from the 50th percentile of 1982 to the 50th
percentile of 1989, less the percent in aggregate necessary to equal the above increases;

(3) effective for services rendered on or after January 1, 2000, payment rates for
dental services shall be increased by three percent over the rates in effect on December
31, 1999;

(4) the commissioner shall award grants to community clinics or other nonprofit
community organizations, political subdivisions, professional associations, or other
organizations that demonstrate the ability to provide dental services effectively to public
program recipients. Grants may be used to fund the costs related to coordinating access for
recipients, developing and implementing patient care criteria, upgrading or establishing
new facilities, acquiring furnishings or equipment, recruiting new providers, or other
development costs that will improve access to dental care in a region. In awarding grants,
the commissioner shall give priority to applicants that plan to serve areas of the state in
which the number of dental providers is not currently sufficient to meet the needs of
recipients of public programs or uninsured individuals. The commissioner shall consider
the following in awarding the grants:

(i) potential to successfully increase access to an underserved population;

(ii) the ability to raise matching funds;

(iii) the long-term viability of the project to improve access beyond the period
of initial funding;

(iv) the efficiency in the use of the funding; and

(v) the experience of the proposers in providing services to the target population.

The commissioner shall monitor the grants and may terminate a grant if the grantee
does not increase dental access for public program recipients. The commissioner shall
consider grants for the following:

(i) implementation of new programs or continued expansion of current access
programs that have demonstrated success in providing dental services in underserved
areas;

(ii) a pilot program for utilizing hygienists outside of a traditional dental office to
provide dental hygiene services; and

(iii) a program that organizes a network of volunteer dentists, establishes a system to
refer eligible individuals to volunteer dentists, and through that network provides donated
dental care services to public program recipients or uninsured individuals;

(5) beginning October 1, 1999, the payment for tooth sealants and fluoride treatments
shall be the lower of (i) submitted charge, or (ii) 80 percent of median 1997 charges;

(6) the increases listed in clauses (3) and (5) shall be implemented January 1, 2000,
for managed care; and

(7) effective for services provided on or after January 1, 2002, payment for
diagnostic examinations and dental x-rays provided to children under age 21 shall be the
lower of (i) the submitted charge, or (ii) 85 percent of median 1999 charges.

(c) Effective for dental services rendered on or after January 1, 2002, the
commissioner may deleted text begin , within the limits of available appropriation, deleted text end increase reimbursements
to dentists and dental clinics deemed by the commissioner to be critical access dental
providers. deleted text begin Reimbursement to a critical access dental provider may be increased by not
more than 50 percent above the reimbursement rate that would otherwise be paid to the
provider. Payments to deleted text end new text begin For dental services rendered after June 30, 2007, the commissioner
shall increase reimbursement by 33 percent above the reimbursement rate that would
otherwise be paid to the provider. The commissioner shall pay the new text end health plan companies
deleted text begin shall be adjusted deleted text end new text begin in amounts sufficient new text end to reflect increased reimbursements to critical
access dental providers as approved by the commissioner. In determining which dentists
and dental clinics shall be deemed critical access dental providers, the commissioner
shall review:

(1) the utilization rate in the service area in which the dentist or dental clinic operates
for dental services to patients covered by medical assistance, general assistance medical
care, or MinnesotaCare as their primary source of coverage;

(2) the level of services provided by the dentist or dental clinic to patients covered
by medical assistance, general assistance medical care, or MinnesotaCare as their primary
source of coverage; and

(3) whether the level of services provided by the dentist or dental clinic is critical to
maintaining adequate levels of patient access within the service area.

In the absence of a critical access dental provider in a service area, 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.

deleted text begin The commissioner shall annually establish a reimbursement schedule for critical
access dental providers and provider-specific limits on total reimbursement received
under the reimbursement schedule, and shall notify each critical access dental provider
of the schedule and limit.
deleted text end

(d) An entity that operates both a Medicare certified comprehensive outpatient
rehabilitation facility and a facility which was certified prior to January 1, 1993, that is
licensed under Minnesota Rules, parts 9570.2000 to 9570.3600, and for whom at least 33
percent of the clients receiving rehabilitation services in the most recent calendar year are
medical assistance recipients, shall be reimbursed by the commissioner for rehabilitation
services at rates that are 38 percent greater than the maximum reimbursement rate
allowed under paragraph (a), clause (2), when those services are (1) provided within the
comprehensive outpatient rehabilitation facility and (2) provided to residents of nursing
facilities owned by the entity.

(e) Effective for services rendered on or after January 1, 2007, the commissioner
shall make payments for physician and professional services based on the Medicare
relative value units (RVU's). This change shall be budget neutral and the cost of
implementing RVU's will be incorporated in the established conversion factor.

Sec. 2.

Minnesota Statutes 2006, section 256L.11, subdivision 7, is amended to read:

Subd. 7.

Critical access dental providers.

Effective for dental services provided
to MinnesotaCare enrollees deleted text begin on or after deleted text end new text begin between new text end January 1, 2007, new text begin and June 30, 2007, new text end the
commissioner shall increase payment rates to dentists and dental clinics deemed by the
commissioner to be critical access providers under section 256B.76, paragraph (c), by 50
percent above the payment rate that would otherwise be paid to the provider. new text begin Effective
for dental services provided to MinnesotaCare enrollees on or after July 1, 2007, the
commissioner shall increase payment rates to dentists and dental clinics deemed by the
commissioner to be critical access providers under section 256B.76, paragraph (c), by
33 percent above the payment rate that would otherwise be paid to the provider. new text end The
commissioner shall deleted text begin adjust the rates paid on or after January 1, 2007, to deleted text end new text begin pay the new text end prepaid
health plans under contract with the commissioner new text begin amounts sufficient new text end to reflect this rate
increase. The prepaid health plan must pass this rate increase to providers who have
been identified by the commissioner as critical access dental providers under section
256B.76, paragraph (c).

Sec. 3. new text begin STAFF FOR ADMINISTRATION OF THE CRITICAL ACCESS
DENTAL PROGRAM.
new text end

new text begin The commissioner of human services, using existing funding for the health care
management budget activity, shall hire staff to assist in administration of the critical access
dental program established under Minnesota Statutes, section 256B.76, paragraph (c).
new text end