HF 2614

as introduced - 89th Legislature (2015 - 2016) Posted on 03/16/2016 01:20pm

A bill for an act
relating to human services; setting requirements for medical assistance coverage
of oral health assessments; clarifying criteria for enhanced dental payment
rates; amending Minnesota Statutes 2014, section 256B.0625, subdivision 14;
Minnesota Statutes 2015 Supplement, section 256B.76, subdivision 2.

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

Section 1.

Minnesota Statutes 2014, 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, blood lead tests new text begin , and oral
health assessments meeting the criteria in this paragraph new text end . new text begin An oral health assessment must
use the risk factors established by the American Academies of Pediatrics and Pediatric
Dentistry to determine a patient's need to be seen by a dentist for diagnosis and assessment
to identify possible signs of oral or systemic disease, malformation, or injury. An oral
health assessment must be conducted by a licensed dental provider in collaborative
practice under section 150A.10, subdivision 1a; 150A.105; or 150A.106. The provider
performing the assessment must have an agreement with a licensed dentist that ensures
that patients needing necessary follow-up services will be able to receive the services in
a timely manner. Prior to submitting a claim for an oral health assessment under this
subdivision, the provider completing the assessment must document in the patient's record
that arrangements were made for the patient to receive follow-up services, or that the
patient did not require follow-up services. Coverage of oral health assessments under this
subdivision is limited to one assessment per patient per year.
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. 2.

Minnesota Statutes 2015 Supplement, section 256B.76, subdivision 2, is
amended to read:

Subd. 2.

Dental reimbursement.

(a) 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; and

(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.

(b) Beginning October 1, 1999, the payment for tooth sealants and fluoride treatments
shall be the lower of (1) submitted charge, or (2) 80 percent of median 1997 charges.

(c) 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.

(d) 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 (1) the submitted charge, or (2) 85 percent of median 1999 charges.

(e) The increases listed in paragraphs (b) and (c) shall be implemented January 1,
2000, for managed care.

(f) Effective for dental services rendered on or after October 1, 2010, by a
state-operated dental clinic, payment shall be paid on a reasonable cost basis that is based
on the Medicare principles of reimbursement. This payment shall be effective for services
rendered on or after January 1, 2011, to recipients enrolled in managed care plans or
county-based purchasing plans.

(g) Beginning in fiscal year 2011, if the payments to state-operated dental clinics
in paragraph (f), including state and federal shares, are less than $1,850,000 per fiscal
year, a supplemental state payment equal to the difference between the total payments
in paragraph (f) and $1,850,000 shall be paid from the general fund to state-operated
services for the operation of the dental clinics.

(h) If the cost-based payment system for state-operated dental clinics described in
paragraph (f) does not receive federal approval, then state-operated dental clinics shall be
designated as critical access dental providers under subdivision 4, paragraph (b), and shall
receive the critical access dental reimbursement rate as described under subdivision 4,
paragraph (a).

(i) Effective for services rendered on or after September 1, 2011, through June 30,
2013, payment rates for dental services shall be reduced by three percent. This reduction
does not apply to state-operated dental clinics in paragraph (f).

(j) Effective for services rendered on or after January 1, 2014, payment rates for
dental services shall be increased by five percent from the rates in effect on December
31, 2013. This increase does not apply to state-operated dental clinics in paragraph (f),
federally qualified health centers, rural health centers, and Indian health services. Effective
January 1, 2014, payments made to managed care plans and county-based purchasing
plans under sections 256B.69, 256B.692, and 256L.12 shall reflect the payment increase
described in this paragraph.

(k) Effective for services rendered on or after July 1, 2015, the commissioner shall
increase payment rates for new text begin dental new text end services deleted text begin furnished by dental providers deleted text end new text begin provided at
sites new text end located outside of the seven-county metropolitan area by the maximum percentage
possible above the rates in effect on June 30, 2015, while remaining within the limits of
funding appropriated for this purpose. This increase does not apply to state-operated
dental clinics in paragraph (f), federally qualified health centers, rural health centers, and
Indian health services. Effective January 1, 2016, payments to managed care plans and
county-based purchasing plans under sections 256B.69 and 256B.692 shall reflect the
payment increase described in this paragraph. The commissioner shall require managed
care and county-based purchasing plans to pass on the full amount of the increase, in the
form of higher payment rates deleted text begin to deleted text end new text begin for new text end dental deleted text begin providers deleted text end new text begin services provided at sites new text end located
outside of the seven-county metropolitan area.