HF 2984

as introduced - 89th Legislature (2015 - 2016) Posted on 03/16/2016 01:24pm

A bill for an act
relating to human services; increasing medical assistance and MinnesotaCare
payment rates for dental services; amending Minnesota Statutes 2015
Supplement, section 256B.76, subdivision 2.

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

Section 1.

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
deleted text begin October 1, 1992, the commissioner shall make payments for dental services as follows:
deleted text end

deleted text begin (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
deleted text end

deleted text begin (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.
deleted text end

deleted text begin (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.
deleted text end

deleted text begin (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.
deleted text end

deleted text begin (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.
deleted text end

deleted text begin (e) The increases listed in paragraphs (b) and (c) shall be implemented January 1,
2000, for managed care. deleted text end new text begin July 1, 2016, payment rates for dental services shall be paid
at the lower of (1) submitted charges, or (2) 50 percent of the 90th percentile of 2013
charges submitted for the applicable American Medical Association's Current Procedural
Terminology (CPT) code. This rate does not apply to state-operated dental clinics under
paragraph (b).
new text end

deleted text begin (f) deleted text end new text begin (b) new text end 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.

deleted text begin (g) Beginning in fiscal year 2011, deleted text end new text begin (c) new text end If the payments to state-operated dental clinics
deleted text begin in paragraph (f) deleted text end , 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 deleted text begin (f) deleted text end new text begin (b) new text end and $1,850,000 shall be paid from the general fund to state-operated
services for the operation of the dental clinics.

deleted text begin (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).
deleted text end

deleted text begin (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).
deleted text end

deleted text begin (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.
deleted text end

deleted text begin (k) deleted text end new text begin (d) new text end Effective for services rendered on or after July 1, 2015, the commissioner
shall increase payment rates for services furnished by dental providers 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, deleted text begin 2016 deleted text end new text begin 2017 new text end , payments to managed care plans and county-based purchasing plans
under sections 256B.69 and 256B.692 shall reflect the payment deleted text begin increase deleted text end new text begin rate new text end described
in deleted text begin this deleted text end paragraph new text begin (a) new text end . 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 to dental providers located outside of the seven-county metropolitan area.