Minnesota Legislature
SF 1073
as introduced - 90th Legislature (2017 - 2018) Posted on 02/17/2017 09:06am
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A bill for an act
relating to health care; increasing medical assistance rates for dental services;
requiring the commissioner of human services to develop a uniform credentialing
process for dental providers and uniform prior authorization criteria for dental
services; amending Minnesota Statutes 2016, sections 256B.0625, by adding
subdivisions; 256B.76, subdivision 2.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1.
Minnesota Statutes 2016, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 9c. new text end
new text begin Uniform prior authorization for dental services. new text end
new text begin
(a) By January 1, 2018,
the commissioner shall develop uniform prior authorization criteria for all dental services
requiring prior authorization. The commissioner shall publish a list of the dental services
requiring prior authorization and the process for obtaining prior authorization on the
department's Web site. Dental services on the list and the process for obtaining prior
authorization approval shall be consistent and shall be required to be used by dental providers,
managed care plans, county-based purchasing plans, and dental benefit administrators,
regardless of whether the services are provided through the fee-for-service system or through
the prepaid medical assistance program.
new text end
new text begin
(b) Managed care plans and county-based purchasing plans may require prior
authorization for additional dental services not on the list described in paragraph (a) so long
as a uniform process for obtaining prior approvals is applied including a process for
reconsideration when a prior approval request is denied that can be utilized by both the
patient and the patient's dental provider.
new text end
new text begin
(c) For purposes of this subdivision, "dental benefits administrator" means an organization
licensed under chapter 62C or 62D that contracts with a managed care plan or county-based
purchasing plan to provide covered dental care services to enrollees of the plan.
new text end
Sec. 2.
Minnesota Statutes 2016, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 9d. new text end
new text begin Uniform credentialing process. new text end
new text begin
(a) By January 1, 2018, the commissioner
shall develop a uniform credentialing process for dental providers. Upon federal approval,
the credentialing process must be accepted by all managed care plans, county-based
purchasing plans, and dental benefit administrators that contract with the commissioner or
subcontract with plans to provide dental services to medical assistance or MinnesotaCare
enrollees.
new text end
new text begin
(b) The process developed in this subdivision shall include a uniform credentialing
application that shall be available in electronic format and accessible on the department's
Web site. The process developed under this subdivision shall include the ability of submitting
a completed application electronically. The uniform credentialing application must be
available to providers free of charge.
new text end
new text begin
(c) A managed care plan, county-based purchasing plan, dental benefit administrator,
contractor, or vendor that reviews and approves a credentialing application must notify a
provider regarding a deficiency on a submitted credentialing application form no later than
30 business days after receipt of the application form from the provider.
new text end
Sec. 3.
Minnesota Statutes 2016, 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 makedeleted text end new text begin January 1, 2018,new text end payments for dental services deleted text begin 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 caredeleted text end new text begin shall be paid at the lower of (1) submitted charges; or (2) 50 percent of
the 90th percentile of 2014 charges submitted for the applicable current dental terminology
code. This rate does not apply to state-operated dental clinics under paragraph (b)new text end .
deleted text begin (f) Effectivedeleted text end new text begin (b)new text end For dental services rendered deleted text begin on or after October 1, 2010,deleted text end by a
state-operated dental clinic, payment shall be paid on a reasonable cost basis that is based
on the Medicare principles of reimbursement. deleted text begin 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 end
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 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.
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) Effective for services rendered on or after July 1, 2015, through December 31, 2016,
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, 2016, through December 31, 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 to dental providers located outside of the seven-county
metropolitan area.
deleted text end
deleted text begin (l) Effective for services provided on or after January 1, 2017, the commissioner shall
increase payment rates by 9.65 percent for dental services provided outside of the
seven-county metropolitan area. This increase does not apply to state-operated dental clinics
in paragraph (f), federally qualified health centers, rural health centers, or Indian health
services.deleted text end new text begin (d)new text end Effective January 1, deleted text begin 2017deleted text end new text begin 2018new text end , payments to managed care plans and
county-based purchasing plans under sections 256B.69 and 256B.692 shall reflect the
payment increase described in deleted text begin thisdeleted text end paragraphnew text begin (a). The commissioner shall require managed
care plans and county-based purchasing plans to increase the rates the plans would otherwise
pay to providers under fee arrangements by the same percentage rate increase described in
paragraph (a). A managed care plan or county-based purchasing plan must pay dental
providers at least the fee-for-service rate fee schedule amount for covered dental services.
The commissioner shall require managed care plans and county-based purchasing plans to
report to the commissioner documenting that the rate increase was paid to the dental
providersnew text end .