SF 1361

as introduced - 82nd Legislature (2001 - 2002) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act 
  1.2             relating to health care; providing dental access 
  1.3             grants; creating a dental access advisory committee; 
  1.4             increasing the reimbursement rate for certain dental 
  1.5             care providers; appropriating money; amending 
  1.6             Minnesota Statutes 2000, sections 256B.0644; 256B.76; 
  1.7             proposing coding for new law in Minnesota Statutes, 
  1.8             chapter 256B.  
  1.9   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.10     Section 1.  Minnesota Statutes 2000, section 256B.0644, is 
  1.11  amended to read: 
  1.12     256B.0644 [PARTICIPATION REQUIRED FOR REIMBURSEMENT UNDER 
  1.13  OTHER STATE HEALTH CARE PROGRAMS.] 
  1.14     A vendor of medical care, as defined in section 256B.02, 
  1.15  subdivision 7, and a health maintenance organization, as defined 
  1.16  in chapter 62D, must participate as a provider or contractor in 
  1.17  the medical assistance program, general assistance medical care 
  1.18  program, and MinnesotaCare as a condition of participating as a 
  1.19  provider in health insurance plans and programs or contractor 
  1.20  for state employees established under section 43A.18, the public 
  1.21  employees insurance program under section 43A.316, for health 
  1.22  insurance plans offered to local statutory or home rule charter 
  1.23  city, county, and school district employees, the workers' 
  1.24  compensation system under section 176.135, and insurance plans 
  1.25  provided through the Minnesota comprehensive health association 
  1.26  under sections 62E.01 to 62E.19.  The limitations on insurance 
  1.27  plans offered to local government employees shall not be 
  2.1   applicable in geographic areas where provider participation is 
  2.2   limited by managed care contracts with the department of human 
  2.3   services.  For providers other than health maintenance 
  2.4   organizations, participation in the medical assistance program 
  2.5   means that (1) the provider accepts new medical assistance, 
  2.6   general assistance medical care, and MinnesotaCare patients or 
  2.7   (2) at least 20 percent of the provider's patients are covered 
  2.8   by medical assistance, general assistance medical care, and 
  2.9   MinnesotaCare as their primary source of coverage.  Patients 
  2.10  seen on a volunteer basis by the provider at a location other 
  2.11  than the provider's usual place of practice may be considered in 
  2.12  meeting this participation requirement.  The clinics where 
  2.13  volunteer dentists provide services may bill for those services 
  2.14  provided to Minnesota health care program recipients.  The 
  2.15  commissioner shall establish participation requirements for 
  2.16  health maintenance organizations.  The commissioner shall 
  2.17  provide lists of participating medical assistance providers on a 
  2.18  quarterly basis to the commissioner of employee relations, the 
  2.19  commissioner of labor and industry, and the commissioner of 
  2.20  commerce.  Each of the commissioners shall develop and implement 
  2.21  procedures to exclude as participating providers in the program 
  2.22  or programs under their jurisdiction those providers who do not 
  2.23  participate in the medical assistance program.  The commissioner 
  2.24  of employee relations shall implement this section through 
  2.25  contracts with participating health and dental carriers. 
  2.26     Sec. 2.  [256B.53] [DENTAL ACCESS GRANTS.] 
  2.27     (a) The commissioner shall award grants to community 
  2.28  clinics or other nonprofit community organizations, political 
  2.29  subdivisions, professional associations, or other organizations 
  2.30  that demonstrate the ability to provide dental services 
  2.31  effectively to public program recipients.  Grants may be used to 
  2.32  fund the costs related to coordinating access for recipients, 
  2.33  developing and implementing patient care criteria, upgrading or 
  2.34  establishing new facilities, acquiring furnishings or equipment, 
  2.35  recruiting new providers, or other development costs that will 
  2.36  improve access to dental care in a region.  
  3.1      (b) In awarding grants, the commissioner shall give 
  3.2   priority to applicants that plan to serve areas of the state in 
  3.3   which the number of dental providers is not currently sufficient 
  3.4   to meet the needs of recipients of public programs or uninsured 
  3.5   individuals.  The commissioner shall consider the following in 
  3.6   awarding the grants:  
  3.7      (1) potential to successfully increase access to an 
  3.8   underserved population; 
  3.9      (2) the long-term viability of the project to improve 
  3.10  access beyond the period of initial funding; 
  3.11     (3) the efficiency in the use of the funding; and 
  3.12     (4) the experience of the applicants in providing services 
  3.13  to the target population. 
  3.14     (c) The commissioner shall consider grants for the 
  3.15  following: 
  3.16     (1) implementation of new programs or continued expansion 
  3.17  of current access programs that have demonstrated success in 
  3.18  providing dental services in underserved areas; 
  3.19     (2) a program for mobile or other types of outreach dental 
  3.20  clinics in underserved geographic areas; 
  3.21     (3) a program for school-based dental clinics in schools 
  3.22  with high numbers of children receiving medical assistance; 
  3.23     (4) a program testing new models of care that are sensitive 
  3.24  to the cultural needs of the recipients; 
  3.25     (5) a program creating new educational campaigns that 
  3.26  inform individuals of the importance of good oral health and the 
  3.27  link between dental disease and overall health status; 
  3.28     (6) a program that organizes a network of volunteer 
  3.29  dentists to provide dental services to public program recipients 
  3.30  or uninsured individuals; and 
  3.31     (7) a program that tests new delivery models by creating 
  3.32  partnerships between local providers and county public health 
  3.33  agencies.  
  3.34     (d) The commissioner shall evaluate the effects of the 
  3.35  dental access initiatives funded through the dental access 
  3.36  grants and submit a report to the legislature by January 15, 
  4.1   2003.  
  4.2      Sec. 3.  [256B.55] [DENTAL ACCESS ADVISORY COMMITTEE.] 
  4.3      Subdivision 1.  [ESTABLISHMENT.] The commissioner shall 
  4.4   establish a dental access advisory committee to monitor the 
  4.5   purchasing, administration, and coverage of dental care services 
  4.6   for the public health care programs to ensure dental care access 
  4.7   and quality for public program recipients.  
  4.8      Subd. 2.  [MEMBERSHIP.] (a) The membership of the advisory 
  4.9   committee shall include, but is not limited to, representatives 
  4.10  of dentists, dental hygienists, community clinics, client 
  4.11  advocacy groups, public health, the University of Minnesota 
  4.12  school of dentistry, department of pediatrics, and the 
  4.13  commissioner of health.  
  4.14     (b) The advisory committee is governed by section 15.059 
  4.15  for membership terms and removal of members.  
  4.16     Subd. 3.  [DUTIES.] The advisory committee shall provide 
  4.17  recommendations on the following: 
  4.18     (1) how to reduce the administrative burden governing 
  4.19  dental care coverage policies in order to promote administrative 
  4.20  simplification, including prior authorization, coverage limits, 
  4.21  and co-payment collections; 
  4.22     (2) developing and implementing an action plan to improve 
  4.23  the oral health of children and persons with special needs in 
  4.24  the state; 
  4.25     (3) exploring alternative ways of purchasing and improving 
  4.26  access to dental services; 
  4.27     (4) developing ways to foster greater responsibility among 
  4.28  health care program recipients in seeking and obtaining dental 
  4.29  care, including initiatives to keep dental appointments and 
  4.30  comply with dental care plans; 
  4.31     (5) exploring innovative ways for dental providers to 
  4.32  schedule public program patients in order to reduce or minimize 
  4.33  the effect of appointment no shows; 
  4.34     (6) exploring ways to meet the barriers that may be present 
  4.35  in providing dental services to health care program recipients 
  4.36  such as language, culture, disability, and lack of 
  5.1   transportation; and 
  5.2      (7) exploring the possibility of pediatricians, family 
  5.3   physicians, and nurse practitioners providing basic oral health 
  5.4   screenings and basic preventive dental services.  
  5.5      Subd. 4.  [REPORT.] The commissioner shall submit an annual 
  5.6   report beginning February 1, 2002, summarizing the activities 
  5.7   and recommendations of the advisory committee. 
  5.8      Subd. 5.  [SUNSET.] Notwithstanding section 15.059, 
  5.9   subdivision 5, this section expires June 30, 2007.  
  5.10     Sec. 4.  Minnesota Statutes 2000, section 256B.76, is 
  5.11  amended to read: 
  5.12     256B.76 [PHYSICIAN AND DENTAL REIMBURSEMENT.] 
  5.13     (a) Effective for services rendered on or after October 1, 
  5.14  1992, the commissioner shall make payments for physician 
  5.15  services as follows: 
  5.16     (1) payment for level one Health Care Finance 
  5.17  Administration's common procedural coding system (HCPCS) codes 
  5.18  titled "office and other outpatient services," "preventive 
  5.19  medicine new and established patient," "delivery, antepartum, 
  5.20  and postpartum care," "critical care," Caesarean cesarean 
  5.21  delivery and pharmacologic management provided to psychiatric 
  5.22  patients, and HCPCS level three codes for enhanced services for 
  5.23  prenatal high risk, shall be paid at the lower of (i) submitted 
  5.24  charges, or (ii) 25 percent above the rate in effect on June 30, 
  5.25  1992.  If the rate on any procedure code within these categories 
  5.26  is different than the rate that would have been paid under the 
  5.27  methodology in section 256B.74, subdivision 2, then the larger 
  5.28  rate shall be paid; 
  5.29     (2) payments for all other services shall be paid at the 
  5.30  lower of (i) submitted charges, or (ii) 15.4 percent above the 
  5.31  rate in effect on June 30, 1992; 
  5.32     (3) all physician rates shall be converted from the 50th 
  5.33  percentile of 1982 to the 50th percentile of 1989, less the 
  5.34  percent in aggregate necessary to equal the above increases 
  5.35  except that payment rates for home health agency services shall 
  5.36  be the rates in effect on September 30, 1992; 
  6.1      (4) effective for services rendered on or after January 1, 
  6.2   2000, payment rates for physician and professional services 
  6.3   shall be increased by three percent over the rates in effect on 
  6.4   December 31, 1999, except for home health agency and family 
  6.5   planning agency services; and 
  6.6      (5) the increases in clause (4) shall be implemented 
  6.7   January 1, 2000, for managed care. 
  6.8      (b) Effective for services rendered on or after October 1, 
  6.9   1992, the commissioner shall make payments for dental services 
  6.10  as follows: 
  6.11     (1) dental services shall be paid at the lower of (i) 
  6.12  submitted charges, or (ii) 25 percent above the rate in effect 
  6.13  on June 30, 1992; 
  6.14     (2) dental rates shall be converted from the 50th 
  6.15  percentile of 1982 to the 50th percentile of 1989, less the 
  6.16  percent in aggregate necessary to equal the above increases; 
  6.17     (3) effective for services rendered on or after January 1, 
  6.18  2000, payment rates for dental services shall be increased by 
  6.19  three percent over the rates in effect on December 31, 1999; 
  6.20     (4) the commissioner shall award grants to community 
  6.21  clinics or other nonprofit community organizations, political 
  6.22  subdivisions, professional associations, or other organizations 
  6.23  that demonstrate the ability to provide dental services 
  6.24  effectively to public program recipients.  Grants may be used to 
  6.25  fund the costs related to coordinating access for recipients, 
  6.26  developing and implementing patient care criteria, upgrading or 
  6.27  establishing new facilities, acquiring furnishings or equipment, 
  6.28  recruiting new providers, or other development costs that will 
  6.29  improve access to dental care in a region.  In awarding grants, 
  6.30  the commissioner shall give priority to applicants that plan to 
  6.31  serve areas of the state in which the number of dental providers 
  6.32  is not currently sufficient to meet the needs of recipients of 
  6.33  public programs or uninsured individuals.  The commissioner 
  6.34  shall consider the following in awarding the grants:  (i) 
  6.35  potential to successfully increase access to an underserved 
  6.36  population; (ii) the ability to raise matching funds; (iii) the 
  7.1   long-term viability of the project to improve access beyond the 
  7.2   period of initial funding; (iv) the efficiency in the use of the 
  7.3   funding; and (v) the experience of the proposers in providing 
  7.4   services to the target population. 
  7.5      The commissioner shall monitor the grants and may terminate 
  7.6   a grant if the grantee does not increase dental access for 
  7.7   public program recipients.  The commissioner shall consider 
  7.8   grants for the following: 
  7.9      (i) implementation of new programs or continued expansion 
  7.10  of current access programs that have demonstrated success in 
  7.11  providing dental services in underserved areas; 
  7.12     (ii) a pilot program for utilizing hygienists outside of a 
  7.13  traditional dental office to provide dental hygiene services; 
  7.14  and 
  7.15     (iii) a program that organizes a network of volunteer 
  7.16  dentists, establishes a system to refer eligible individuals to 
  7.17  volunteer dentists, and through that network provides donated 
  7.18  dental care services to public program recipients or uninsured 
  7.19  individuals. 
  7.20     (5) beginning October 1, 1999, the payment for tooth 
  7.21  sealants and fluoride treatments shall be the lower of (i) 
  7.22  submitted charge, or (ii) 80 percent of median 1997 charges; and 
  7.23     (5) effective for services rendered on or after July 1, 
  7.24  2001, the commissioner may provide enhanced payments to dental 
  7.25  care providers based on increases in total public program dental 
  7.26  services and on the proportion of each provider's revenue 
  7.27  derived from public programs.  Total payments to providers made 
  7.28  under this clause shall not exceed 85 percent of the median 
  7.29  charge for dental services; and 
  7.30     (6) the increases listed in clauses (3) and (5) (4) shall 
  7.31  be implemented January 1, 2000, for managed care.  
  7.32     (c) An entity that operates both a Medicare certified 
  7.33  comprehensive outpatient rehabilitation facility and a facility 
  7.34  which was certified prior to January 1, 1993, that is licensed 
  7.35  under Minnesota Rules, parts 9570.2000 to 9570.3600, and for 
  7.36  whom at least 33 percent of the clients receiving rehabilitation 
  8.1   services in the most recent calendar year are medical assistance 
  8.2   recipients, shall be reimbursed by the commissioner for 
  8.3   rehabilitation services at rates that are 38 percent greater 
  8.4   than the maximum reimbursement rate allowed under paragraph (a), 
  8.5   clause (2), when those services are (1) provided within the 
  8.6   comprehensive outpatient rehabilitation facility and (2) 
  8.7   provided to residents of nursing facilities owned by the entity. 
  8.8      Sec. 5.  [INSTRUCTION TO REVISOR.] 
  8.9      The revisor of statutes shall change the headnote found in 
  8.10  Minnesota Statutes, chapter 256B, from "dental care for senior 
  8.11  citizens" to "dental care access" in the next edition of 
  8.12  Minnesota Statutes. 
  8.13     Sec. 6.  [APPROPRIATION.] 
  8.14     (a) $....... is appropriated for the biennium beginning 
  8.15  July 1, 2001, from the general fund to the commissioner of human 
  8.16  services for the medical assistance reimbursement rates for 
  8.17  dental care providers in accordance with section 4. 
  8.18     (b) $....... is appropriated for the biennium beginning 
  8.19  July 1, 2001, from the general fund to the commissioner of human 
  8.20  services for the dental access grant program established under 
  8.21  section 2.  This appropriation shall be available until expended.