SF 1371

as introduced - 92nd Legislature (2021 - 2022) Posted on 03/26/2021 01:55pm

A bill for an act
relating to human services; establishing uniform prior authorization and
credentialing processes for dental services; amending Minnesota Statutes 2020,
section 256B.0625, by adding subdivisions.

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

Section 1.

Minnesota Statutes 2020, section 256B.0625, is amended by adding a subdivision
to read:

Subd. 9c.

Uniform prior authorization for dental services.

(a) 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.

(b) By January 1, 2022, the commissioner, in consultation with dental benefits
administrators, 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 website. Dental services on the list and the process for obtaining prior
authorization approval must be consistent. The commissioner shall require that dental
providers, managed care plans, county-based purchasing plans, and dental benefit
administrators use the dental services on the list regardless of whether the services are
provided through a fee-for-service system or through a prepaid medical assistance program.

(c) Managed care plans and county-based purchasing plans may require prior
authorization for additional dental services not on the list described in paragraph (b) if 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.

Sec. 2.

Minnesota Statutes 2020, section 256B.0625, is amended by adding a subdivision
to read:

Subd. 9d.

Uniform credentialing process.

(a) For purposes of this subdivision, "dental
benefits administrator" has the meaning given in subdivision 9c.

(b) By January 1, 2022, in consultation with dental benefits administrators, 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.

(c) The process developed in this subdivision must include a uniform credentialing
application that must be available in electronic format and accessible on the department's
website. The process developed under this subdivision must include an option to submit a
completed application electronically. The uniform credentialing application must be available
to providers for free.

(d) If applicable, 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 receiving the application form from the provider.