SF 2012

as introduced - 86th Legislature (2009 - 2010) Posted on 02/09/2010 11:33pm

A bill for an act
relating to health care; establishing dental care pilot projects; requiring dental
services to be provided on a fee-for-service basis; limiting dental benefits;
amending Minnesota Statutes 2008, sections 256B.0625, by adding subdivisions;
256B.69, subdivision 6; 256L.03, subdivision 1; proposing coding for new law in
Minnesota Statutes, chapter 256; repealing Minnesota Statutes 2008, sections
256B.037; 256B.0625, subdivision 9; 256B.69, subdivision 6c.

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

Section 1.

new text begin [256.964] DENTAL CARE PILOT PROJECTS.
new text end

new text begin Subdivision 1. new text end

new text begin Urgent dental care services. new text end

new text begin The commissioner shall authorize a
pilot project to reduce the total cost to the state for dental services provided to enrollees
of the state public health care programs by reducing hospital emergency room costs
for preventable or nonemergency dental services. As part of the project, a community
dental clinic or dental provider, in collaboration with a hospital emergency room, shall
provide urgent care dental services as an alternative to the hospital emergency room for
nonemergency dental care. The project participants shall establish a process to divert a
patient presenting at the emergency room for nonemergency dental care to the dental
community clinic or to an appropriate dental provider. The commissioner may establish
special payment rates for urgent care services provided and may change or waive existing
payment policies in order to adequately reimburse providers for providing cost-effective
alternative services in an outpatient or urgent care setting. The commissioner may
establish a project in conjunction with the initiative authorized under section 256.963.
new text end

new text begin Subd. 2. new text end

new text begin Dental care in nursing facilities. new text end

new text begin The commissioner shall establish a
pilot project to improve access to dental services for residents of a nursing facility by
authorizing and paying for dental services to be provided to multiple residents in a single
facility at the same time through a special arrangement with a dentist, dental clinic, or
other dental provider. The pilot project must demonstrate methods of reducing total costs
to the state by providing more cost-effective dental services, including preventive care,
screenings, and dental services. As part of the pilot project, the commissioner may:
new text end

new text begin (1) establish a special group payment rate for dental services provided;
new text end

new text begin (2) contract with a single dental vendor to provide dental services to all residents
of a single facility; and
new text end

new text begin (3) waive existing reimbursement policies.
new text end

new text begin Subd. 3. new text end

new text begin Dental health care home. new text end

new text begin The commissioner may establish a pilot project
under which dental providers shall be paid a care coordination fee to coordinate dental
care for patients with existing dental disease and for whom the total cost of dental care
for the patients can be reduced through better prevention, coordination of services, use
of cost-effective treatments and settings, and reducing utilization of hospital emergency
rooms for preventable or nonemergency dental care.
new text end

Sec. 2.

Minnesota Statutes 2008, section 256B.0625, is amended by adding a
subdivision to read:

new text begin Subd. 9a. new text end

new text begin Dental services for children. new text end

new text begin Medical assistance covers dental services
for children with the following limits:
new text end

new text begin (1) preventive services:
new text end

new text begin (i) sealants are limited to permanent teeth and once every five years; and
new text end

new text begin (ii) fluoride varnish is limited to once every six months; and
new text end

new text begin (2) restorative services, posterior restoration only, at the amalgam rate regardless of
the materials used.
new text end

Sec. 3.

Minnesota Statutes 2008, section 256B.0625, is amended by adding a
subdivision to read:

new text begin Subd. 9b. new text end

new text begin Dental services for adult recipients. new text end

new text begin (a) Medical assistance covers
the following dental services for adults:
new text end

new text begin (1) diagnostic:
new text end

new text begin (i) a comprehensive examination is limited to once every five years;
new text end

new text begin (ii) a periodic examination is limited to once every six months;
new text end

new text begin (iii) limited examination is limited to once every two years;
new text end

new text begin (iv) bitewing x-rays are limited to once every two years;
new text end

new text begin (v) periopical x-rays; and
new text end

new text begin (vi) panoramic x-ray is limited to once every five years and must be provided in
conjunction with a posterior extraction or scheduled outpatient facility procedure;
new text end

new text begin (2) preventive:
new text end

new text begin (i) prophylaxis is limited to once every six months; and
new text end

new text begin (ii) fluoride varnish is limited to once every year;
new text end

new text begin (3) restorative, posterior restorations only, at the amalgam rate regardless of the
material used;
new text end

new text begin (4) endodontics, anterior and premolars only;
new text end

new text begin (5) periodontics:
new text end

new text begin (i) gross debridement is limited to once every five years; and
new text end

new text begin (ii) periomaintenance is limited to twice every year with prior authorization;
new text end

new text begin (6) prosthodontics, dentures or partials are limited to one set every ten years; and
new text end

new text begin (7) oral surgery, extractions only.
new text end

new text begin (b) Diagnostic outpatient facility services:
new text end

new text begin (1) diagnostic, full-mouth survey is limited to once every five years;
new text end

new text begin (2) periodontics, periodental scaling and root planing is limited to once every two
years; and
new text end

new text begin (3) general anesthesia.
new text end

Sec. 4.

Minnesota Statutes 2008, section 256B.69, subdivision 6, is amended to read:

Subd. 6.

Service delivery.

(a) Each demonstration provider shall be responsible for
the health care coordination for eligible individuals. new text begin Except for the services identified in
paragraph (c), new text end demonstration providers:

(1) shall authorize and arrange for the provision of all needed health services
including but not limited to the full range of services listed in sections 256B.02,
subdivision 8, and 256B.0625 in order to ensure appropriate health care is delivered to
enrollees. Notwithstanding section 256B.0621, demonstration providers that provide
nursing home and community-based services under this section shall provide relocation
service coordination to enrolled persons age 65 and over;

(2) shall accept the prospective, per capita payment from the commissioner in return
for the provision of comprehensive and coordinated health care services for eligible
individuals enrolled in the program;

(3) may contract with other health care and social service practitioners to provide
services to enrollees; and

(4) shall institute recipient grievance procedures according to the method established
by the project, utilizing applicable requirements of chapter 62D. Disputes not resolved
through this process shall be appealable to the commissioner as provided in subdivision 11.

(b) Demonstration providers must comply with the standards for claims settlement
under section 72A.201, subdivisions 4, 5, 7, and 8, when contracting with other health
care and social service practitioners to provide services to enrollees. A demonstration
provider must pay a clean claim, as defined in Code of Federal Regulations, title 42,
section 447.45(b), within 30 business days of the date of acceptance of the claim.

new text begin (c) A demonstration provider shall not authorize, arrange, or provide dental services
listed under section 256B.0625; 256D.03, subdivision 4; or 256L.03, as part of the
comprehensive health care services that are required to be provided by the demonstration
provider under this section. Dental services shall be reimbursed on a fee-for-service basis.
new text end

Sec. 5.

Minnesota Statutes 2008, section 256L.03, subdivision 1, is amended to read:

Subdivision 1.

Covered health services.

"Covered health services" means the
health services reimbursed under chapter 256B, with the exception of inpatient hospital
services, special education services, private duty nursing services, adult dental care
services other than services covered under section deleted text begin 256B.0625, subdivision 9 deleted text end new text begin 256B.0625,
subdivision 9b new text end , orthodontic services, nonemergency medical transportation services,
personal care assistant and case management services, nursing home or intermediate care
facilities services, inpatient mental health services, and chemical dependency services.

No public funds shall be used for coverage of abortion under MinnesotaCare
except where the life of the female would be endangered or substantial and irreversible
impairment of a major bodily function would result if the fetus were carried to term; or
where the pregnancy is the result of rape or incest.

Covered health services shall be expanded as provided in this section.

Sec. 6. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2008, sections 256B.037; 256B.0625, subdivision 9; and
256B.69, subdivision 6c, new text end new text begin are repealed.
new text end