SF 2133

1st Engrossment - 88th Legislature (2013 - 2014) Posted on 03/21/2014 08:18am

A bill for an act
relating to human services; modifying the critical access dental provider
requirements; amending Minnesota Statutes 2013 Supplement, section 256B.76,
subdivision 4.

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

Section 1.

Minnesota Statutes 2013 Supplement, section 256B.76, subdivision 4, is
amended to read:

Subd. 4.

Critical access dental providers.

(a) Effective for dental services
rendered on or after January 1, 2002, the commissioner shall increase reimbursements
to dentists and dental clinics deemed by the commissioner to be critical access dental
providers. For dental services rendered on or after July 1, 2007, the commissioner shall
increase reimbursement by 35 percent above the reimbursement rate that would otherwise
be paid to the critical access dental provider. The commissioner shall pay the managed
care plans and county-based purchasing plans in amounts sufficient to reflect increased
reimbursements to critical access dental providers as approved by the commissioner.

(b) The commissioner shall designate the following dentists and dental clinics as
critical access dental providers:

(1) nonprofit community clinics that:

(i) have nonprofit status in accordance with chapter 317A;

(ii) have tax exempt status in accordance with the Internal Revenue Code, section
501(c)(3);

(iii) are established to provide oral health services to patients who are low income,
uninsured, have special needs, and are underserved;

(iv) have professional staff familiar with the cultural background of the clinic's
patients;

(v) charge for services on a sliding fee scale designed to provide assistance to
low-income patients based on current poverty income guidelines and family size;

(vi) do not restrict access or services because of a patient's financial limitations
or public assistance status; and

(vii) have free care available as needed;

(2) federally qualified health centers, rural health clinics, and public health clinics;

(3) city or county owned and operated hospital-based dental clinics;

(4) a dental clinic or dental group owned and operated by a nonprofit corporation in
accordance with chapter 317A with more than 10,000 patient encounters per year with
patients who are uninsured or covered by medical assistance or MinnesotaCare;

(5) a dental clinic owned and operated by the University of Minnesota or the
Minnesota State Colleges and Universities system; and

(6) private practicing dentists if:

(i) the dentist's office is located within a health professional shortage area as defined
under Code of Federal Regulations, title 42, part 5, and United States Code, title 42,
section 254E;

(ii) more than 50 percent of the dentist's patient encounters per year are with patients
who are uninsured or covered by medical assistance or MinnesotaCare;

deleted text begin (iii) the dentist does not restrict access or services because of a patient's financial
limitations or public assistance status; deleted text end and

deleted text begin (iv) deleted text end new text begin (iii) new text end the level of service provided by the dentist is critical to maintaining
adequate levels of patient access within the service area in which the dentist operates.

(c) A designated critical access clinic shall receive the reimbursement rate specified
in paragraph (a) for dental services provided off site at a private dental office if the
following requirements are met:

(1) the designated critical access dental clinic is located within a health professional
shortage area as defined under Code of Federal Regulations, title 42, part 5, and United
States Code, title 42, section 254E, and is located outside the seven-county metropolitan
area;

(2) the designated critical access dental clinic is not able to provide the service
and refers the patient to the off-site dentist;

new text begin (3) the designated critical access dental clinic and the dentist providing the service
have entered into a contractual agreement that specifies that the critical access dental clinic
is responsible for the services provided;
new text end

deleted text begin (3) deleted text end new text begin (4) new text end the service, if provided at the critical access dental clinic, would be
reimbursed at the critical access reimbursement rate;

deleted text begin (4) deleted text end new text begin (5) new text end the dentist and allied dental professionals providing the services off site are
licensed and in good standing under chapter 150A;

deleted text begin (5) deleted text end new text begin (6) new text end the dentist providing the services is enrolled as a medical assistance provider;

deleted text begin (6) deleted text end new text begin (7) new text end the critical access dental clinic submits the claim for services provided off
site and receives the payment for the services; and

deleted text begin (7) deleted text end new text begin (8) new text end the critical access dental clinic maintains dental records for each claim
submitted under this paragraph, including the name of the dentist, the off-site location, and
the license number of the dentist and allied dental professionals providing the services.